Surgeon General Highlights Link Between Alcohol And Cancer

IRA FLATOW: This is Science Friday. I’m Ira Flatow. Most of us are very familiar with the dangers of alcohol, how risky driving under the influence is, the damage alcohol can do to the liver.

But now the surgeon general has highlighted another negative consequence of drinking alcohol, and that is cancer. In his latest report, Dr. Vivek Murthy detailed the growing body of research showing that drinking alcohol can increase the risk of certain types of cancer.

He’s also recommended adding a warning label to alcoholic drinks, outlining the connection between alcohol use and cancer. Dr. Murthy joins me to talk about the science that informed his latest advisory. Welcome back to Science Friday. Nice to have you.

VIVEK MURTHY: Thanks so much, Ira. I always love being on with you.

IRA FLATOW: Thank you. Nice to have you here. Dr. Murthy, what are the types of cancers we’re talking about here for which alcohol is a cause?

VIVEK MURTHY: Well, thanks, Ira. Look, alcohol is now the third leading preventable cause of cancer, behind tobacco and obesity. It’s responsible for 100,000 cases of cancer and 20,000 cancer deaths in the United States every year.

It’s now clear that alcohol is causally linked to seven types of cancer– breast cancer, colorectal cancer, mouth, throat, voice box, esophageal, and liver cancer. There may be additional cancers as well where there’s a causal link, but that evidence is still developing.

Now, the reason I issued this advisory on alcohol and cancer risk is it turns out that most people don’t know that alcohol increases the risk for cancer. I think it’s important that they know that so that they can’t make decisions for themselves and guide and shape their consumption of alcohol accordingly.

IRA FLATOW: Well, I’m with you on that because I don’t think anybody that I know knew the risks between alcohol and cancer. What is going on in the body that makes it such a risk?

VIVEK MURTHY: Well, there are a few things that are happening. Number one, alcohol breaks down into our body, into acetaldehyde, which is toxic to our cells. It damages DNA in multiple ways and increases the risk of mutations and cancer.

But there are other ways that alcohol can cause cancer as well. And we lay out all four of these, actually, in our advisory. It can induce what’s called oxidative stress on cells, which, again, increases the risk of cancer by damaging DNA.

It can alter the levels of multiple hormones, including estrogen, which can, in turn, increase the risk of breast cancer. And finally, alcohol can lead to a greater absorption of other carcinogens.

And so you put this all together, and what we see is a growing body of evidence, like, over the years, that’s linking alcohol to cancer.

IRA FLATOW: Is there a minimum amount of alcohol that you can drink safely?

VIVEK MURTHY: So that’s a really good question. And it’s something that I’ve thought about a lot as a doctor, because you have to advise patients on what they should do. And generally with health behaviors, we tend to think about things not as zero risk, but as low risk versus higher risk.

And what the data tells us fairly clearly is that more alcohol consumption is associated with more risk, so less consumption is associated with less risk. I wish there was a magic number that we could tell people at which they could drink and have zero risk altogether. But clearly, if you are drinking, let’s say, occasionally or once or twice a week, your risk of cancer is going to be significantly less than if you were drinking on a daily basis.

IRA FLATOW: Should the guidelines then be changed about what we tell people?

VIVEK MURTHY: Well, I’m glad you asked that because the current dietary guidelines set the limits on alcohol consumption at one drink a day for women and two drinks a day for men. But what we found in our analysis of the data is that the risk of cancer increases even within those guideline limits.

So one of the recommendations I have called for in this advisory is for those limits to be reassessed and to include and incorporate the cancer risk. And in my belief, is that those levels should in fact be lower if we truly want to reduce people’s risk of cancer.

IRA FLATOW: Do you really think people are going to stop drinking? I mean, we had prohibition, things like that. I mean, this must be a really tough sell, I would think.

VIVEK MURTHY: Well, it’s interesting you say that, Ira, because I’ve been surprised by the variety of responses that we’ve gotten. First of all, not telling everyone that they should completely stop drinking and that there’s never an occasion at which you can have a drink.

What we are doing is asking people to re-examine their practices and behaviors with alcohol, and particularly the amount that they consume, because most people were led to believe that alcohol is an unmitigated, positive thing for your health and you should drink and it’ll help you live longer.

IRA FLATOW: We were told glass of wine a day was good for you.

VIVEK MURTHY: That’s right. And it turns out that story is actually a lot more complicated as more and more data has emerged showing that the impact on our heart is actually more complicated. There are certain types of illness when it comes to the heart, which are made worse by alcohol.

We know the risk of abnormal heart rhythms like atrial fibrillation goes up with drinking, as do high blood pressure and the risk of heart failure. There is a chance that there may be a positive benefit, when it comes to heart attacks, from drinking at certain levels. But exactly what that level is and how much benefit one gets is uncertain.

So the overall impact on your heart is unclear. What is clear is that there is a causal link between alcohol and cancer. And I think if people know that, then especially if they have a personal history of cancer or if they’re at increased risk because of their genetics or family history, they may choose to make decisions differently and perhaps reduce how much they drink.

IRA FLATOW: So if you quit drinking today– I’m thinking about smoking– would that decrease your risk of developing cancer if you’ve been a moderate drinker for, let’s say, 20 years?

VIVEK MURTHY: Yeah. So we don’t have enough data to be able to tell you with certainty how your risk will decrease over what period of time. With smoking, we generally have much better data to help us understand that.

But I think given the data we have, my advice to people would be that if you are drinking at a level, let’s say on a daily basis, and you want to reduce your risk, that reducing that, going down even to a couple of times a week from daily is likely going to reduce your risk for the longer term.

Whether that benefit manifests in a month, in a year, in two years, we need data to tell us. But the data is right now telling us that less drinking means less risk of cancer.

IRA FLATOW: You’re also recommending adding a warning label. Congress would need to approve that, right? Does that stand any chance in the upcoming Congress?

VIVEK MURTHY: So warning label would need to be approved by Congress. And one of the things that I’m encouraged by is that cancer prevention has largely been a bipartisan issue that has enjoyed broad support, and for good reason, because many of us know people who have cancer.

Cancer devastates individuals and families as I’ve seen firsthand as a doctor caring for people with cancer over the years. In the past, when we have come out with recommendations for labels or reports that highlight health concerns, in the past, we have seen Congress act.

Going back to 1964, when the Surgeon General’s office issued the first report on tobacco, linking smoking to cancer, the very next year, Congress passed legislation that put a warning label on boxes of cigarettes.

So we have a warning label right now already on alcohol containers. They speak to the risk of drinking during pregnancy and drinking while operating cars or heavy machinery. But we now need to update them to include cancer risk.

IRA FLATOW: This week you released your quote, “parting prescription” to America in which you focus on the importance of community. Please tell me about that.

VIVEK MURTHY: Well, this is deeply meaningful to me, Ira, because over the last two terms that I’ve had the privilege of serving, there has been a question that has been on my mind and that I’ve struggled to figure out.

And that has been what is the deeper root cause of the unhappiness and pain that I see so often in communities across America. So often, this is a pain that’s not easily explained. It’s not always solely due to economic hardship or concerns about safety or the negative headlines people are reading.

Often, there’s something deeper. And after many conversations, digging into the research in this area, talking to experts from a variety of disciplines, what I’ve come to understand is there are three critical elements that we need in our life to be fulfilled that have been eroding over time.

And those are relationships, purpose, and service. And in this parting prescription, what I called for is us to re-anchor our lives around what I call the triad of fulfillment, relationships, purpose, and service.

Right now, Ira, the challenge we have is that society has been moving more and more in the direction of a different triad, the triad of success, which, as young people tell me all the time, is anchored in money, fame, and power.

And there’s nothing wrong with pursuing any of those three. But the challenge is when we come to assume that that’s the path to fulfillment, when we assume that that’s going to make us happy in a sustained way. And the reality is, it just doesn’t.

So this parting prescription is fundamentally about shifting the balance in our lives towards relationships, purpose, and service. And when we do that, what we find is that we can build lives where we feel a sense of belonging and have a strong sense of community.

IRA FLATOW: Yes, we’ve seen this over your career talking about depression, talking about loneliness, which are all part, I think, of what you’re talking about. And we have a very fractured community as a country. Do you think that we can live up to those ideals that you’re talking about?

VIVEK MURTHY: I think we can. And I think we must, because what’s at stake is nothing less than our fulfillment, our health, our happiness, and the well-being of our children. People across the country and, really, across the world are struggling with how to navigate the extraordinarily complex world that we’re living in and to figure out how to create the health, happiness, and fulfillment that we want for ourselves and for our children.

And they’re working really hard at it. I don’t think people are unhappy because somehow they’re lazy or not putting in the work. I think people are working harder than ever. But as the world has grown more complex and changed so rapidly, I worry that we’ve lost hold of some of these foundational elements that used to support our life and used to help us make it through difficult times, all kinds of adversity, and still find a reason to be happy and to be fulfilled.

And I think, fundamentally, at a very deep level, we all want relationships in our life. We want to live with a sense of purpose. Our instinct is to help other people, like when we see somebody in need.

So I see the call to rebuild our lives on relationships, purpose, and service not so much as a call to transform ourselves into something we’re not, but as a return to who we fundamentally are. And this is something that I think we can do.

I’ve been really overwhelmed by the response we’ve gotten to this prescription from people across the political spectrum, across the country who have said, this is what we need. This is what has been missing in our lives.

And my hope and the work I want to keep doing after I’m surgeon general is to help rebuild that sense of community, to re-anchor our world in the relationships, purpose, and service that will bring us fulfillment.

IRA FLATOW: Let’s talk about what’s next for you. How would you continue this campaign?

VIVEK MURTHY: It’s a good question. Well, I think there’s a lot more that needs to be done to bring this message to more corners of our country and to, frankly, also bring the rest of the world into this conversation as well.

Many countries are struggling with the same drivers of unhappiness and pain that we are. And so that communications piece is going to be important.

But I also find myself wanting to create experiences for people where they can actually see and feel what it’s like to be a part of community, even if it’s for a brief period of time where they can recognize what a powerful impact it can have on their life.

So I’m thinking about how to do this next. But I’ll tell you what’s at the center of my mind and my heart as I contemplate the future are my children. My kids are six and eight years old.

And l, like many parents, look at the world around them and think, gosh, we have to do something better to address the polarization and the pain and the division that we have so that we can have a more hospitable, nurturing world for our kids.

And that’s why I believe this work is so important. I want my kids to live the American dream in the way that I was able to and my parents were able to. But the American dream– when Thomas Jefferson wrote about the pursuit of happiness as an inalienable right in the Declaration of Independence, he wasn’t talking about achievement and wealth and fame and focusing more and more on ourselves.

To Jefferson, the pursuit of happiness was a virtuous pursuit that involved serving others and contributing to something greater than yourself.

IRA FLATOW: Do you think that public service is still in your future?

VIVEK MURTHY: I don’t know.

IRA FLATOW: Maybe politics?

VIVEK MURTHY: Well, look, I want to serve in the best way I can to make sure that we rebuild community in America. And I’m open to how that happens. But for right now, I think my time in public services, in government service has come to an end.

But I still look at my calling as very much to serve the public. And I will do that in my next phase as a private citizen. But to me, this is the work that really matters. It’s the work that gives meaning to my life.

And if we can rebuild a society that’s anchored in relationships, purpose, and service, then there’s a really good shot that my kids and all of our children will be able to inherit a world that’s kinder, that’s more generous, and ultimately more harmonious than what we’re experiencing right now.

IRA FLATOW: Is that what you would like your legacy to reflect, your efforts to do that?

VIVEK MURTHY: Well, I think history determines what our legacies are. What I want is to be able to look in the mirror every morning when I wake up and feel a sense of purpose and to know that I’m getting up to work on things that are going to make the world better for my kids.

And I say this because there were many times caring for patients in Boston during the earlier part of my career, where I would see challenges that they were facing that were rooted in the social fabric of our country, which was fraying.

I would recognize that, yeah, I could diagnose an illness and make the right prescriptions for them in terms of medications, but if they didn’t have a family to support them, if they didn’t know their neighbors, if they lived in an unsafe neighborhood, if people didn’t care about the policies that my patients needed because they didn’t affect other people, if we didn’t feel like we were connected to each other and invested in each other, it was really hard to address the deeper root causes of so much of what I was seeing as a doctor in the hospital.

And so yeah, this is what matters to me right now. I want to address these deeper root causes. I want us to be a country that can care deeply about each other and courageously support each other and sacrifice for each other. And I think we can do that because I think it’s in our DNA. I think it’s who we are.

IRA FLATOW: Any advice you’d like to give the next surgeon general?

VIVEK MURTHY: Well, one of the most important things I learned as surgeon general is what I learned as a doctor, which is that you can have your own ideas about what issues you want to take on, but spend as much time as you can listening to people and asking them what they need, what issues are on their mind. And then craft your agenda based on that.

It was a listening tour that I did my very first term as surgeon general that fundamentally changed my agenda and that taught me the second time around to go out there, to listen to people, and to let their stories and their experiences shape the issues you choose to take on.

IRA FLATOW: Well, Dr. Murthy, I want to thank you for your public service and for all you’ve done and bringing your message to us. And I hope you’ll stay in touch wherever you go and whatever you do. Check in with us every now and then.

VIVEK MURTHY: Well, thank you so much, Ira. It has been the honor of my life to serve as surgeon general. And I am just so grateful for the chance to serve the country that I love and the chance to be a part of something that will always be meaningful to me and close to my heart. So I’m grateful to you.

IRA FLATOW: You’re welcome. Dr. Vivek Murthy, US Surgeon General, based in Washington, DC. Something tells me we will be hearing a lot from him sometime in the future.

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