In a recent advisory, U.S. Surgeon General Dr. Vivek Murthy underscored the connection between alcohol consumption and increased cancer risk. Citing alcohol as the third leading preventable cause of cancer in the U.S., the advisory links it to at least seven types of cancer, including breast and colorectal cancers. Despite this, according to Dr. Murthy, less than half of Americans recognize alcohol as a cancer risk factor. Dr. Murthy notes that alcohol is implicated in around 100,000 cancer cases and 20,000 cancer deaths annually, exceeding alcohol-related traffic fatalities. The advisory recommends updating the health warning label on alcohol beverages, reassessing recommended limits for alcohol consumption, strengthening public educational awareness, and promoting alcohol screenings in the clinical setting.
The health warning label on alcohol products, mandated pursuant to 27 U.S.C. 215, has remained unchanged since 1988. Although Dr. Murthy provides his recommendation to update the warning, his advisory admits that the "power to change the label statement lies with Congress." Notably, Dr. Murthy's advisory does not provide a sample of the language he would recommend to add to the existing health warning label on alcoholic beverages. However, his advisory points out that Ireland has a new health label going into effect in 2026 that will state that “there is a direct link between alcohol and fatal cancers”. Given the existing research showing some benefit from limited consumption of some alcohol, we expect that if Congress adopted such language, it would be challenged in the courts.
While the advisory calls for a reassessment of alcohol consumption guidelines and increased public health education, critics might question whether the recommendations adequately consider the complexity of cancer risk factors. The advisory also suggests a significant role for health care providers in informing patients about the risks, which may be challenging given the nuanced nature of individual risk factors. Dr. Murthy explains the cancer risk is also heavily determined by complex factors– biological, environmental, social, and economic factors. For example, as explained in the advisory, individuals of East Asian descent have a genetic variant that results in flushing, producing a higher biological risk for certain alcohol-related cancers. Social factors includes social norms, such as cultural norms. Asking individuals to commit to long-term quitting could be difficult due to the role alcohol plays in different social backgrounds and cultures. Additionally, the practicality of implementing widespread label changes and public awareness campaigns could face logistical and economic hurdles, potentially limiting the advisory's effectiveness. The effectiveness could also be limited by incomplete or conflicting scientific findings, as noted above.
Alcohol is not alone in being targeted for health warnings by government actors. For instance, recently the sugar-sweetened beverage segment undertook a multi-year fight against an ordinance passed in San Francisco requiring that outdoor signs advertising sugar-sweetened beverages include a warning label, covering twenty percent of the sign, advising of the negative health impact of consuming such products. Round one of that litigation ultimately went for industry, with the Ninth Circuit ruling that the ordinance likely violated industry’s First Amendment rights. In response, San Francisco passed a new ordinance in 2020 that imposed a similar warning requirement but which reduced the size requirement to ten percent. Litigation again ensued, but this time resulted in San Francisco repealing the ordinance in 2021.