Alcohol is one of the most common preventable causes of cancer, and alcoholic beverages should carry a warning label like cigarette packs, the U.S. surgeon general said Friday.

It’s the latest salvo in a heated debate over the risks and benefits of moderate alcohol consumption, as the influential U.S. Dietary Guidelines for Americans are set to be updated. For decades, moderate alcohol consumption was considered a way to prevent heart attacks and strokes.

This perception is embedded in dietary recommendations for Americans. But increasing research has shown that alcohol consumption, sometimes even within recommended limits, is linked to various types of cancer.

Labels currently placed on bottles and cans of alcoholic beverages warn against drinking while pregnant or driving or operating other machinery, as well as general “health risks.”

But alcohol contributes directly to 100,000 cases of cancer and 20,000 related deaths each year, said Surgeon General Dr. Vivek Murthy.

He called for labels to be updated to include an increased risk of breast cancer, colon cancer and at least five other malignancies that scientific studies now show are linked to alcohol consumption.

“Many people out there assume that there is no risk to their health or well-being as long as they are above or below the limits or current guidelines limits of one drink per day for women and two for men,” says Dr. Murthy said in an interview.

“The data doesn’t support that in terms of cancer risk.”

Only Congress can issue new warnings from Dr. Murthy recommended, and it is not clear whether the new government would support the change.

Still, President-elect Donald J. Trump doesn’t drink, and Robert F. Kennedy Jr., who has chosen to lead the Health and Human Services Department, swore off alcohol and drugs decades ago and says he regularly attends AA meetings .

There is no question that heavy consumption is harmful. But advocates of moderate alcohol consumption — including wine, beer and spirits makers as well as some doctors and scientists — argue that a little alcohol every day can reduce cardiovascular disease, the No. 1 killer in the United States.

However, recent scientific studies have criticized the methodology of previous studies and challenged this view, which was once a consensus.

While most cancer-related deaths occur with alcohol consumption above current recommended dietary guidelines, the risk of breast, mouth and throat cancer may increase with consumption of just one drink per day or even less, Dr. Murthy on Friday.

Overall, one in six breast cancer cases can be attributed to alcohol consumption, said Dr. Murthy. Recent studies have also linked moderate alcohol consumption to certain forms of heart disease, including atrial fibrillation, a heart rhythm disorder.

Two scientific opinions are used to support the updated alcohol consumption recommendations in the Federal Dietary Guidelines.

Five years ago, the scientific report that influenced the creation of the 2020-2025 Dietary Guidelines acknowledged that alcohol is carcinogenic and generally unhealthy and proposed “tightening guidelines” by increasing the recommendation for men to one standard drink, or 14 grams of alcohol per person Day limited became day.

However, when the final guidelines were developed, there was no change to the recommendation that moderate consumption of up to two drinks per day was acceptable for men.

However, the government acknowledged new evidence suggesting that “even alcohol consumption within recommended limits may increase the overall risk of death from a variety of causes, such as from various types of cancer and some forms of cardiovascular disease.”

Since then, even more studies have linked alcoholic beverages to cancer. But any attempt to change warning labels on alcoholic drinks is likely to face an uphill battle.

The current warning has not been changed since it was introduced in 1988, even though the link between alcohol and breast cancer has been known for decades.

It was first mentioned in the US Dietary Guidelines in 2000. In 2016, the Surgeon General’s report on alcohol, drugs and health linked alcohol abuse to seven different types of cancer.

Recently, Congress mandated a scientific review of research on moderate alcohol consumption conducted under the auspices of the National Academies of Sciences, Engineering and Medicine.

This analysis found an association between alcohol consumption and a slight increase in breast cancer, but no clear association with other cancers. The report also reinforced the theory that moderate alcohol consumption is associated with fewer heart attack and stroke deaths and fewer deaths overall compared to abstaining from alcohol consumption.

However, the World Health Organization says there is no safe limit for alcohol consumption and 47 countries require warning labels on alcoholic drinks. But cancer is rarely mentioned.

So far, only South Korea has a label warning about liver cancer. However, manufacturers can also choose alternative labels that do not mention cancer. Ireland is currently scheduled to introduce labels stating there is a “direct link between alcohol and fatal cancers” in 2026.

The industry has a long history of fighting warnings that mention cancer, and alcohol-producing countries have also challenged warnings under international trade law.

Industry opposition led to the early termination of a government-funded Canadian study into the effects of warning labels that mentioned cancer.

The Surgeon General’s advisory provided a brief overview of research studies and reviews published over the past two decades, including a global study of 195 countries and territories involving 28 million people.

They all found that higher alcohol consumption was linked to a higher risk of cancer.

Other studies looked at specific types of cancer, such as breast cancer and oral cancer, and found that the risk was 10 and 40 percent higher for those who drank just one drink a day, respectively, than for those who didn’t drink alcohol.

The report described the biological mechanisms by which alcohol is known to cause cancerous changes at the cellular level.

The most widely accepted theory is that alcohol breaks down in the body to form acetaldehyde, a metabolite that binds to and damages DNA, causing a cell to grow uncontrollably and forming a malignant tumor.

Animal studies have shown that rodents whose drinking water was fortified with either ethanol, the alcohol used in alcoholic beverages, or acetaldehyde, developed large numbers of tumors throughout their bodies.

Research has shown that alcohol creates oxidative stress, which increases inflammation and can damage DNA.

It also alters levels of hormones such as estrogen, which may play a role in the development of breast cancer, and facilitates the absorption of carcinogens such as tobacco smoke particles into the body, increasing susceptibility to mouth and throat cancers.

The surgeon general’s report also details the increase in risk associated with alcohol, distinguishing between the increase in absolute risk and the increase in relative risk.

For example, a woman’s absolute risk of breast cancer over her lifetime is about 11.3 percent (11 out of 100) if she drinks less than one drink per week.

With one drink per day, the risk increases to 13.1 percent (13 out of 100 people) and with two drinks per day to up to 15.3 percent (15 out of 100).

For men, the absolute risk of developing alcohol-related cancer increases from about 10 percent (10 in 100 people) for those who consume less than one drink per week to 11.4 percent (11 in 100) for those who consume each Drink something a day on average every week. For those who drink an average of two drinks per day, it rises to 13 percent (13 out of 100 people).

Many Americans don’t know that there is a connection between alcohol and cancer.

According to a 2019 American Institute for Cancer Research survey of U.S. adults ages 18 and older, fewer than half of Americans identified alcohol consumption as a risk factor for cancer, compared to 89 percent who recognized tobacco as a carcinogen.

According to the surgeon general’s report, alcohol consumption is the third most common preventable cause of cancer, after tobacco and obesity.

Dr. Murthy said it’s important to know that the risk increases as alcohol consumption increases. However, the risk of cancer is different for each person and depends on family history, genetic makeup and environmental influences.

“I wish we had a magic shutdown that we could use to tell people it’s safe,” he said. “What we know is that when it comes to reducing cancer risk, less is better.”

“If someone drinks occasionally on special occasions, or if you have one or two drinks a week, your risk is likely to be significantly lower than if you drink every day,” he added.