When the U.S. Surgeon General called for alcohol labels with cancer warnings, I was a little puzzled. Is alcohol a carcinogen? Really? Turns out I was late to the party, along with about half of you reading this right now.
When it comes to cancer facts, the gap between science and public perception has always been massive. In 1761, a doctor recognized that tobacco, in the form of snuff, caused cancer. Still, in the early '80s, over 30% of American adults smoked cigarettes. This included both my parents, in the car, windows rolled up.
So it’s not really surprising that, 30ish years since research first linked alcohol consumption and cancer (PDF), more than half of American adults still don’t know alcohol increases your cancer risk. Humans seem to sip their science slowly, the way you might a cognac. It takes a while for things to sink in.
Alcohol myths we want to believe
I’m not the kind of Gen X person who thinks that because I spent years rattling around in the back of my parents’ junky Ford without a seatbelt, current safety laws are bunk. I always buckle up.
I also pay attention to what’s generally deemed ‘healthy.’ That means I make sure to get in at least 150 exercise hours a week. Regular visits to the dentist? Check. Mammograms, spinach, SPF 50? Done.
So how did I miss the bulletin about alcohol?
I’ve never had a primary care provider tell me my drinking was harmful. And red wine is part of the Mediterranean diet. I was under the impression that red wine helped your heart. Happily so.
Apparently not. I think back on my childhood, realizing that so much of what is known about cancer has changed drastically, not just in my lifetime, but in the last decade. Not only have treatments advanced, but the rates of mortality and incidence have shifted, too. Hence the recent U.S. Surgeon General’s advisory advocating for warning labels on alcohol (PDF), not unlike those on cigarettes.
Two of our UVA Health experts helped me understand the cancer facts I’d apparently missed. Neeral Shah, MD, is a liver disease specialist. And Kara Wiseman, PhD, helped spur U.S. Surgeon General Vivek Murthy to recently highlight the link between alcohol consumption and cancer.
If alcohol causes cancer, how come people I know who died from cancer weren’t big drinkers?
Shah points out that, “this is not one size fits all. Alcohol is processed by your body differently and different people have different tolerances. In our society, we're surrounded by people who process alcohol differently.”
Wiseman underscores the need to understand the 2 main ways scientists talk about risk.
1. Relative risk: “So for alcohol and cancer,” Wiseman explains, “the available data has shown that there are more cancer cases seen among people who consume alcohol compared to people who do not consume alcohol.”
2. Absolute risk: “For example, for women, the absolute risk of cancer due to alcohol for those who consume one drink daily on average is 19%. So, among 100 women who drink one drink daily on average, we would expect 19 of them to develop cancer,” says Wiseman.
Is alcohol a carcinogen? What’s in it that causes cancer?
The advisory describes 4 ways that alcohol is thought to cause cancer (these are called mechanisms). Alcohol, in alcoholic drinks, can:
- Break down into acetaldehyde, which damages DNA and can lead to cancer
- Cause oxidative stress, which also damages DNA, proteins, and cells, and increases inflammation
- Change hormone levels, including estrogen
- Make it easier for the body to absorb other things that cause cancer
Which cancers can alcohol cause and why?
Alcohol is directly linked to several cancers:
- Mouth
- Throat
- Larynx
- Esophagus
- Liver
- Colon and rectum
- Breast
- Stomach
But it's also linked to several more, including pancreatic cancer. Alcohol is more likely to cause cancer in the body parts it directly interacts with. But its impact on hormones can also lead to additional cancers, like breast cancer.
Is there a way to assess how much damage you’re causing yourself by drinking?
Yes. You can assess your current drinking levels and risk with this Center for Disease Control tool.
You can use this online tool to build a personalized plan. Another resource: Your primary care provider.
Is one kind of alcohol worse than another?
No. It turns out there’s no type of alcoholic drink is safer than another. Wine, beer, and liquor carry the same risk.
“Alcohol is generally the same,” Shah says. “Now, the percentage of alcohol in these drinks is different. It’s harder to process larger volumes of hard liquor, which has more alcohol per volume.”
This runs a bit counter to how most of us understand alcohol. We might think of wine as better, filled with fruits. Or we might consider a hard spritzer or hard kombucha a better choice than a slug of whiskey. But Wiseman underscores that the amount of alcohol matters, not type.
What does drinking alcohol do to your body? How does it affect your liver?
Shah emphasizes that alcohol “is a direct toxin in the liver that leads to inflammation.”
Over time, this inflammation can scar the liver and lead to cirrhosis. This liver disease causes scarring that can't be cured. And this can worsen your health in a number of ways. “The liver's at the root of a lot of different functions in the body,” Shah adds.
Does Dry January help you cleanse out these toxins? Is it worth it?
Shah says yes. “Even with one month off, your body can recover. The liver does have some regenerative properties. It can rebuild some of those injured liver cells.”
Dry January seems like it could be too short a time to do any good. Shah says that even a short pause in alcohol consumption can improve your:
- Hair health
- Skin clarity
- Sleep patterns
- Energy levels
- Immune system
"When your body doesn’t have to spend all its energy processing alcohol,” Shah says, “sugars, lipids, and fats can be optimized.”
Still Drinking?
Find out what you need to know for your health.
Are there any risks with quitting cold turkey?
Yes. “If you have alcohol use disorder or are alcohol dependent, you need to quit drinking in a monitored setting. Otherwise, stopping cold turkey can cause withdrawal or other side effects that could be harmful to the body,” Shah explains.
Is alcohol a carcinogen? Yes. Now what?
As for those of us who drink more casually, we can choose to limit our alcohol intake or quit it altogether on our own. Thankfully, there are more alcohol alternatives on the shelves these days. And finding ways to connect with family and friends that doesn’t involve drinking could turn out to super fulfilling.
Whatever your situation, prioritizing self-care isn’t just about prevention of a potential risk in the future. It’s about enhancing and enjoying your life right now.
