AIIMS researchers call for warning labels on alcohol, cite low awareness
In an opinion piece titled "Expanding behavioural interventions through cancer warning labels in India: from cigarette packs to alcohol bottles" published in Frontiers in Public Health on July 24, the doctors have highlighted that alcohol, like tobacco, is a proven carcinogen, yet awareness remains low.
The opinion piece by oncologists Dr Abhishek Shankar, Dr Vaibhav Sahni and Dr Deepak Saini from the Department of Radiation Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, AIIMS, Delhi stated that adolescence forms a crucial period for the initiation and intensification of substance use behaviour, including alcohol.
Behavioural interventions instituted by means of alcohol warning labels may prove to be effective in affecting positive changes in the consumption habits of individuals belonging to this age group, particularly in Low- and Middle-Income Countries (LMICs), where it is all the more important for certain sections of society to be educated and sensitised towards the consequences of substance use, the researchers said.
They stated that cancer cases in India have seen a steep rise, with data from the 2012 to 2022 period suggesting a 36 per cent increase in incidence (1.01 million-1.38 million).
GLOBOCAN 2022 data saw about 1.41 million new cancer cases in India with a five-year prevalence at around 3.25 million and a total cancer mortality at 916,827.
Alcohol attributable a fraction for cancer and age-standardised rate per 100,000 in India are 4.7 per cent and 4.8 per cent, respectively, according to the GLOBOCAN 2020 data.
Data from 2016 suggested that 6.6 per cent of Disease Adjusted Life Years in India were attributable to alcohol consumption which followed that of tobacco at 10.9 per cent, the researchers said.
The researchers also mentioned about the advisory brought out by the US surgeon general in January 2025 regarding the consumption of alcohol and the risk of cancer, which stated that alcohol consumption demonstrably elevates the risk for developing at a minimum, seven types of cancer (colon/rectum, liver, breast, esophagus, larynx, pharynx and oral cavity).
The advisory also mentioned the mechanistic links between alcohol consumption and the risk of developing cancer along with the fact that this effect is observable regardless of gender.
Even before the release of this advisory, alcohol-attributable cancers have been recognised to contribute significantly to the global burden of disease, the researchers said.
Cancer warning labels on alcohol containers have been observed to be of benefit in reducing alcohol consumption and lowering the perception of consumption, they said.
The Global Adult Tobacco Survey (GATS) in 2016-17 noted an increase by 16 per cent for health warnings on cigarette packs, with pictorial health warnings demonstrating a 50 per cent elevated impact on the intention to quit smoking cigarettes.
Warnings can be differentiated based on the type of messaging involved into loss-framed and gain-framed which have an emphasis on associated risks/harms and the benefits of quitting, respectively, the researchers explained.
There is evidence in literature to suggest that gain-framed messaging possesses an advantage over loss-framed warnings but the research on such aspects has mainly focused on loss-framed warnings in the case of cigarette smoking.
It is also suggested that a combination of messaging can help inform behaviour change in a more effective manner which is based off the concept of the role individual beliefs play in determining outcomes, they said.
India being an LMIC, this trend indicates the effect of cancer warning labels in modifying the behaviour of a significant number of people consuming such products, the researchers highlighted.
"The LMICs may look into expanding the positive experience gained from tobacco warning labels to those pertaining to alcohol containers, which clearly state a cancer risk from consumption. It may also be useful for these cancer labels to state that there is no lower threshold for alcohol-related cancer risk along with the types of cancers demonstrably attributable to alcohol consumption so far," the doctors said.
They pointed out that a crucial but often ignored aspect while considering warning labels is the multiplicative interaction of smoking and alcohol consumption in determining cancer risk.
A National Cancer Institute (NCI) Workshop in December 2020 emphasised the importance of addressing the combined usage of tobacco and alcohol.
Co-use of tobacco and alcohol has been found to be associated with a multiplicative effect in cancer risk, particularly for pharyngeal and oral sites.
The importance of reciprocative warning labels on tobacco and alcohol product packaging is further underscored by the fact that alcohol usage has been observed to go up with an increase in cigarette smoking, with the former being associated with lower rates of quitting and higher relapse rates in smokers.
It may also be worth considering to have helpful or constructive labelling on containers which guide the user to seek medical advice or undergo screening for cancer instead of being terminalistic in its messaging by suggesting graphic or fatal outcomes upon consumption, the researchers said.
"Since cancer as a disease may present as a result of the combined effect of alcohol and tobacco consumption, it makes sense to place such cancer warning labels and not address these risk factors in isolation," they said.
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