The United States surgeon general recently called for a warning of cancer risk on alcohol labels. And I agree. But the discourse that has come out in the media, by health professionals and health influencers, has been alarmist and a disservice to informing the public on the real cancer risks associated with alcohol.
I’m a professor in Health Sciences at Simon Fraser University and I study how behaviours relate to the disease. I also write a blog on the role health behaviours play in your health.
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Alcohol and cancer risk
The surgeon general’s comments follow reports from the World Health Organization and Canada’s Guidance on Alcohol and Health, both of which state there is no safe amount of alcohol you can consume.
This has been repeated by health professionals, those in public health and on social media, where health influencers have described alcohol as a toxin.
But are these alarmist statements a good motivator for health messaging, or is there danger to using them?
Statistically, your risk for cancer goes up from the very first sip of alcohol. That doesn’t mean you will get cancer from drinking alcohol, it just means your chances increase. And as you drink more alcohol, your chances further increase. It’s like betting in roulette: the more numbers you bet on, the more likely you are to win. Or in this case, lose.
However, what’s lost in this messaging is how much this risk is. Based on Canada’s Guidance on Alcohol and Health, having one drink per week increases a women’s risk for breast cancer by 1.8 per cent. Approximately one in eight women will develop breast cancer in their life. Therefore, out of 800 women, one drink per week will result in two additional women getting breast cancer. Having one drink per day increases the risk seven-fold. These are real people who might otherwise not get breast cancer if they abstained from alcohol.
While saying no amount of alcohol is safe is true, this can apply to a lot of common activities. In Canada, there are approximately 300 pedestrian deaths per year. Each day, on average, five Canadians die in motor vehicle accidents.
While these numbers are much lower than the number of people who die from cancer each year, it would also be accurate to say there is no amount of walking or driving that is safe. Despite this, people will continue to cross the street and people will continue to drive. But this illustrates the challenge in informing the public about risks and changing behaviour.
Fear in public health messaging
The use of fear in public health has a long history. But measuring the effect of these campaigns is hard. Graphic images are used on tobacco products to scare people away from smoking. Carefully controlled studies indicate they increase health awareness but may have limited effect on smoking. However, similar graphic images on bottles of sugar-sweetened beverages in controlled studies has been shown to reduce consumption.
During the COVID-19 pandemic, fear was at the forefront of public health efforts to control the spread of SARS-CoV-2. Indeed, the use of fear in public health messaging seemed to be quite an effective tool in ensuring behavioural compliance in pandemic measures. Community interviews of parents showed fear was at the root of both getting their children vaccinated (fear of the disease) or not (fear of the vaccination).
The use of fear in public health messaging should only be used if there’s an effective solution. In the case of alcohol, there is: abstinence. But the use of fear should also be commensurate with the risk, otherwise it risks having people tune out.
This may be particularly problematic when previous guidelines stated beneficial effects of moderate drinking and current guidelines on alcohol state one to two drinks per day is acceptable. Instead, the public may be best served by communicating the risk in terms the public understands, such as how many more people will get cancer from drinking.
Alcohol should have a warning label on it
Alcohol consumption in Canada is on the decline. In 2022, alcohol consumption decreased by 1.2 per cent compared to 2021. And in 2023, 54 per cent of Canadians reported having no alcohol over the previous week, with younger Canadians drinking less than their older counterparts. These trends are similar in the United States.
More than 40 countries have a warning label on alcohol (although far fewer mention cancer), but Canada and many European countries are not included. They should be. Alcohol is a highly addictive substance that can destroy the lives of those addicted to it and those around them. It impairs judgment and accounts for dozens of deaths per year from drinking and driving.
Pregnant women drinking alcohol also increase their risk of their child having fetal alcohol spectrum disorder. Alcohol is also a drug you can overdose from.
Warning labels on alcohol are a good step to reduce health risks, as long as they are clear and informative.
