Lisa R. Lowry, MD
I stood before a cool blue water wall, illuminated by a soft, unidentified energy, entranced. Amber colored orbs with delicately fluted edges crowned a long streaming center piece of gelatinous petal-like structures which, in turn, spiraled around long root-like cords. A halo of thin, fine streamers, delicately balanced at the edge of the crown, undulated with rhythmic pulsation, mesmerizing as it moved through its serene universe. The swirling of colors, the luminosity, the elegant architecture, and the alluring movement beckons the onlooker. “Come closer.” But beauty is as beauty does. This carnivorous jellyfish specimen captures its prey with its clever tentacles, and soon paralysis will quiet the fight of the unsuspecting.
How often in life we are transfixed by things that appear beautiful or mysterious, or that offer up a solution, or answer a need, even if only in the short term. How often do the consequences, the trade-offs, the risks to the benefits, hide in the shadows? As we focus on cancer as a main topic for this article, there is no shortage of subjects that could be addressed. The question of “why” lurks at the top of the list. Science is homing in on the many complexities of “why”: genetics, environment, behaviors, toxin exposure, to name a few. Now, the question of “what do we have the ability to change” is giving power to cancer patients across the globe.
Recently, the scientific spotlight swung round and focused its great big light on the great big presence of a great big carcinogen hiding in plain sight: Alcohol. Before I wade any further into this very delicate topic, I want to make my position very clear. My goal is simply to provide information, and you, the grown-up with free will, can use your judgement about how to use this information. I would also like to remind everyone that people who do not drink or have never had alcohol still get cancer. It is a complex disease with many contributing factors.
There is no “brief” history of alcohol as it relates to humanity. It has been a part of our existence since ancient civilizations discovered that natural fermentation of fruits, grains, and honey could produce a substance that transformed us both mentally and physically, with both immediate as well as long-term effects. Today, it is a ubiquitous feature of daily life, and escaping its reach is nearly impossible. When it is present at celebrations, meals, sporting events, and business gatherings (including medical conferences), one might conclude that used in moderation it’s not such a bad deal. Past studies, the conclusions of which are now hotly debated, found having a glass of red wine with dinner was a “healthy” choice.
So, what exactly did the Surgeon General mean when he issued an advisory early in 2025 that alcoholic beverages should carry a warning label about the increased risk of cancer associated with alcohol consumption?
The intent is to raise awareness of the role alcohol is playing in the current cancer crisis, and to give information to the public to guide their decision-making about their use of alcohol as it relates to their risk of developing cancer. While 91% of Americans are aware of the risk radiation exposure poses in the formation of cancer, less than half of Americans are aware of the carcinogenic effects of alcohol.
In 1988, alcohol was identified as a Level One Carcinogen, the level reflecting the certainty of the information used to draw that conclusion. For reference, tobacco is also a Level One carcinogen. After ingestion, the liver breaks down alcohol to acetaldehyde, the carcinogenic substance, which is capable of damaging DNA. The increase in oxidative stress also damages proteins, cells, and increases inflammation. Alcohol facilitates the absorption of other carcinogens and alters some hormone levels, notably estrogen, contributing to breast cancer. By disrupting other metabolic systems and the microbiome, alcohol may also contribute to cancer formation by impairing immune system function. This list could certainly be expanded upon if one begins diving into alcohol related sleep disruption and anxiety disorders.
What cancers do we need to be thinking about when tipping one back? Breast cancer claims a prime spot on the list of alcohol-related cancer deaths in women in the United States, while liver and colorectal cancer rack up 33% and 22% of cancer deaths in men, respectively. The remaining cancers to flush out the list of the seven cancers are oral (mouth), pharyngeal, laryngeal (voice box), and esophageal (throat).
In 2020, when we were all just trying to make it through COVID, globally 741,300 new cancer cases related to alcohol consumption were reported. Alcohol related traffic fatalities, usually around 13,500 annually in the US, take second place to the 20,000 annual alcohol related cancer deaths here on our own soil. A sobering summary, alcohol is the third leading preventable cause of cancer, behind tobacco and obesity, according to the Surgeon General’s report.
With most adults in the United States reporting at least low levels of regular alcohol consumption, the question of what is “safe” just begs to be asked. US Dietary Guidelines currently suggest “safe” drinking as one drink per day for women with no more than 7 per week, and 2 for men, no more than 14 per week. A drink is defined as 12 ounces of 5% alcohol (beer), 5 ounces of 12% alcohol (wine), or 1.5 ounces of 40% (distilled spirits). Other studies concluded that the more you drank, the greater you increased your risk. But there are now studies showing that ANY amount of alcohol consumption can increase your risk of some cancers, most notably breast cancer. The American Cancer Society has put pen and paper to it, stating each alcoholic drink per day increases breast cancer risk by 7-10% (over a lifetime). With these types of numbers, why has this message not gotten louder?
Perusing the literature and even a cursory knowledge of human behavior explains a lot. Alcohol is used by many as a social lubricant, a stress reducer, a sleep inducer, a companion to food, an intriguing conversation starter or intensifier, an inhibition reducer, and a wallet opener at charitable events. This is not in support of its use, simply an observation. The negative short-term and long-term effects of alcohol use are abundant but are quickly pushed from the forefront as its pleasure induction reaches the bloodstream. Those who enjoy alcohol and have embedded it into their lifestyle may be reluctant to relinquish the perceived benefits. With mistrust of established medical entities registering at an all-time high, messaging today is more difficult than perhaps at any other time in our history. Speaking historically, many point to the flagrant failure of the Prohibition Era. Others point out that if you simply wait a few years, scientific thinking will revert, and red wine will return to its rightful place on the menu. (Remember when pasta was “healthy” in the 1980s?). With so many voices speaking in different directions 24/7, how does one make a reasonable choice for their own health?
Two groups that ARE paying attention to the recent acknowledgement regarding alcohol as a carcinogen (and overall health factor) are the alcohol industry and people who are part of the Sober Curious movement. Sober Curious describes people who are choosing alcohol free or reduced alcohol living not as a pathway from addiction, but as a pathway towards better health and well-being. Simply stated, they are questioning the widespread acceptance of alcohol as part of adult life. Dry January is an extension of this movement. While the bar tabs for Baby Boomers are becoming more expansive, the younger generation, in particular the Gen Z and Millennials, are leaning into non-alcoholic beverages and venues for daily living as well as celebrations and special occasions. My own observation has been that plenty of cancer patients are doing the same. The non-alcoholic beverage sector is growing with enthusiasm as well as products such as non-alcoholic wines, beers, and spirits appear on store shelves and the art of the Mocktail expands in creativity and presentation.
As with most things in life, risk/benefit analysis provides a good stepping off point for change, beginning with a careful and honest evaluation of your genetic, environmental, and behavioral risks for cancer. If you are not certain about what presents a risk, a conversation with your health care provider may be in order. Every person will have a different constellation of contributing factors, and a different recipe for and definition of what is right for them. Free will is great and even better with informed choice.
I recently visited yet another aquarium hosting yet another jellyfish exhibit. The most unusual one I have encountered to date; it was part of a touch exhibit. The Moon Jellyfish, delicate and nearly transparent save for a beautiful four-horseshoe patterned star on its back, does not sting. After a careful evaluation of my risks vs benefits, my hands dove in.