Even moderate drinking can lead to cancer, Public Health Director Vivek Murthy warned last week. But a congressionally mandated report released last month found that moderate drinking is associated with lower overall mortality rates.
Although these findings are not as contradictory as they seem, the dueling explanations reflect the complexity and ambiguity of the dynamics. The evidence on this topic is vast, yet open to interpretation, leaving plenty of room for debate, especially in the case of this year’s politically problematic revisions to the federal government’s dietary advice.
According to Murthy advisoryAlcohol consumption has been positively linked to “at least seven different types of cancer.” For some cancers, Murthy says, “evidence shows that this risk may begin to increase after drinking one drink or less per day.”
These consumption levels are within the limits of the latest edition. Dietary Guidelines for Americansproduced jointly by the U.S. Department of Agriculture and the Department of Health and Human Services, recommends that men drink two drinks a day and women drink one drink a day. Murthy, who believes Congress should require cancer warning labels on alcoholic beverages, argues that even drinking within that limit can be fatal.
According to Murthy’s calculations, “of the 20,000 alcohol-related cancer deaths per year in the United States, 17% occur at levels within recommended limits.” The estimated 3,400 deaths correspond to about 0.6% of the total population. total cancer mortality rate In 2024.
The threat highlighted by Murthy is minimal even from the perspective of the individual drinker. For example, the lifetime risk of breast cancer for women who drink less than one drink a week is 11.3%, compared to 13.1% for women who drink one drink per day.
Strangely, Murthy did not find it appropriate to mention anything new. evidence review The National Academies of Sciences, Engineering, and Medicine (NASEM) is tasked with informing Congress of this year’s amendments. dietary guidelines. NASEM report conclusion They say there is “moderate certainty” that consuming alcohol within currently recommended limits increases the risk of breast cancer by 10 per cent, but “no conclusions can be made” for other cancers.
More surprisingly, NASEM’s expert panel found enough evidence to conclude with “moderate certainty” that drinkers who consume “moderate amounts of alcohol” have a lower risk of death from cardiovascular disease than abstainers. The panel also concluded, with the same level of confidence, that “moderate drinking is associated with reduced all-cause mortality.”
The significance of such associations is scientifically controversial because they may be explained by variables other than alcohol consumption. One difficulty is that people may stop drinking due to illness or alcohol-related problems, which tends to magnify the apparent health benefits of moderate drinking.
The NASEM report avoids this pitfall by limiting its analysis to studies in which the comparison group consisted of lifelong abstainers. However, as the report’s authors point out, moderate drinkers differ from abstainers in other ways that can affect their health, including socioeconomic status, physical activity, smoking, and eating habits.
Another problem is that people have a tendency to lie In other words, to put it more generously, we tend to underestimate our drinking, bringing it closer to the level we consider socially acceptable. Data providing formal advice in light of such trends may include: systematically biased There is a move towards looking for health risks at relatively low levels of consumption, and such advice may itself increase the likelihood of under-reporting.
given inherent limitations In observational studies that rely on self-reports of alcohol consumption and do not account for all factors that may increase or decrease disease incidence, it is not surprising that people continue to debate the risks and benefits of moderate drinking. But one thing is clear: most Americans like drinkingRegardless of the latest medical research findings, they will not be dissuaded by new warning labels or changes in official recommendations they already ignore.
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