Why Alcohol Needs a Cancer Warning Label

More than six in 10 Americans drink alcohol. But less than half of them know that they’re increasing their cancer risk while they’re doing it.

Alcohol consumption is the third-leading preventable cause of cancer in the U.S., after tobacco and obesity, and leads to a higher risk of at least seven types of cancer, including colorectal, liver, esophageal, laryngeal, throat, mouth, and breast—the link to which was demonstrated in 1987.

Based on mounting evidence connecting alcohol consumption—even in small amounts—to increased risk of cancer, on January 3, then-U.S. Surgeon General Vivek Murthy issued a health advisory on the link between alcohol and cancer, and recommended that the warning label on alcohol containers be changed to reflect the connection. The WHO, which in February issued a similar call for alcohol labels to carry a cancer warning, declared alcohol a Class I carcinogen—in the same category as cigarette smoking and asbestos—in 1990.

To raise awareness about the risk of cancer from drinking, experts say it’s time to update U.S. alcohol warning labels.

A Long History of Labels in Limbo

The concept for a federally mandated label was introduced to Congress in 1967, but it wasn’t until 1988 that a warning label was approved, with the passage of the Alcoholic Beverage Labeling Act (ABLA). The label reads: 

GOVERNMENT WARNING: (1) According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects. (2) Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery, and may cause health problems.

The ABLA was enacted in 1989, and the label hasn’t been updated since.

It is incredibly outdated, says Jennifer Brown, PhD ’20, MPH, assistant scientist in Health, Behavior and Society. “In order for [the labels] to really be effective at preventing alcohol use and encouraging moderation for those who use alcohol, they should be updated.”

The ABLA is enforced by the Secretary of the Treasury. The law states that if the USSG alerts the treasury secretary to alcohol-associated health harms that would justify a change in the warning label, they must report such information to Congress. No such reports have been made—even though “we have a lot more evidence on the health risks of alcohol consumption since the current labels were implemented,” Brown says.

Even if a report were made, she adds, Congress would have to authorize new warning labels of the sort Murthy recommended, and it’s not clear whether the current administration would support the change.

An Educational Opportunity

Research cited in Murthy’s advisory shows that cancer risk increases as drinking increases, and for breast, mouth, and throat cancers, that risk may increase with just one drink a day. Research also shows that cancer risk increases regardless of the type of alcohol consumed.

“We have known since the 1920s that alcohol … causes cancer, but no one had brought together all the literature,” Otis Brawley, MD, a Bloomberg Distinguished Professor of Oncology and Epidemiology, told the Hub.

Yet “the fact that alcohol causes cancer is not widely known in the U.S.,” Johannes Thrul, PhD, MS, associate professor in Mental Health says. Only 45% of Americans recognize alcohol use as a risk factor for cancer. “Warning labels can be one tool to literally give people an opportunity to make an informed decision.”

“It’s been well documented empirically: People are really ignorant about the harms of alcohol,” says Jeffrey Drope, PhD, a research professor in Health, Behavior and Society. But, he says, stronger warning labels could serve as educational reminders of the powerful research connecting alcohol intake with an increased risk of cancer.

“The precautionary principle is, if it might cause cancer, you should warn people that it might cause cancer,” Brawley said. “This is not a ‘might cause cancer.’ This is ‘it does cause cancer.’”

Do Warning Labels Work?

According to a WHO snapshot series on alcohol control policies and practice, warning labels on alcohol containers increase awareness, slow down drinking, decrease drinking events, and reduce purchase occasions.

Labeling does influence consumer behavior, Brown says. “Strong health warning labels on tobacco products, for example, are effective at informing consumers about the dangers of smoking, keeping people from starting to smoke, and motivating people who do smoke to quit.”

There is a growing body of evidence that this could be effective for alcohol. A 2024 study from the Institute of Alcohol Studies, for example, found that the warnings significantly increased people’s awareness that alcohol can cause cancer, with about one-third of survey participants showing a marked increase in understanding. And Thrul points to a 2020 study published in the Journal of Studies on Alcohol and Drugs that found that when large colorful labels were added to bottles of alcohol warning it can cause cancer, sales of labeled products in a state-run Canadian liquor store decreased by more than 6%.

However, data like this could also energize manufacturers and distributors. “The industry knows that this will hurt their bottom line,” Thrul says. “They know awareness works, and they are not pleased about it. We expect that there will be some sand in the gears of the political decision-making, lobbying efforts, and implementation.”

Changing consumers’ perspectives with alcohol labels might be a long game, Drope says. “Having warning labels on alcoholic products is a great thing from the sheer perspective of education. Whether it will hugely shift behavior, time will tell. If every time you pick up a bottle of wine and it says, ‘drinking alcohol causes cancer’—the message will eventually start to sink in.”

Size (and Image) Matters

To be impactful, experts agree that an updated version of the label would need to shift from the current simplified text form to something more eye-catching.

“A small text box on the back of a product is very different from, for example, the warning labels on Australian cigarette packages, where three-quarters of the front of the pack and 90% of the back is a graphic warning label representing some of the health consequences of smoking,” says Thrul. “These are both warning labels, but one is much more impactful than the other.”

A shift toward icons, rotating graphics, realistic photos, and colors that pop on the front, back, and all sides—as opposed to only the sides or back—of the container would make the label most effective, Brown says. “Graphic tobacco labels, for example, usually depict the negative consequences of smoking, like cancer and lung disease.”

Other countries have been more aggressive about their alcohol health warnings: Beginning in 2026, Ireland will require labels that read “There is a direct link between alcohol and fatal cancers” and “Drinking alcohol causes liver disease” in red capital letters on all containers of beer, wine, and liquor sold in the country.

South Korea has had a warning about liver cancer, along with other mandated labels, since 2016. Thailand is now working on regulations that would require alcohol to have labels with graphic images and text warnings.

Thrul says that the current labels probably aren’t making a huge dent on alcohol consumption, but hopes that “if we change them, put them more front and center, and make them more explicit, we would expect to see many more effects from them.”

Labeling does take marketing power away from industry advertising, Brown says. Cigarette packs, for example, are a key marketing and communications tool for Big Tobacco. “It becomes a way for them to advertise their product, to inform consumers about different product characteristics. By filling some of the space on the package with a health warning label, you're also taking away space for advertising on the pack.”

A Multifaceted Approach

In addition to updating the label, Murthy’s recommendations for increasing public awareness of the dangers of alcohol included calling on the public health community to create educational messaging, reassessing recommended alcohol consumption limits, and urging health care providers to discuss the link between alcohol and cancer and to promote alcohol screenings and treatment.

To be most effective, these elements must be synchronized. “The messages that are on liquor bottles should be the same ones that public health agencies are spreading,” Drope says. “The countries where these messages are loud, consistent, and understandable are where the messages are resonating. Folks are getting the same messages over and over again from different sources. That is when we really start to have that effect, where we start to actually see norms changing.”