Warnings about moderate alcohol use and cancer require more patient education, Atlanta doctors say

Alcohol use is the third-most common preventable cause of cancer behind tobacco use and obesity.

The report and other recent federal studies on cancer and alcohol use are expected to play into revisions of U.S. dietary guidelines. About 80% of an estimated 20,000 U.S. alcohol-related cancer deaths a year result from people drinking more than the current recommended dietary limits of two drinks a day for men and one drink a day for women, the report stated.

Less than half, 45%, of Americans in one survey cited in the report were aware of the link between alcohol use and cancer compared to 89% for tobacco use. The surgeon general’s office reported that consuming alcohol increases risks for developing at least seven types of cancer: mouth, throat, esophagus, voice box, breast, liver, colon and rectum. Over time, drinking alcohol also increases risks for stroke, heart and liver disease, according to the Centers for Disease Control and Prevention.

Most Atlanta doctors consulted for this story said their patients haven’t expressed concerns about alcohol’s cancer risk since the recent reports.

Credit: courtesy

Credit: courtesy

Piedmont Oncology Chief Walter “Wally” Curran said he’s heard from some oncologists that their patients lament the recent precautions as “another risk of everyday living.”

“It’s something I hear socially as well as from patients: ‘Does this mean I’m at increased risk of developing certain cancers if I’m drinking wine occasionally?’” His response? “Hard to say. For everyone, reducing total alcohol consumption is a good idea.”

The general medical community might not have been aware of the known risks of alcohol use for long as the evidence only recently emerged, Curran said. Previous observational studies couldn’t apply their findings to the general public because other risk factors also influence cancer, such as family history, he said.

“There has been increasingly strong evidence over the past several years that alcohol consumption increases the risk of several types of cancer, especially breast and colorectal cancers,” Curran said.

“The surgeon general has the unenviable role of bringing the public news they don’t want to hear.”

Curran cited similar warnings about tobacco use nearly 60 years ago when cigarette smoking was widely accepted in America. In 1964, the U.S. surgeon general released a landmark report showing that cigarette smoking causes lung cancer. Cigarette smoking among all U.S. adults has declined by more than 70% since 1965, according to another recent surgeon general report.

Labels of alcohol sold in the U.S. contain warnings about the risks of drinking while pregnant or driving. The latest surgeon general proposal would add cancer risks to the text like on cigarette packages. The change would require Congress to pass a new law or update the Alcoholic Beverage Labeling Act of 1988.

Curran doesn’t believe labels citing cancer risks will appear any time soon on alcohol in America. Only one country requires such warning labels, South Korea, though he expects more countries will follow in the next decade.

Educating Americans, especially younger drinkers, about alcohol’s cancer risk would be more helpful than a warning label, he said.

“I applaud the surgeon general’s proposal, and whether or not warning labels are implemented, his proposal has increased the public’s awareness of this heightened risk of alcohol use,” Curran said. “There will be many conversations between patients and providers over the next months and years.”

Those discussions might begin with a doctor using a screening tool to ask about alcohol use, “focusing on the amount of intake and the presence of binge drinking,” said Frederick Turton, director of primary care at Emory at Peachtree Hills.

“Counseling patients about risky health habits takes time and persistence,” he said, adding the subject might arise several times over the course of treating patients. “Alcohol has always been an important talking point. The surgeon general’s actions provided another way of bringing the subject up.”

But Turton doesn’t believe behavior changes will occur quickly. “It took decades for us to make the progress we have made on tobacco use. Alcohol will take time also.”

Wellstar’s Chief Cancer Officer Michael Andrews said he planned to summarize the surgeon general’s report to help primary care doctors talk to their patients about the cancer risks.

He said doctors can develop their own tools for educating patients about the risks while taking basic assessments of their smoking and alcohol consumption habits along with body composition measurements.

Marietta family physician Brian Nadolne said he talks to patients about diet as part of larger discussions on preventive care. “If you are a social drinker and you have one to two drinks a month, are you at risk for cancer? I don’t think so.”

He added that many dietary habits have to change to reduce cancer, not just alcohol use. “There are other risk factors. Obesity is rampant in this country,” he said, adding alcohol use contributes to obesity. “We probably should put a warning label on candy.”

Roni Robbins has been a journalist for 36 years. This is her second stint as a freelance reporter for the AJC. She also freelances for Medscape, where she was an editor. Her writing has appeared in WebMD, HuffPost, Forbes, NY Daily News, BioPharma Dive, MNN, Adweek, Healthline, and others. She’s also the author of the award-winning Hands of Gold: One Man’s Quest to Find the Silver Lining in Misfortune.