A Warning from the U.S. Surgeon General by Craig Fuller

These two leading paragraphs in a WALL STREET JOURNAL story in the past few days got my attention:

The U.S. surgeon general said alcoholic beverages should carry cancer warnings to increase awareness that the drinks are a leading cause of preventable cancers.

“Alcohol is a well-established, preventable cause of cancer responsible for about 100,000 cases of cancer and 20,000 cancer deaths annually in the United States,” Dr. Vivek Murthy said in his advisory issued Friday. “Yet the majority of Americans are unaware of this risk.”

Really, I thought?

Later, as five friends gathered for lunch, one who does not drink said, “…I hope you guys who drink saw the story about alcohol causing cancer.”

Is this for real, I thought?

There are a few things I know: any cancer diagnosis gets 100% of an individual’s and their family’s attention. Rightfully so!

Also, if a person wishes to reduce the risk of experiencing a health issue, I am all for it.

That said, I also know that health professionals in government often see as their mission the modification of behaviors through labeling and regulation. And, if you can assert a link to cancer, regulatory action most likely will follow. Usually following news coverage and a book deal!

I should say that I do consume alcohol in moderation and have done so for a significant majority of my seven-plus decades on the planet. Thus, I decided to read the report issued by the Surgeon General, a report released in the last month of the current administration.

There are several questions that come to mind to put all of this in perspective:

Q. How many people in the U.S. consume alcohol?

A. The Surgeon General says 72% consume one or more drinks per week.

Q. How many people die in the U.S. each year?

A. About 3.4 million.

Q. How many die from cancer?

A. About 611,000.

Q. How many people does the Surgeon General believe die each year as a result of the relationship between alcohol and cancer?

A. He says it’s about 20,000. (Not sure how he calculated this, but 20,000 a year would be 0.6% of total deaths from all causes and 3.2% of cancer related deaths.)

Q. How many does the Surgeon General think receive a cancer diagnosis related to alcohol consumption?

A. From the report: In 2019, an estimated 96,730 cancer cases were related to alcohol consumption including 42,400 in men and 54,330 in women.

The report discusses the risk of having cancer, but it does not share some of the positive news around the treatment of cancer. For example, this comes from the American Cancer Society:

The American Cancer Society estimates that as of 2025, there are about 18 million cancer survivors in the U.S. This includes individuals who have been diagnosed with cancer at any point in their lives. With a U.S. population of around 334 million, this translates to roughly 5.4%.

And, the Surgeon General’s report focuses on breast cancer in women, stating:

The largest burden of alcohol-related cancer in the U.S. is for breast cancer in women with an estimated 44,180 cases in 2019, representing 16.4% of the approximately 270,000 total breast cancer cases for women.

However, it does not share this statistic:

In the U.S., the 5-year relative survival rate for breast cancer is around 90%, according to the American Cancer Society.

One wonders just how the Surgeon General came to understand the risk relationship between alcohol and cancer. Well, the report explains that:

Determining whether there is a causal relationship between a risk factor—a behavior, exposure, or characteristic—and a health outcome such as cancer is done through comprehensive assessments of scientific evidence and the application of well‑established scientific criteria, such as the Bradford Hill criteria.

So, I wondered, who is Bradford Hill?

Well, he was born in 1897. In 1965 he established a set of principles.

The Bradford Hill Criteria are a set of principles established by Sir Austin Bradford Hill in 1965 to assess causal relationships between a potential risk factor and an observed effect, such as cancer.

In so many words, what Sir Austin laid out is a protocol for studying studies. An approach called epidemiology, it suggests, among other things, that if enough studies (the Surgeon General used 22) come to a similar conclusion, there must be a risk relationship. (OK, maybe that is oversimplified.)

Here’s the conundrum.

If a person who drinks is diagnosed with some form of cancer, can anyone really determine if the cause of the cancer diagnosis for that individual was their drinking?

Here is a finding from the University of Missouri:

Alcohol and nicotine use have long been known to go hand in hand. Previous research shows that more than 85 percent of US adults who are alcohol-dependent also are nicotine-dependent.

So, the Surgeon General indicates that the greatest cause of cancer today is tobacco use. By the way, the second is obesity. Which begs the question, if study after study in the 22 selected by the Surgeon General compare the incidence of a cancer diagnosis between people who drink a little, a lot, or none at all, what about these other issues and behaviors in the life of one who drinks, say “smoking” for example?

To end where we began, is there really a strong case that warning labels should be placed on every bottle of wine, beer and spirits because, after using a protocol developed in 1965 and reviewing 22 studies, the Surgeon General finds a “…body of scientific evidence demonstrates a causal relationship between alcohol use and increased risk for at least seven different types of cancer?”

I doubt that very many people really believe today that alcohol provides health benefits (although, there are some studies suggesting that), but I do think if you are going to scare the 72% of our citizens who consume some amount of alcohol each week, then you might point out that what you are concerned about is the possibility of an increased cancer risk for a fraction of the roughly 5% or so of Americans who are alive today who have or have had cancer or might have a cancer diagnosis in the future.

I am the first to suggest that bad decisions and risky behaviors should be avoided. They cause harm and heartbreak. I’m just not sure I am fully sold on this 11th hour announcement from the Surgeon General where the headlines seem way out ahead of what is actually contained in the report.

But, everyone should make their own decision on this one.

Craig Fuller served four years in the White House as assistant to President Reagan for Cabinet Affairs, followed by four years as chief of staff to Vice President George H.W. Bush. Having been engaged in five presidential campaigns and running public affairs firms and associations in Washington, D.C., he now resides on the Eastern Shore and publishes DECADE SEVEN on Substack.