The outgoing US Surgeon General's report highlighting alcohol’s link to various cancers provides an opportunity for insurers to leverage the public spotlight and reinforce the risks to mortality from any level of consumption.
The headlines were everywhere:
Those in the insurance and reinsurance industries calmly sipped their coffee and said some version of “This is news?”
As he prepared to leave office after serving for Presidents Obama, Trump, and Biden, US Surgeon General Dr. Vivek Murthy issued a report entitled “Alcohol and Cancer Risk.” The 22-page general advisory identified alcohol consumption as a leading preventable cause of cancer, stating that 741,300 cancer cases worldwide were attributable to alcohol in 2020, with a quarter of those cases afflicting people who consumed two or fewer drinks per day.
Even more alarming to some, that percentage did not vary significantly as consumption increased. Just more than 28% of cases were linked to those who consumed around two to four drinks a day, with roughly 21% affecting those who consumed four to six, and 26% for those with six or more. The report considered one drink comparable to a 5-ounce glass of wine, a 12-ounce beer, or 1.5 ounces of liquor.
In concluding his report, Murthy called for warning labels to be placed on alcoholic beverage containers similar to those on cigarette packs.
Whether such labels are appropriate is a matter for politicians and regulators to decide. For insurers, alcohol’s link to cancer is nothing new. The connection has been well established through multiple studies dating back to the 1980s and long factored into insurance risk assessment.
The headline-grabbing message that sparked so much public attention has been understood in the life insurance industry for decades: There is no completely safe level of alcohol consumption. Cancer is just one of the danger areas, layered on top of increased risk of liver disease and accidental death, for increased mortality.
The US Surgeon General’s warning on alcohol’s link to cancer may have grabbed headlines, but it’s not just a United States issue, and it’s not just cancer.10
The World Health Organization states there is no safe amount of alcohol consumption for optimal human health. Globally, alcohol is a factor in up to 80% of liver-related deaths in many countries and is responsible for 5% of deaths around the world. Alcohol is also the leading cause of death globally in those 15 to 49 years old and is a factor in 48% of all cirrhosis-related deaths. It has risen from the 15th leading risk factor worldwide in 1990 to 10th in 2021.
The COVID-19 pandemic worsened the situation. A Reinsurance Group of America, Inc. (RGA) analysis of US mortality data from the National Vital Statistics System11,12 found a spike in alcohol-induced mortality in the early years of the pandemic. This appears to have eased in 2022 and 2023.
But unlike the United States, England and Wales experienced a COVID-era increase in alcohol-specific mortality that continued into 2022.
This spike could lead to an additional 8,000 deaths from alcohol-associated liver disease, nearly 19,000 cases of decompensated cirrhosis, and 1,000 cases of hepatocellular carcinoma globally from 2020 to 2040.13
Dive deeper into RGA’s research on a post-pandemic view of alcohol consumption.
Alcohol consumption trails only tobacco and obesity as a leading preventable cause of cancer in the United States.1 Research has demonstrated a causal relationship between alcohol use and an increased risk for seven types of cancer – breast, colorectum, esophagus, liver, mouth, throat, and voice box.2 And, as the Surgeon General correctly points out, that risk starts increasing for some of those cancers – such as breast, mouth, and throat – with as little as one drink a day or less.
Scientifically, the call for warning labels makes sense. Alcohol metabolism occurs mainly in the liver and produces acetaldehyde, a metabolite from ethanol that can cause DNA damage that ultimately leads to cancer development. The International Agency for Research on Cancer (IARC) classifies alcoholic beverages, ethanol in alcoholic beverages, and acetaldehyde as carcinogenic to humans (Group 1).3
The recent headlines led many who have heard from their doctors for years that a nightly glass of red wine might actually be good for them to scratch their heads. Then again, there was a time when doctors4 (not to mention the beloved children’s cartoon Flintstone characters5 ) endorsed cigarettes on television commercials.
While tobacco’s link to cancer has been the subject of massive awareness campaigns for decades, alcohol’s connection has largely flown under the public radar. In fact, only 45% of Americans surveyed in 2019 by the American Institute of Cancer Research said they believed alcohol causes cancer.6 More than 40% believed smoking was a major cause of cancer – in 1966.7 That number rose to 71% by 2001.8 While the percentage today varies depending on the type of cancer, a National Institute of Health study found 97% of US adults believe smoking causes lung cancer.9
That discrepancy – more than 97% for smoking’s link to lung cancer compared to just 45% for alcohol’s connection to cancer overall – justifies the Surgeon General’s warning. But Dr. Murthy is ringing a bell the insurance industry has been sounding for years.
That said, this added attention presents life and health insurers – along with all those in the health and wellness space – a timely opportunity to reinforce that there is no completely safe level of alcohol consumption. As insurers continue to account for alcohol use in risk assessment, they can also take steps to educate consumers about its contributing role to a variety of cancers and other conditions, further establishing themselves as policyholders’ wellness partners.
Learn more: Explore alcohol consumption’s contribution to mortality beyond cancer in RGA’s latest research.
