The recent advisory issued by the U.S. Surgeon General Dr. Vivek Murthy underscores an important public health issue: the link between alcohol consumption and cancer risk. According to the advisory, alcohol consumption is the third leading preventable cause of cancer in the United States and is responsible for approximately 100,000 cancer cases and 20,000 cancer-related deaths annually. The Surgeon General’s recommendations, which include updating health warning labels for alcohol-containing beverages and strengthening public education efforts, aim to reduce alcohol-related cancer cases and deaths.
While the advisory provides a stark reminder of the risks associated with alcohol, it also raises important questions about how to address these risks in a way that reflects the complexity of scientific evidence, particularly concerning wine. Is it fair to lump wine together with other alcoholic beverages? Or does the available evidence suggest that moderate wine consumption, especially as part of a balanced diet, warrants a more nuanced perspective?
Alcohol and Cancer: The Stark Reality
Over the past four decades, studies have consistently shown that alcohol consumption increases the risk of at least seven types of cancer, including cancers of the breast, liver, esophagus, mouth, throat, and voice box. For some cancers, such as breast cancer, the risk increases even at low levels of consumption (around one or fewer drinks per day). This means that for certain individuals, even moderate alcohol consumption may pose significant health risks.
The Surgeon General’s advisory seeks to address the alarming gap in public awareness of this issue. Despite the growing body of evidence, less than half of Americans recognize alcohol consumption as a cancer risk factor. This lack of awareness underscores the importance of public health campaigns that clearly communicate these risks, including the potential benefits of revising the alcohol consumption guidelines and improving alcohol-related health warnings.
The Unique Role of Wine
While the risks of alcohol are clear, wine occupies a unique position in scientific discussions. Unlike other alcoholic beverages, wine, especially red wine, is associated with potential health benefits. These benefits are largely attributed to its polyphenolic compounds such as resveratrol, which have antioxidant, anti-inflammatory, and lipid-regulating properties. Moderate wine consumption has been linked to reduced risk of cardiovascular diseases, type 2 diabetes, metabolic syndrome, and even certain neurological disorders.
One of the most compelling pieces of evidence comes from a study of UK Biobank participants, which found the following:
- U-shaped association with mortality: This study identified a significant U-shaped association between wine intake and all-cause, non-cancer, and cardiovascular disease (CVD) mortality. Light-to-moderate wine consumption was associated with a decreased mortality risk compared to no consumption or heavy consumption.
- Optimal consumption level: The lowest mortality risk, or “nadir,” was observed at 19–23 g of alcohol per day, equivalent to approximately 2–3 glasses.
- Sex-specific findings: These protective effects were consistent for both males and females, highlighting that they are not sex dependent.
- In contrast to non-wine alcoholic beverages, non-wine alcoholic beverages demonstrated a dose-dependent positive association with mortality, indicating that their consumption increased health risks as intake rose.
According with Centers for Disease Control and Prevention. Moderate alcohol drinking is defined as up to one drink each day for women and up to two drinks each day for men. Alcohol and Public Health: Frequently Asked Questions. U.S. Department of Health and Human Services. Updated June 8, 2017. Available at https://www.cdc.gov/alcohol/faqs.htm.
Wine and Cancer: A Complex Relationship
The relationship with wine is less straightforward with respect to cancer risk. While other alcoholic beverages, such as beer and spirits, show a clear positive association with cancer mortality, the evidence for wine is more nuanced.
- No significant association in the primary analysis: The study found no significant association between wine intake and cancer mortality in its main analysis, which excluded non-drinkers.
- Potential protective effects in sensitivity analyses When including non-drinkers in the analysis, researchers observed a statistically significant protective association between moderate wine intake and reduced cancer mortality in certain groups.
- Variability between studies: Contradictory results in past studies may stem from differences in how non-drinkers were included in the analyses, emphasizing the importance of careful study design.
These findings highlight that, while wine may not pose the same level of risk as other alcoholic beverages, its effects on cancer are far from uniform and warrant further research.
Public Health, Realism, and the Broader Context
The Surgeon General’s call to action addresses a critical public health challenge: reducing alcohol-related harm without disregarding its deep cultural and social significance. From a public health perspective, it is essential to discourage alcohol consumption among vulnerable groups, including :
- Those under the legal drinking age of 21 years old
- Women who are or may be pregnant
- Those driving, planning to drive, or those doing any activity needing skill and awareness
- Those taking any medicine (over-the-counter or prescription) that may be affected by alcohol
- Those with certain illnesses or conditions
- Those who are cannot control the amount they drink or are recovering from alcoholism.
However, treating all alcohol as equally harmful ignores the nuances of scientific evidence and cultural tradition. Wine, particularly as part of the Mediterranean diet, have been consistently associated with longer lifespans and reduced rates of chronic diseases. Its role in such dietary patterns complicates efforts to issue blanket recommendations against alcohol consumption.
Realistically, prohibiting alcohol consumption entirely is unlikely to succeed. Instead, public health efforts should aim to reduce alcohol consumption while promoting safer patterns such as the moderate intake of wine recommended within the context of the Mediterranean diet. For example, two to three glasses of wine per day, accompanied by a nutrient-rich diet, may align better with realistic public health goals than with blanket restrictions.
The American Context and Cultural Hypocrisy
Another layer of complexity lies in how alcohol is portrayed in the American society. The United States often prioritizes regulating industries, such as winemaking, while largely ignoring the glamorization of alcohol in popular culture. Films and television shows frequently depict excessive drinking as normal, undermining public health efforts. This inconsistency—where warnings are issued but cultural attitudes remain permissive—reveals the level of hypocrisy in how alcohol-related risks are addressed.
A Balanced Approach to Alcohol Consumption
The conversation between alcohol and health must strike a balance between caution and realism. While it is clear that individuals should not start drinking for perceived health benefits, moderate wine consumption, when paired with a healthy lifestyle, offers unique advantages that are not shared by other alcoholic beverages. These benefits, particularly in the context of cardiovascular health and longevity, cannot be ignored.
Therefore, public health policies must reflect this nuance. Instead of vilifying all alcohol, policies should promote moderate, mindful consumption, and educate the public about the risks of excessive intake. For wine, this means emphasizing its role in health-promoting dietary patterns such as the Mediterranean diet and highlighting the importance of balance and moderation.
Conclusion
Public health efforts should aim to reduce the overall harm caused by alcohol as well as acknowledge the unique characteristics of wine and its potential role in promoting health as a part of a balanced diet.
Education, not prohibition, is key to empowering individuals to make informed decisions about their health. By fostering a realistic, evidence-based dialogue on alcohol consumption, we can move closer to achieving public health goals while respecting cultural traditions and the complexities of scientific evidence.
Read more at: https://www.hhs.gov/about/news/2025/01/03/us-surgeon-general-issues-new-advisory-link-alcohol-cancer-risk.html
Schaefer SM, Kaiser A, Behrendt I, Eichner G, Fasshauer M. Association of alcohol types, coffee and tea intake with mortality: prospective cohort study of UK Biobank participants. Br J Nutr. 2023 Jan 14;129(1):115-125. doi: 10.1017/S000711452200040X. Epub 2022 Feb 3. PMID: 35109963; PMCID: PMC9816653. https://pmc.ncbi.nlm.nih.gov/articles/PMC9816653/