In a Q&A, Peter Monti, a professor of alcohol and addiction studies at Brown University and a leading researcher of alcohol and disease exacerbation, shared his perspective on alcohol and cancer.
PROVIDENCE, R.I. [Brown University] - To ring in the new year, U.S. Surgeon General Dr. Vivek Murthy took a strong stance against alcohol consumption: he issued an advisory that outlined links between alcohol and cancer risk and offered recommendations to reduce alcohol-related cancers, including adding cancer warnings to alcoholic beverages. With advisories reserved for public health challenges that require immediate action, the move offered a clear signal of the surgeon general's interest in changing behavior around alcohol consumption.
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 warning labels on alcoholic beverages in the same way that cigarettes carry 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 there, 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.
