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Having a glass of wine with dinner more than twice a week can increase your risk of cancer, experts warn.

Should alcohol carry a warning label?

There is no safe level of alcohol consumption, according to updated guidelines from the Canadian Centre on Substance Use and Addiction (CCSA).

The guidelines recommend consuming no more than two alcoholic drinks per week. That’s the equivalent of two bottles of beer, two glasses of wine, or two shots of spirits.

CCSA is also calling on Health Canada, which funded the guidelines, to require warning labels on all alcoholic beverages.

Changing consensus

“All levels of alcohol consumption are associated with some risk, so drinking less is better for everyone,” the guidelines state.

Previously, CCSA suggested a maximum of 10 drinks per week for women and 15 per week for men – recommendations that form the basis of Health Canada’s alcohol guidelines.

But the scientific consensus on the health impacts of alcohol has changed dramatically over the past decade, with recent studies showing that even small quantities can be harmful.

According to CCSA’s review of more than 5000 studies, three to six drinks per week pose a moderate health risk including an increased risk of cancer, while seven or more drinks pose increasingly higher risks for heart disease and stroke. And the lifetime risks of consuming more than two drinks per week increase more steeply for women than men due to a host of biological differences.

Low awareness of alcohol risks

Many people in Canada are unaware of these risks, according to CCSA. More than half of those over age 15 consume more than two drinks per week. Two in five are not aware alcohol is carcinogenic. And the notion that drinking in moderation protects the heart is still widely publicized, despite systematic reviews debunking the claim.

CCSA and the Canadian Cancer Society argue the federal government should require warning labels on alcohol packaging to inform people about the cancer risk and how many standard drinks are in every container.

Consumers “have a right to clear and accessible information about the health and safety of the products they buy,” according to CCSA.

International debate

The guidelines have sparked debate internationally, with the BBC dubbing the guidelines as “drastic” compared to recommendations in other countries.

Recent Australian and French guidance recommend a maximum of 10 drinks per week, while the United Kingdom suggests no more than 14 units or six standard drinks.

However, according to the World Health Organization, half of all alcohol-attributable cancers in Europe are caused by “light” and “moderate” consumption.

“We cannot talk about a so-called safe level of alcohol use,” said Carina Ferreira-Borges, regional advisor for alcohol and illicit drugs in WHO’s European office. “The only thing that we can say for sure is that the more you drink, the more harmful it is.”

The WHO has echoed the call for warning labels noting that alcohol has long been categorized as one of the highest-risk carcinogens alongside asbestos, radiation, and tobacco.

Do alcohol warning labels work?

In one of the only real-world experiments of cancer warnings on alcoholic beverages, labels on products in Yukon liquor stores were found to decrease per capita alcohol sales by more than 6% compared to control sites.

“What we learned from that study was that the cancer labels grabbed consumer attention,” study coauthor Erin Hobin told CBC News. “They read the cancer warning very closely. They thought about that message. They talked to their neighbours and friends about that message.”

However, the study was cut short due to alcohol industry pressure.

Industry representatives have also questioned CCSA’s methodology and called for an independent review of the updated guidelines.

According to CJ Helie of Beer Canada, the alcohol industry already voluntarily informs people to drink responsibly, so there’s no need for any labels.

For example, Wine Growers of Canada is developing a QR code manufacturers could voluntarily place on alcohol containers directing consumers to information about responsible drinking.

Duty to inform

Some experts argue that doesn’t go far enough to fulfill the industry’s legal duty to clearly inform consumers of risks, especially if those risks are not well known.

Such warnings “are not just critical, they are required under the law,” and a manufacturer’s obligation to inform is greater when a product is ingested, according to Jacob Shelley, a director of the health ethics, law and policy lab at Western University.

In the case of tobacco, warning labels have been effective in attracting consumers’ attention and increasing health knowledge, but their impact on behaviour can wear off over time and varies depending on the size and design of the warning.

Health Canada appears reluctant to weigh in on the issue. Although the agency acknowledged to the media that alcohol presents serious and complex public health and safety issues, it has declined to comment on requiring warning labels.

Photo credit: Linda Raymond/E+ via Getty Images

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