美国卫生局局长表示，酒精是导致癌症的主要可预防原因，饮料应贴上警告标签
【中美创新时报2025 年 1 月 3 日编译讯】（记者温友平编译） 美国卫生局局长周五表示，酒精是导致癌症的主要可预防原因，酒精饮料应像香烟包装一样贴上警告标签。《纽约时报》记者Roni Caryn Rabin对此作了下述报道。
这是关于适度饮酒风险和益处的激烈辩论的最新进展，因为有影响力的《美国膳食指南》即将更新。几十年来，人们一直认为适度饮酒有助于预防心脏病和中风。
这种看法一直存在于给美国人的饮食建议中。但越来越多的研究表明，饮酒，有时甚至在推荐限度内，也与各种类型的癌症有关。
目前贴在酒精饮料瓶和罐上的标签警告怀孕期间、驾驶和操作其他机器前饮酒，以及一般的“健康风险”。
但卫生局局长维韦克·穆尔蒂博士表示，酒精每年直接导致 10 万例癌症病例和 2 万例相关死亡。
他呼吁更新标签，包括乳腺癌、结肠癌和至少五种其他恶性肿瘤的风险增加，目前科学研究表明，饮酒与饮酒有关。
“许多人认为，只要他们饮酒量不超过现行指导方针（女性每天一杯、男性每天两杯）的限量或低于限量，就不会对他们的健康或福祉构成风险，”穆尔蒂在接受采访时说。
“数据并未证明癌症风险如此。”
只有国会才能强制使用穆尔蒂建议的那种新警告标签，目前尚不清楚新政府是否会支持这一改变。
尽管如此，当选总统唐纳德·特朗普不喝酒，他选择的卫生与公众服务部负责人罗伯特·肯尼迪几十年前就发誓戒酒戒毒，并表示他经常参加匿名戒酒会。
毫无疑问，大量饮酒有害健康。但适度饮酒的支持者——包括葡萄酒、啤酒和烈酒制造商以及一些医生和科学家——认为，每天少量饮酒可能会减少心血管疾病，而心血管疾病是美国的头号杀手。
然而，较新的科学研究批评了早期研究的方法，并对这一曾经是共识的观点提出了挑战。
虽然大多数癌症死亡发生在饮酒量超过当前推荐的饮食指南时，但穆尔蒂周五表示，每天只喝一杯甚至更少的酒，乳腺癌、口腔癌和咽喉癌的风险就可能上升。
总体而言，每 6 例乳腺癌中就有 1 例与饮酒有关，穆尔蒂说。最近的研究还将适度饮酒与某些形式的心脏病联系起来，包括心房颤动，一种心律失常。
两份科学评论将用于为联邦饮食指南中关于饮酒的最新建议提供信息。
五年前，2020-25 年饮食指南编写过程中的科学报告承认酒精是一种致癌物，通常不健康，并建议“收紧指南”，将男性的推荐饮酒量限制在一杯标准酒，即每天 14 克酒精。
然而，在起草最终指南时，并没有改变建议，即男性每天适量饮酒两杯是可以接受的。
但政府承认，有新证据表明“即使在建议的限度内饮酒也可能增加因各种原因导致的总体死亡风险，例如几种类型的癌症和某些形式的心血管疾病。”
从那时起，越来越多的研究将酒精饮料与癌症联系起来。然而，任何试图改变酒精饮料警告标签的尝试都可能面临一场艰苦的战斗。
目前的警告标签自 1988 年采用以来就没有改变过，尽管酒精和乳腺癌之间的联系已经为人所知数十年了。
它首次出现在 2000 年的美国饮食指南中。 2016 年，美国卫生局局长关于酒精、毒品和健康的报告将酒精滥用与七种不同类型的癌症联系起来。
最近，国会委托对适度饮酒研究进行了科学审查，该研究由美国国家科学、工程和医学院赞助。
该分析发现，饮酒与乳腺癌发病率略有增加之间存在联系，但与其他癌症没有明显联系。该报告还重申了这样一种理论，即与从不饮酒相比，适度饮酒与心脏病发作和中风死亡人数减少以及总体死亡人数减少有关。
然而，世界卫生组织表示，饮酒量没有安全限度，47 个国家要求在酒精饮料上加贴警告。但很少提到癌症。
到目前为止，只有韩国的标签上有关于肝癌的警告，不过制造商可以选择不提及癌症的替代标签。爱尔兰目前计划在 2026 年推出标签，上面写着“酒精与致命癌症有直接联系”。
该行业在反对提到癌症的警告标签方面有着悠久的历史，酒精生产国也根据国际贸易法对警告标签提出了质疑。
行业的反对导致加拿大一项由联邦政府资助的研究提前终止，该研究旨在研究提到癌症的警告标签的影响。
卫生局长的报告简要概述了过去二十年发表的研究和评论，包括一项涉及 195 个国家和地区、涉及 2800 万人的全球研究。
他们都发现，饮酒量越高，患癌症的风险就越大。
其他研究则关注乳腺癌和口腔癌等特定癌症，发现与不喝酒的人相比，每天只喝一杯酒的人患癌症的风险分别增加了 10% 和 40%。
该报告描述了酒精在细胞水平上诱发癌变的生物学机制。
最广为接受的理论是，酒精在体内分解成乙醛，乙醛是一种与 DNA 结合并对其造成损害的代谢物，使细胞开始不受控制地生长并形成恶性肿瘤。
动物实验表明，如果啮齿动物的饮用水中掺入了乙醇（酒精饮料中使用的酒精）或乙醛，它们全身都会出现大量肿瘤。
研究表明，酒精会产生氧化应激，从而加剧炎症并损害 DNA。
酒精还会改变雌激素等激素的水平，而雌激素在乳腺癌发展中起着重要作用，并使烟草烟雾颗粒等致癌物更容易被人体吸收，从而增加口腔和咽喉癌的易感性。
卫生局局长的报告详细介绍了饮酒导致的风险增加，区分了绝对风险和相对风险的增加。
例如，每周饮酒量不足一杯的女性一生中患乳腺癌的绝对风险约为 11.3%（100 人中有 11 人）。
每天喝一杯时，风险增加到 13.1%（100 人中有 13 人），每天喝两杯时，风险增加到 15.3%（100 人中有 15 人）。
对于男性来说，患上与酒精有关的癌症的绝对风险从每周饮酒量少于一杯的人的约 10%（每 100 人中有 10 人）增加到平均每天饮酒一次的人的 11.4%（每 100 人中有 11 人）。对于平均每天喝两杯酒的人来说，这一风险上升到 13%（每 100 人中有 13 人）。
许多美国人不知道酒精和癌症之间存在联系。
根据美国癌症研究所 2019 年对 18 岁及以上美国成年人进行的一项调查，不到一半的美国人认为饮酒是癌症的风险因素，而 89% 的人认为烟草是致癌物。
然而，根据外科医生的报告，酒精消费是继烟草和肥胖之后的第三大可预防癌症原因。
穆尔蒂说，重要的是要知道，随着酒精消费的增加，风险也会增加。但每个人患癌症的风险是不同的，这取决于家族史、基因构成和环境暴露。
“我希望我们有一个神奇的临界点，可以告诉人们是否安全，”他说。“我们知道的是，在降低癌症风险方面，越少越好。”
“如果一个人偶尔在特殊场合喝酒，或者如果你每周喝一两杯，那么你的风险可能比每天喝酒要小得多，”他说。
本文最初发表于《纽约时报》。
题图：SIMON WOHLFAHRT/AFP via Getty Images
附原英文报道：
Alcohol is a leading preventable cause of cancer and drinks should carry warning label, surgeon general says
By Roni Caryn Rabin New York Times,Updated January 3, 2025
SIMON WOHLFAHRT/AFP via Getty Images
Alcohol is a leading preventable cause of cancer, and alcoholic beverages should carry a warning label as packs of cigarettes do, the US surgeon general said Friday.
It is the latest salvo in a fierce debate about the risks and benefits of moderate drinking as the influential US Dietary Guidelines for Americans are about to be updated. For decades, moderate drinking was said to help prevent heart attacks and strokes.
That perception has been embedded in the dietary advice given to Americans. But growing research has linked drinking, sometimes even within the recommended limits, to various types of cancer.
Labels currently affixed to bottles and cans of alcoholic beverages warn about drinking while pregnant or before driving and operating other machinery, and about general “health risks.”
But alcohol directly contributes to 100,000 cancer cases and 20,000 related deaths each year, the surgeon general, Dr. Vivek Murthy, said.
He called for updating the labels to include a heightened risk of breast cancer, colon cancer and at least five other malignancies now linked by scientific studies to alcohol consumption.
“Many people out there assume that as long as they’re drinking at the limits or below the limits of current guidelines of one a day for women and two for men, that there is no risk to their health or well-being,” Murthy said in an interview.
“The data does not bear that out for cancer risk.”
Only Congress can mandate new warning labels of the sort Murthy recommended, and it’s not clear that the incoming administration would support the change.
Still, President-elect Donald Trump does not drink, and his choice to head the Health and Human Services Department, Robert F. Kennedy Jr., swore off alcohol and drugs decades ago, and says he regularly attends Alcoholics Anonymous meetings.
There is no question that heavy consumption is harmful. But supporters of moderate drinking — including makers of wine, beer and spirits, and some physicians and scientists — argue that a little alcohol each day may reduce cardiovascular disease, the No. 1 killer in the United States.
Newer scientific studies have criticized the methodology of earlier studies, however, and have challenged that view, which was once a consensus.
While most cancer deaths occur at drinking levels that exceed the current recommended dietary guidelines, the risk for cancers of the breast, the mouth and the throat may rise with consumption of as little as one drink a day, or even less, Murthy said on Friday.
Overall, 1 of every 6 breast cancer cases is attributable to alcohol consumption, Murthy said. More recent studies have also linked moderate alcohol consumption to certain forms of heart disease, including atrial fibrillation, a heart arrhythmia.
Two scientific reviews will be used to inform the updated recommendations about alcohol consumption in the federal dietary guidelines.
Five years ago, the scientific report that informed the writing of the 2020-25 dietary guidelines acknowledged that alcohol is a carcinogen and generally unhealthy and suggested “tightening guidelines” by capping the recommendation for men at one standard drink, or 14 grams of alcohol a day.
When the final guidelines were drafted, however, there was no change in the advice that moderate drinking of up to two drinks a day for men was acceptable.
But the government acknowledged emerging evidence indicating that “even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease.”
Since then, even more studies have linked alcoholic beverages to cancer. Yet any attempt to change the warning labels on alcoholic beverages is likely to face an uphill battle.
The current warning label has not been changed since it was adopted in 1988, even though the link between alcohol and breast cancer has been known for decades.
It was first mentioned in the 2000 U.S. Dietary Guidelines. In 2016, the surgeon general’s report on alcohol, drugs and health linked alcohol misuse to seven different types of cancer.
More recently, a scientific review of the research on moderate drinking, carried out under the auspices of the National Academies of Sciences, Engineering and Medicine, was commissioned by Congress.
That analysis found a link between alcohol consumption and a slight increase in breast cancer, but no clear link to any other cancers. The report also revived the theory that moderate drinking is linked to fewer heart attack and stroke deaths, and fewer deaths overall, compared with never drinking.
The World Health Organization says there is no safe limit for alcohol consumption, however, and 47 nations require warnings on alcoholic beverages. But cancer is rarely mentioned.
To date, only South Korea has a label warning about liver cancer, though manufacturers can choose alternative labels that don’t mention cancer. Ireland is currently slated to introduce labels that say there is a “direct link between alcohol and fatal cancers” in 2026.
The industry has a strong history of fighting warning labels that mention cancer, and alcohol-producing nations have also challenged warning labels under international trade law.
Industry opposition led to the premature termination of a federally funded Canadian study of the impact of warning labels that mentioned cancer.
The surgeon general’s advisory provided a brief overview of research studies and reviews published in the past two decades, including a global study of 195 countries and territories involving 28 million people.
They all found that higher levels of alcohol consumption were associated with a greater risk of cancer.
Other studies looked at specific cancers, like breast cancer and mouth cancer, finding the risks increased 10% and 40%, respectively, for those who had just one drink a day, when compared with those who did not drink.
The report described the biological mechanisms by which alcohol is known to induce cancerous changes at the cellular level.
The most widely accepted theory is that inside the body, alcohol breaks down into acetaldehyde, a metabolite that binds to DNA and damages it, allowing a cell to start growing uncontrollably and creating a malignant tumor.
Animal experiments have shown that rodents whose drinking water was spiked with either ethanol, the alcohol used in alcoholic beverages, or with acetaldehyde developed large numbers of tumors all over their bodies.
Research has shown that alcohol generates oxidative stress, which increases inflammation and can damage DNA.
It also alters levels of hormones like estrogen, which can play a role in breast cancer development, and makes it easier for carcinogens like tobacco smoke particles to be absorbed into the body, increasing susceptibility to cancers of the mouth and the throat.
The surgeon general’s report goes into detail about the increase in risk associated with drinking, differentiating between the increases in absolute risk and in relative risk.
For example, the absolute risk of breast cancer over a woman’s life span is about 11.3% (11 out of 100) for those who have less than a drink a week.
The risk increases to 13.1% (13 of 100 individuals) at one drink a day, and up to 15.3% (15 of 100) at two drinks per day.
For men, the absolute risk of developing an alcohol-related cancer increases from about 10% (10 of every 100 individuals) for those who consume less than one drink a week to 11.4% (11 per 100) for those who have a drink every day on average. It rises to 13% (13 of 100 individuals) for those who have two drinks a day on average.
Many Americans don’t know there is a link between alcohol and cancer.
Fewer than half of Americans identified alcohol use as a risk factor for cancer, compared with 89% who recognized tobacco as a carcinogen, according to a 2019 survey of U.S. adults ages 18 and older carried out by the American Institute for Cancer Research.
Yet alcohol consumption is the third leading preventable causes of cancer, after tobacco and obesity, according to the surgeon general’s report.
Murthy said it was important to know that the risk rises as alcohol consumption increases. But each individual’s risk of cancer is different, depending on family history, genetic makeup and environmental exposures.
“I wish we had a magic cutoff we could tell people is safe,” he said. “What we do know is that less is better when it comes to reducing your cancer risk.”
“If an individual drinks occasionally for special events, or if you’re drinking a drink or two a week, your risk is likely to be significantly less than if you’re drinking every day,” he said.
This article originally appeared in The New York Times.
