Alcohol "Right to Know" can save lives.
AMA's policy statement on labeling of Alcohol

-The exact composition of many beverages is confidential business information, though many published data define

the organic compounds typically present at low levels. Several of the components and contaminants identified in beer, wine, and

spirits are known or suspected human carcinogens, including acetaldehyde, nitrosamines, aflatoxins, ethyl carbamate (urethane),

asbestos, and arsenic compounds (IARC 1988).

Consumption of alcoholic beverages is causally related to cancers of the mouth, pharynx, larynx, and esophagus. Cohort and case

control studies in a variety of human populations are notable for their consistency in reporting the presence of moderate to strong

associations with dose-response relationships for these four sites. Evidence supports a weaker, but possibly causal, relation between

alcoholic beverage consumption and increased risk of cancers of the liver and breast (Longnecker 1994).

The effect of a given level of alcoholic beverage intake on absolute risks of cancer of the mouth, pharynx, larynx, and

esophagus is influenced by other factors, especially smoking. However, smoking does not explain the observed increased risk of

cancers associated with increased alcoholic beverage consumption (IARC 1988, Longnecker and Enger 1996).

No adequate experimental animal carcinogenicity studies of

alcoholic beverages have been reported in the literature. Studies

specifically examining the carcinogenicity of ethanol in animals have

not yielded results that would suggest that the ethanol component of

alcoholic beverages is solely responsible for the increases in cancer

observed in people consuming alcoholic beverages.

Increased frequencies of chromosomal aberrations, sister chromatid

exchanges, and aneuploidies have been found in the peripheral

lymphocytes of alcoholics. Ethanol-free extracts of some alcoholic

and mutations in bacteria (IARC 1988).

The mechanism by which consumption of alcoholic beverages can

cause cancers in humans is not established.

Ethanol and water are the main constituents of most alcoholic beverages. Using a standard measure of most drinks, the amount of

ethanol consumed is similar for beer, wine, and spirits (10 to 14 g).  Beer, wine, and spirits also contain volatile and nonvolatile flavor

compounds that originate from raw materials, fermentation, wooden  casks used for maturation, and synthetic substances added to specially

flavored beverages. The exact composition of many beverages is

confidential business information, though many published data define

the organic compounds typically present at low levels. Several of the

components and contaminants identified in beer, wine, and spirits are

known or suspected human carcinogens, including acetaldehyde,

nitrosamines, aflatoxins, ethyl carbamate (urethane), asbestos, and

arsenic compounds (IARC 1988).

Alcoholic beverages have been made and used by most societies for thousands of years (IARC 1988). Consumption trends, including

overall level of alcohol consumption, beverage choice, age and sex differences, and temporal variations, differ among and within

societies. In many cultures, alcohol also has been used in medicine and various pharmaceutical preparations.

All alcoholic beverages are produced by the fermentation of fruit or other vegetable matter. Most commercial and home production

involves fermented beverages that are classified, based on raw materials and production methods used, as beer, wine, or spirits,

although smaller quantities of other kinds of fermented beverages (cider, rice wine, palm wine, etc.) also are produced. Beer is

produced by fermentation of malted barley or other cereals with the addition of

hops. Wine is made from fermented grape juice or crushed grapes;

fortified wines include additional distilled spirits. Distilled spirits, so named because of liquid distillation to increase the alcohol

content after sugar fermentation, originate from sources of starch or sugar,

including cereals, molasses from sugar beets, grapes, potatoes, cherries,

plums, and other fruits (IARC 1988). Although ethanol can be

chemically synthesized from ethylene, alcohol synthesis for use in

beverages is not employed by the alcoholic beverage industry because

of the presence of impurities from the synthetic process.

In 1990, American wine production was 4.5 million metric tons (10

billion pounds), beer production was 375 million hectoliters (10 billion

gallons), and spirit production was 18.5 million hectoliters (490 million

gallons) (ARF 1994). World total production of the same beverages was

29 million metric tons (6.4 billion pounds) of beer, 1 million hectoliters

(26.4 million gallons) of wine, and 58 million hectoliters (1.5 billion

gallons) of spirits. In the United States in 2001, per capita consumption

of beer was 21.7 gallons (82.1 L), of wine was 2.0 gallons (7.6 L), and of

distilled spirits was 1.3 gallons (4.9 L) (USDA 2003). The United States

International Trade Administration (ITA) tracks import and export data

for various categories of beer, wine, distilled spirits, and other alcoholic

beverages. In 2002, U.S. domestic exports and imports of many alcoholic

beverages ranged from millions to billions of liters (ITA 2003).

A downward trend in alcohol consumption occurred in the United

States and many European countries from the turn of the twentieth

century until the period between the world wars. Alcohol consumption

in the United States increased from the 1940s until the early 1980s, and

then began to decrease steadily. By 1993, consumption had declined to

the lowest level since 1964. Apparent per capita consumption expressed

in gallons of pure alcohol per year was 1.6 gallons in 1940,

approximately 2.2 gallons in 1964 and 1993, and approximately 2.8

gallons in 1980. Per capita consumption of wine and beer in the United

States was relatively stable over the period beginning in the early 1980s

and continuing into the 1990s when overall alcohol consumption was

consumption can be attributed to decreased consumption of spirits. Per

capita consumption of wine was the same in 1993 as it was in 1977,

while consumption of spirits fell by almost 35% over the same period.

Per capita consumption of beer decreased from 1981 to 1985,

fluctuated thereafter, and in 1993 was 1% below 1977 consumption

levels (NIAAA 1997). The total number of drinks consumed in the

United States in 1999 was about 65.5 billion for beer, 13.7 billion for

wine, and 29.3 billion for distilled spirits. Underage drinkers (aged 12

to 20) consumed 19.7% of the total, and adult excessive drinkers (more

than 2 drinks per day) accounted for 46.3%. The heaviest adult drinkers

Since 1971, the Substance Abuse and Mental Health Administration

(SAMHSA 2003) has conducted an annual survey on the use of illicit drugs, alcohol, and tobacco by the civilian, no institutionalized

population of the United States aged 12 years old or older. This survey, now called the National Survey on Drug Use and Health (formerly called the National Survey on Drug Abuse) reports prevalence and trends

of alcohol consumption at three levels. These include current use (at least

one drink in the past 30 days), binge use (five or more drinks on the

same occasion at least once in the past 30 days), and heavy use (five or

The probability that a resident of the United States will develop cancer

at some point in his or her lifetime is 1 in 2 for men and 1 in 3 for

women (ACS 2004). Nearly everyone’s life has been directly or

indirectly affected by cancer. Most scientists involved in cancer research

believe that the environment in which we live and work may be a major

this context, the "environment" is anything that people interact with,

including exposures resulting from lifestyle choices, such as what we eat,

drink, or smoke; natural and medical radiation, including exposure to

sunlight; workplace exposures; drugs; socioeconomic factors that affect

exposures and susceptibility; and substances in air, water, and soil (OTA