Should Australia mandate cancer warnings for alcoholic drinks?

Alcohol causes huge harm in Australia, responsible for 5,800 new cancer cases per year. Yet many of us remain in the dark about its health risks.

In January, the United States’ Office of the Surgeon General, the country’s leading public health spokesperson, recommended warnings about alcohol’s cancer risks should be displayed on drink packaging.

These messages have already been made obligatory in Ireland and South Korea.

So, do they work? And should we mandate them here?

Isn’t a glass of wine or two good for me?

Most of us know heavy drinking is unhealthy.

Yet the belief a few glasses of wine helps protect against heart disease and other conditions has persisted. That is despite evidence in recent years showing the benefits have been overestimated and the harms underplayed.

In fact, any level of alcohol use increases the risk for several types of cancer, including colorectal cancer (affecting the large intestine and rectum) and breast cancer.

In recent years, the evidence has strengthened showing alcohol plays a clear, causal role increasing cancer risk and other serious health problems, as well as all-cause mortality.

One study estimated how many new cancer cases will develop across the lifetimes of the 18.8 million Australian adults who were alive in 2016. It predicted a quarter of a million (249,700) new cancers – mostly colorectal – will arise due to alcohol.

We know what causes this harm. For example, acetaldehyde – a chemical produced by the body when it processes alcohol – is carcinogenic.

Alcohol also increases cancer risk through “oxidative stress”, an imbalance in the body’s antioxidants and free radicals which causes damage to DNA and inflammation.

It can also affect hormone levels, which raises the risk for breast cancer in particular.

Australians unaware of the risk

While the harms are well-known to researchers, many Australians remain unaware.

Figures vary, but at best only 59% of us know about the direct link between alcohol and cancer (and at worst, just one in five are aware).

Perhaps the best evidence this message has failed to sink in is our continued love affair with alcohol.

In 2022–23 69% of us drank alcohol, with one in three doing so at levels deemed risky by the National Health and Medical Research Council. For both men and women, that means having more than ten standard drinks per week or more than four in one day.

Read more: Mother's little helper: interviews with Australian women show a complex relationship with alcohol

What are other countries doing?

Like Australia, the US already has warnings on alcohol about its impacts on unborn children and a person’s ability to operate cars and machinery.

The US Surgeon General wants additional explicit warnings about cancer risk to be compulsory.

This follows Ireland, the first country to mandate cancer labels for alcohol. From 2026, alcohol packaging will include the warning: “there is a direct link between alcohol and fatal cancers”.

Other countries, including Norway and Thailand, are also reportedly investigating cancer warning labels.

Since 2017, alcohol producers in South Korea have had to choose between three compulsory warning labels – two of which warn of cancer risks. However they can instead opt for a label which warns about alcohol’s risks for dementia, stroke and memory loss.

Will Australia follow suit?

Australian health bodies have been advocating for cancer warnings on drink packaging for over a decade.

Currently, whether to include warnings about alcohol’s general health risks is at the discretion of the manufacturer.

Many use vague “drink responsibly” messages or templates provided by DrinkWise, an organisation funded by the alcohol industry.

Pregnancy warning labels (“Alcohol can cause lifelong harm to your baby”) only became obligatory in 2023. Although this covers just one of alcohol’s established health effects, it has set an important precedent.

We now have a template for how introducing cancer and other health warnings might work.

With pregnancy labels, the government consulted public health and industry bodies and gave a three-year transition period for manufacturers to adjust. We even have examples of colour and formatting of required labels that could be adapted.

Perhaps most promisingly, four in five surveyed Australians support adding these cancer-specific warnings.

Would it work?

We know the existing “drink responsibly”-style warnings are not enough. Research shows consumers find these messages ambiguous.

But would warnings about cancer be an improvement? Ireland’s rules are yet to come into effect, and it’s too early to tell how well South Korea’s policy has worked (there are also limitations give manufacturers can choose a warning not related to cancer).

But a trial of cancer warnings in one Canadian liquor store found they increased knowledge of the alcohol–cancer link by 10% among store customers.

Cancer messages would likely increase awareness about risks. But more than that – a 2016 study that tested cancer warnings on a group of 1,680 adults across Australia found they were also effective at reducing people’s intentions to drink.

The evidence suggests a similar policy could replicate the success of cancer warnings on cigarette packaging – first introduced in the 1970s – at increasing knowledge about risks and reducing consumption. Smoking rates in Australian adults have declined steadily since these warnings were first introduced.

It may take years before Australia changes its rules on alcohol labelling.

In the meantime, it’s important to familiarise yourself with the current national low-risk drinking guidelines, which aim to minimise harm from alcohol across a range of health conditions.