Is Alcohol as Dangerous as Cigarettes? The Answer Might Surprise You.

Photo by Peter Boccia on Unsplash

You probably know that smoking causes cancer. But what about alcohol? The answer might surprise you.

In 2023, The World Health Organization (WHO) released a bluntly but succinctly titled report called  “No level of alcohol consumption is safe for our health.” In the report, the WHO stated, “Alcohol is a toxic, psychoactive, and dependence-producing substance and has been classified as a Group 1 carcinogen by the International Agency for Research on Cancer decades ago-this is the highest risk group, which also includes asbestos, radiation and tobacco.”

Say what? American media is flooded with anti-asbestos attorney commercials and national anti-drug tobacco campaigns. These messages constantly remind us of the significant cancer risks associated with asbestos, radiation and tobacco. As I’m writing this, I’m watching a commercial showing a mother speaking to her prematurely born baby in intensive care while warning about the dangers of smoking during pregnancy. Don’t get me wrong- persistent and continued anti-tobacco commercials are needed and necessary public health campaigns. Tax dollars well spent. But, it’s also old news.

On the other hand, I bet you’ve never seen a commercial warning that alcohol significantly increases the risks of at least seven major cancers, including elevating oropharyngeal cancer risk by as much as 10 % and increasing breast cancer risk by a staggering 15%. Breast cancer is now the most common cancer in American women: 1 in 9 American women will develop it. My own mother, my maternal aunt, and my mother-in-law all got breast cancer. My best friend’s mother just died from it. Luckily, the mortality rate from breast cancer is decreasing-largely due to the increased emphasis on annual mammogram screenings. Regular mammogram screenings saved all three of my relatives. But all were shocked to find out that alcohol intake also significantly increased their risk of getting this cancer. It is a sobering (no pun intended) fact that every American woman ought to know before purchasing alcohol.

I bet you also don’t know that as little as four alcoholic drinks per week, an amount well under the weekly limit recommended by the CDC and the National Institute on Drug Abuse, triples your chances of developing dementia. Just one night of binge drinking reduces the ability to perform complex mental tasks for up to four days. Yet the United States recommendations state that men can “safely” drink up to 5 drinks per day or 14 drinks per week, while women can “safely” drink up to 2 drinks per day or 7 drinks per week. Huh? Why are our national health guidelines so inconsistent with evidence-based medicine? We’ll get to that.

But first- a little more information about alcohol. While tobacco is responsible for up to 8% of cancer deaths worldwide every year, alcohol is a very close second, causing 5% of cancer deaths annually. If tobacco and alcohol are race cars in the Indianapolis 500 cancer race, alcohol is racing in for a photo-finish second place. Recent WHO statistics show that there are approximately 3 million deaths worldwide annually due to alcohol, or about 8000 deaths per day. That is 1 death every 10 seconds. Put another way, about 300-400 people will die from alcohol related deaths in the time it takes you to read this article. Whoa.

In addition to significantly increasing the risk of many cancers, alcohol will cause or worsen over 65 acute and chronic diseases, including hypertension, high cholesterol, atrial fibrillation, congestive heart failure, type two diabetes, stroke, liver failure, dementia, and immunosuppressed conditions. Lauren, how could alcohol possibly be this damaging, you ask?

Well, Alcohol is a neurotoxin that has the very unique ability to be both water soluble and fat soluble. Unlike most other drugs which attach only to external cell surface receptors, alcohol directly enters the internal compartments of the cell itself, causing more immediate and extensive cellular damage. With both fat and water solubility, alcohol accelerates the aging process by attaching directly to and damaging the protective caps of our chromosomes called “telomeres.”  If alcohol was the villain in a horror movie, the call would be coming from the inside of the house.

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In 2018, The Lancet published a nearly 25-year alcohol study conducted from 1990-2016 across 195 countries. The study concluded that, “…the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of alcohol consumption, and the level of consumption that minimizes health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.”

In December 2023, The Lancet also published arguably the most influential article of the year (if not the decade) entitled “Alcohol intake and cause-specific mortality: conventional and genetic evidence in a prospective cohort study of 512,000 adults in China.” This article made big media waves.  And rightfully so. Like its 2018 predecessor, the 2023 article also contradicted the notion of “healthy” alcohol intake with very compelling data. The main message of this study was that, contrary to the “one glass of red wine a day keeps the doctor away” folklore, no amount of alcohol is safe or beneficial to your body. It is now speculated that the longer life spans previously attributed to people who drank one glass of red wine a day are most likely due to the higher socioeconomic status of those who drink occasional red wine instead of the red wine itself. Put another way, wealth often translates to a higher quality of life, which helps you live longer in spite of, not because of, red wine intake.

In January 2023 the Canadian Centre on Substance Use and Addiction (CCSA) published a nearly 90-page report detailing a variety of health risks associated with what was previously considered low level alcohol consumption. The Canadian report had the same data and take-home message as The Lancet articles: no amount of alcohol is good for your health. Specifically, the report described a continuum of health risk associated with alcohol consumption, with 1–2 drinks a week representing low (but not no) risk of harm, 3–6 drinks a week representing a moderate risk, and 7 or more drinks a week representing an increasingly high risk. 

The guidance unambiguously stated that no amount of alcohol is safe, and that drinking even one bottle of wine per week is associated with an increased risk of lifetime cancer. It also noted that alcohol is a carcinogen that can cause at least seven types of cancer, including breast, colon, rectum, mouth and throat, liver, esophagus, and larynx cancer. According to the CCSA, drinking less alcohol is one of the top 10 behaviors that can reduce cancer risk. Maybe more importantly, the CCSA's guidance also included other recommendations, such as mandatory warning labels for all alcoholic beverages (as is done with its sister carcinogen, cigarettes). 

The January 2023 CCSA report resulted in both Canada and the World Health Organization updating their formal alcohol drinking guidelines to state that no amount of alcohol is safe. Several other countries updated their formal drinking guidelines at that time to also state the same.  The United States was not one of these countries. The Substance Abuse and Mental Health Services Administration (SAMHSA) still defines heavy alcohol intake as more than 15 drinks per week for men and more than 8 drinks per week for women. It is largely silent on the health risks associated with lower alcohol intake levels.

Alcohol enjoys a unique cultural significance in our country. It is closely integrated with daily American life in ways that are difficult to extricate. It is also backed by a very powerful alcohol industry that uses fistfuls of cash and strategic initiatives to influence alcohol policy.

Most recent studies show that one bottle of wine contains approximately the same level of carcinogenic risk as 5 cigarettes for men, and 10 cigarettes for women. Cigarettes unambiguously state cancer risk on the package. Where is alcohol’s risk label?

The American people deserve the same readily available evidence-based advice on alcohol as exists for cigarettes so they can make informed decisions about their health. American public health policies are based on the principle of autonomy in harm reduction, and the fundamental idea behind it that people have a right to be informed of accurate health risks so they can make their own informed decisions. The data is in. Any level of alcohol intake comes with risks- risks that are similar in carcinogenic severity to tobacco, asbestos, and radiation. Right now, American drinking guidelines remain unchanged. Cancer warning labels on alcoholic beverages remain conspicuously absent.  The central question is, when will we have the courage to change this?