With a guy like Peter Hegseth as nominee for Defense Secretary, how likely is Trump likely to listen to Biden's Surgeon General?
What does this mean for people who drink alcohol and for the
public at large? Peter Monti, a professor of alcohol and addiction studies at
Brown University, has been studying the bio-behavioral mechanisms that underlie
addictive behavior, as well as its prevention and treatment, for several
decades. He led the Center for Alcohol and Addiction Studies at the Brown
University School of Public Health for nearly 25 years and is now director and
principal investigator of the school’s Center for
Addiction and Disease Risk Exacerbation.
To Monti, the actions recommended by the surgeon general are
reminiscent of those that public health experts advised in the 1970s to address
the health risks of tobacco. And that effort have been spectacularly
successful, he said.
“Warning labels on tobacco, public education about health risks, communication from doctors about the link between cancer and tobacco usage — these are the kinds of strategies that helped increase public awareness about the health risks of tobacco use,” Monti said. “As a result, tobacco use has decreased significantly. That’s one of the biggest public health successes of the past century.”
As the surgeon general’s report noted, 89% of Americans
recognize tobacco use as a risk factor for cancer, compared to 45% who
recognize alcohol consumption as a risk. Long term, smoking rates have fallen
73% among adults, from 42.6% in 1965 to 11.6% in 2022, according to the American Lung
Association.
In this Q&A, Monti weighed in the advisory and shared
his perspective about alcohol and health risks.
Q: What's the link between alcohol and cancer, and how well
known is this risk among researchers?
As the surgeon general’s report notes, there is extensive
evidence from biological studies that ethanol, the type of pure alcohol found
in all alcohol-containing beverages, causes cancer in at least four distinct
ways. The link between alcohol and breast cancer, particularly among women, has
been known for a long time, so that link is certainly not news to the research
community. While breast cancer has been studied a good deal, we've made inroads
in terms of understanding alcohol’s link to other cancers as well, including
colorectum, esophagus, liver, mouth, throat and larynx.
What's interesting is that the public hasn't appreciated
that link. That could be partially due to the way that information was rolled
out of the National Institutes of Health about 15 years ago. The tone and the
way it was presented just wasn’t helpful for people, and it didn’t help
motivate behavior change.
How doctors talk to their patients is its own area of study,
and presenting information and or misinformation can have important
ramifications. From a public health perspective, whatever we can do to get the
word out with respect to alcohol and cancer is going to move us more in the
direction of what I see as one of the biggest public health successes in the
last 50 years, and that is getting out the word on tobacco use and cancer.
We've really reversed attitudes, beliefs and behavior with respect to tobacco
in a way that I think we could for alcohol, as well.
Q: The surgeon general called for updated warning labels on
alcoholic beverages that make cancer risks clear, in the same way that
cigarettes carry explicit warnings about health risks. Is there a strong enough
link to justify strongly-worded labels?
We have more data now than we've had ever before. The last
couple of decades have provided us with numerous studies making it very clear
that there's a solid link between alcohol and cancer, and given the downsides
of not saying anything, it does make sense to get this out on the labels now.
In fact, we should have done this years ago.
It should be noted that there hasn’t been a study where some
people have been randomly assigned to drink one alcoholic beverage a day and
other people have been assigned to drink no alcohol at all, with all followed
over time. That type of study would be very expensive, and some of the health
effects would take months and years to develop. Those studies have been
conducted with lab animals, and there has been clear evidence of the negative
effect of alcohol. Ultimately, a randomized control study with humans is what
we need to conclusively prove a causal link between alcohol consumption and
cancer. But in the meantime, we have a lot of persuasive evidence.
Q: Do you think is cancer is the biggest health risk of
alcohol consumption and the one that drinkers should be most worried about?
It certainly is one of the biggest risks. The other big risk
is cardiovascular disease, particularly atrial fibrillation, which is an
irregular, often rapid heart rate that commonly causes poor blood flow —
there are clear links between alcohol consumption and atrial fibrillation. The
risk between alcohol and cardiovascular disease is an emerging research area
that that I think will get lots of attention in the years to come.
Q: Does the risk change in terms of the type of alcohol that
is consumed?
It's a myth that if you drink beer or wine you're less
susceptible to the negative effects of alcohol than if you drink hard liquor.
The research does not support that at all.
Q: Does the amount of alcohol matter?
Yes. Alcohol is broken down in the body into acetaldehyde,
which is a metabolite that binds to our DNA. And when it does so, it damages
the DNA and allows the cell to which it binds to grow out of control, and to
ultimately form into a cancerous tumor. Multiple studies with rats and mice
have shown that ethanol results in tumors at multiple places in the body. The
more alcohol one consumes, the more acid acetaldehyde is likely to bind to the
DNA, and the higher likelihood of tumor growth.
The last couple of decades have provided us with numerous
studies making it very clear that there's a solid link between alcohol and
cancer, and given the downsides of not saying anything, it does make sense to
get this out on the labels now. We should have done this years ago.
Q: The report explains how cancer risk is affected by
alcohol, using this example: A study of 226,162 individuals reported that the
absolute risk of developing any alcohol-related cancer over the lifespan of a
woman increases from approximately 16.5% for those who consume less than one
drink per week, to 19.0% for those who consume one drink daily on average, to
approximately 21.8% for those who consume two drinks daily on average. Is that
a big difference?
It's certainly a difference worth noting. It would be enough
for me, particularly if I had other risk factors for cancers like genetics,
environmental stressors, etc.
Another way to view it is that alcohol is the third leading
preventable cause of cancer, after tobacco and obesity. So if you don’t smoke
and you are able to prevent becoming overweight and don’t drink (or cut down on
your drinking), your cumulative risk is going to go down exponentially. That
may be very motivating for some people.
Q: Does research show that warning labels are an effective
way to increase awareness around the risks of addictive substances?
I think there's proof positive in tobacco. The warning
labels on cigarettes have proven effective in increasing awareness of cancer
risk and decreasing use.
Q: In addition to warning labels, the advisory calls upon
public health professionals to highlight alcohol consumption as a leading
modified cancer risk and strengthen, expand education efforts to increase
general awareness, and reassess guideline limits for alcohol consumption to
account for cancer risk. What do you think of these recommendations?
I agree that there needs to be an all-hands-on-deck
approach. The recommendations by the surgeon general in the report are the
kinds of tactics that we have seen work to increase awareness of the health
risks of tobacco.
Q: In the report, the surgeon general talked about a need
for research on questions including, for example, how specific patterns such as
binge drinking may affect cancer risk. What research questions do you have?
I think that looking into the pattern of alcohol use would
be very informative, because we know that a lot of people think abstaining
during the week and bingeing on the weekend is healthier than drinking
moderately every day. (That's not the case, by the way.) We have recently had
many researchers studying alcohol and the adolescent brain, and I think that
linking their findings to the development of cancers would really advance our
understanding of alcohol and health risks.
