Did Drinking Give Me Breast Cancer?

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I thought I’d
done everything right: breastfeeding my children, a careful
diet, plenty of exercise. I wasn’t overweight and didn’t have a
family history. I bought BPA-free bottles for my filtered water.
But on a visit to the radiology department last spring, a pair of
red brackets highlighted something worrisome on the ultrasound
monitor.

Invasive lobular carcinoma—a malignant breast tumor. This
spidery little beast measuring nearly three centimeters meant I had
stage 2 cancer.

At 47, I was a decade and a half younger than the median age for
breast cancer diagnosis in the United States. Was this just bad
luck? Maybe, but the journalist in me was still curious to know:
Why me? So I dug into the literature on risk factors to see where I
might have fit in. It’s an impossible question to answer
definitively for an individual, like trying to prove that a single
weather event was caused by climate change. As one doctor told me,
“You know who’s at risk for getting breast cancer? People with
breasts!”

Still, most of the broad indicators didn’t seem to apply to me.
The biggest one is age: The median diagnosis in the United States
is at 62, and the highest breast cancer rates are in women older
than 70. Another is taking hormone replacement therapy after
menopause, but I’m premenopausal and haven’t taken it. Obesity
raises risk, but I’ve never been overweight.

Then I saw one that gave me pause: alcohol consumption. I’m not
a heavy drinker, but like most women I know, I have consumed a lot
of alcohol in my lifetime.

While doctors have frequently admonished me for putting cream in
my coffee lest it clog my arteries—a correlation that’s been
pretty thoroughly debunked—not once has any
doctor suggested I might face a higher cancer risk if I didn’t cut
back on drinking. I’d filled out dozens of medical forms over the
years asking how much I drank every week, but no one ever followed
up other than to say with nodding approval, “So you drink
socially.”

The research linking alcohol to breast cancer is deadly solid:
Alcohol, regardless of whether it’s in Everclear or a vintage
Bordeaux, is carcinogenic.

I quickly discovered that way back in 1988, the World Health Organization declared
alcohol a Group 1 carcinogen, meaning that it’s been proved to
cause cancer. There is no known safe dosage in humans, according to
the WHO. Alcohol causes at least seven types of cancer, but it kills more women
from breast cancer than from any other. The International Agency
for Research on Cancer estimates that for every drink consumed
daily, the risk of breast cancer goes up 7 percent.

The research linking alcohol to breast cancer is deadly solid.
There’s no controversy here. Alcohol, regardless of whether it’s in
Everclear or a vintage Bordeaux, is carcinogenic. More than 100 studies over several decades have
reaffirmed the link with consistent results. The National Cancer
Institute says alcohol raises breast cancer risk even at low
levels.

I’m a pretty voracious reader of health news, and all of this
came as a shock. I’d been told red wine was supposed to defend
against heart disease, not give you cancer. And working
at Mother Jones, I thought I’d written or read
articles on everything that could maybe possibly cause cancer:
sugar, plastic, milk, pesticides, shampoo, the wrong sunscreen,
tap water…You name it, we’ve reported on the odds that it might
give you cancer. As I schlepped back and forth to the hospital for
surgery and radiation treatments, I started to wonder how I could
know about the risk associated with all these other things but not
alcohol. It turns out there was a good reason for my ignorance.

I was born and raised in
Utah, and after my cancer diagnosis, I wondered what would have
happened if I’d stayed put. My home state has one of the lowest
rates of breast cancer in the country. Observant Mormon women don’t
drink, and like other populations that abstain, they have significantly lower rates of breast cancer than
drinkers. In Utah, Mormon women’s breast cancer rates are more than
24 percent lower than the national average. (Mormon men have lower
rates of colon cancer, which alcohol can also cause.)

Researchers suspect the low overall rate of breast cancer in
Utah has to do with the LDS church’s strict control over state
alcohol policy. Gentiles, as we non-Mormons are called, grouse
mightily over the watery 3.2 percent beer sold in Utah
supermarkets, the high price of vodka sold exclusively in state-run
liquor stores, and the infamous “Zion Curtain,” a barrier that restaurants were
until recently required to install to shield kids from seeing
drinks poured. Yet all those restrictions on booze seem to make
people in Utah healthier, Mormon or not, especially when it comes
to breast cancer.

Epidemiologists first recognized the connection between cancer
and alcohol consumption in the 1970s. Scientists have since found biological
explanations for why alcohol is carcinogenic, particularly in
breast tissue.

When you take a drink, enzymes in your mouth convert
even small amounts of alcohol into high levels of acetaldehyde, a
carcinogen. People who consume more than three drinks a day are two
to three times likelier to contract oral cavity cancer than those
who don’t. Alcohol also damages the cells in the mouth, priming the
pump for other carcinogens: Studies have found that drinking and
smoking together pose a much higher risk of throat, mouth, and
esophageal cancer than either does on its own.

Alcohol continues its trail of cellular damage as enzymes from
the esophagus to the colon convert it into acetaldehyde. The liver
serves as the body’s detox center, but alcohol is toxic to liver
cells and can scar the organ tissue, leading over time to
cirrhosis, which raises the risk of liver cancer.

Researchers estimate that alcohol accounts for 15 percent of US
breast cancer cases and deaths.

As acetaldehyde courses through the body, it can bind to DNA,
causing mutations that can lead to cancer, particularly in the
colon. Alcohol is suspected of inflicting a double whammy on breast
tissue because it also increases the level of estrogen in a woman’s
body. High levels of estrogen prompt faster cell division in the
breast, which can lead to mutations and ultimately tumors.

Researchers estimate that alcohol accounts for 15 percent of US breast cancer cases and
deaths—about 35,000 and 6,600 a year, respectively. That’s about
three times more than the number of breast cancer cases caused by a
mutation of the BRCA genes, which prompted Angelina Jolie, who carries one of the abnormal
genes, to have both her healthy breasts removed in 2013. The breast
cancer risk from alcohol isn’t nearly as high as the lung cancer
risk from smoking. But alcohol-related breast cancer kills more
than twice as many American women as drunk drivers do. And alcohol
is one of the few breast cancer risk factors women can control.
Others, like starting menstrual periods before the age of 12 and
entering menopause after 55, are baked in.

Overall, American women have about a 12 percent lifetime risk of getting breast
cancer. Walter Willett, an epidemiology professor at the Harvard
T.H. Chan School of Public Health who has conducted studies on
alcohol and breast cancer, says a woman who consumes two to three
drinks a day has a lifetime risk of about 15 percent—a 25 percent
increase over teetotalers. By comparison, mammography reduces the
death rate from breast cancer by about 25 percent. “Alcohol can
undo all of that at about two drinks a day,” Willett says.

When the evidence of
alcohol’s cancer risks emerged, public health advocates sought to
spread the word. In 1988, California added alcohol to its list of
cancer-causing chemicals that required a warning label. The next
year, when Congress first mandated nationwide warning labels on
alcohol, advocates tried to include cancer on them. Battered by
activism around drunk driving and fetal alcohol syndrome, the booze
industry was already in a slump, with alcohol consumption per
capita on a steep slide since its 1981 peak. Fearing health advocates would do to
alcohol what they had done to tobacco, the industry fought back
with an audacious marketing campaign.

Alcohol companies worked to rebrand booze as a staple of a
healthy lifestyle, like salads and jogging. The wine industry led,
with vintner Robert Mondavi taking rabbis and doctors on
educational tours about the alleged health benefits of moderate
drinking. He told the New York Times in 1988 that wine “has been praised for centuries
by rulers, philosophers, physicians, priests, and poets for life,
health, and happiness.

The industry’s attempt to transform its products into health
tonics might never have succeeded without the help of Morley Safer.
In 1991, Safer hosted a 60
Minutes segment about the “French paradox,” the idea that
the French eat heaps of red meat, cheese, and cream but have lower
heart disease rates than Americans, who were many years into a
low-fat dieting craze. On the show, he held up a glass of red wine
and declared, “The answer to the riddle, the explanation of the
paradox, may lie in this inviting glass.” New research, he said,
showed red wine might flush out fatty deposits on artery walls and
counteract the effects of the heavy French diet.

That TV episode, which according to the International Wine &
Food Society was viewed by more than 20 million people, created a media sensation
and caused a spike in red wine sales nationwide. Researchers soon
debunked the idea that wine was helping French heart health, and
France’s heart disease rate turned out to be higher than
advertised. Meanwhile, all the wine the French consumed was killing
large numbers of them. The same year as the 60
Minutes episode, France passed some of the world’s
strictest regulations of alcohol advertising to combat prevalent
liver cirrhosis.

The Distilled Spirits Council of the United States “is working to
ensure cultural acceptance of alcohol beverages by ‘normalizing’
them in the minds of consumers as a healthy part of a normal
lifestyle,” the group’s CEO said in 2000.

Even so, the US wine industry lobbied to include a positive health message
about alcohol in the 1995 Dietary Guidelines for Americans
published by the Department of Agriculture. The new guidelines
removed language indicating that alcohol had “no net health
benefit” and stated that for some people, moderate alcohol
consumption might reduce the risk of heart disease.

At a conference of beer wholesalers in 1996, the Miller Brewing Co.’s vice president
of corporate relations touted the success of the 60
Minutes episode and the subsequent changes in government
health messages as progress in the industry’s effort to brand its
products as healthy. She urged attendees to open every meeting with
an elected official by saying, “Alcohol can be part of a healthy
diet.”

Over the past two decades, the alcohol industry has gone all out
to tie its products to an active lifestyle. Peter Cressy, the
former CEO of the Distilled Spirits Council of the United States
(DISCUS), the liquor lobby, explained in 2000, “DISCUS is working to ensure cultural acceptance
of alcohol beverages by ‘normalizing’ them in the minds of
consumers as a healthy part of a normal lifestyle.”

Alcohol companies, long sponsors of football games and NASCAR
events, now sponsor 5K races and triathlons. During last year’s Super Bowl, a Michelob Ultra ad
featured extremely fit people working out and then grabbing a beer
to quench their thirst. (Drinking alcohol after exercise causes
dehydration and impedes muscle recovery.) Hard liquor companies
concocted products like Devotion Spirits vodka, which supposedly
contained a protein that would help build muscle while preventing
hangovers. (In 2012, Devotion Spirits withdrew many of its
health claims after the Federal Trade Commission opened an
investigation.)

Indeed, the supposed health upside of moderate drinking is one
of the industry’s go-to talking points. When Mother
Jones reached out to the leading beer and liquor
companies and the major industry groups, those that responded
acknowledged the connection between alcohol and cancer, but some
argued the risk belongs mostly or entirely to heavy drinkers. Sarah
Longwell, the managing director of the American Beverage Institute,
said in a statement that “a substantial number of well-conducted
studies reveal no correlation between cancer and moderate to light
alcohol consumption.” Moderate drinking, she noted, has been found
to reduce the risk of heart disease, among other benefits. “There
has been a concerted effort by some researchers to reverse that
knowledge,” she said in an earlier conversation. “I think it is
flying in the face of good science.”

Edmon De Haro

Marketing alcohol as a health product should be a tough sell.
Cancer is only one of the many ways it can kill you. Drunk driving,
alcohol poisoning, injuries, domestic violence, liver
disease—alcohol is responsible for the deaths of nearly 90,000 Americans every year, more than double
the estimated 40,000 US opioid deaths in 2015. To overcome this
hurdle, the industry needed to give its PR campaign scientific
backing. The strategy came straight from the tobacco playbook,
which wasn’t a surprise: Sometimes the companies were one and the
same. The tobacco giant Philip Morris, which bought Miller in 1970,
later became Altria, which today has a big stake in Anheuser-Busch.

Big Tobacco had set up research centers to dispute science tying
smoking to lung cancer and funded research designed to show
benefits from smoking, like stress reduction, to help fend off
stricter regulation. The alcohol industry took a similar tack,
aided by research it had been funding since the late 1960s. In a
1993 book called Forward Together: Industry and
Academia, Thomas Turner, the former dean of the Johns
Hopkins University medical school, explained how, starting in 1969,
he had worked with the heads of the world’s biggest beer companies
to create the Alcoholic Beverage Medical Research Foundation (now
called the Foundation for Alcohol Research). The foundation took
academics to exotic destinations for conferences and gave grants to
scientists.

Between 1972 and 1993, Turner bragged, the beer foundation and
its precursor funded more than 500 studies on alcohol and
distributed grants to dozens of researchers and universities. One
was Dr. Arthur Klatsky of Kaiser Permanente. In the early 1970s,
Klatsky had access to extensive data through Kaiser’s health system
that included information about patients’ alcohol intake. In 1974,
he published one of the first papers suggesting that light drinkers
had lower rates of heart disease than abstainers. Soon after, the
beer foundation started funding Klatsky’s data collection at
Kaiser, a relationship that continued for decades. Between 1975 and
1991, according to Turner’s book, the foundation contributed $1.7
million to Klatsky’s research on alcohol and health. The industry
widely promoted his work suggesting health benefits from drinking,
and Klatsky is still quoted regularly in the media, often without
any disclosure of his relationship with the industry.

“You’re looking at industries that are adept at creating doubt when
it comes to protecting their profits,” says one public health
advocate.

Klatsky says industry funding has never compromised the
objectivity of his research. He notes that the first study he did
with beer foundation money showed that drinkers had an elevated
risk of high blood pressure. He also published an early study on
the link between alcohol and breast cancer. “I think that most
people who know me and know my work think I’m unbiased,” he told
me. “I see both sides of the alcohol issue. It’s a double-edged
sword.”

The industry has also funded researchers who cast doubt on
studies that pose problems for it. For example, the Distilled
Spirits Council paid for a 1994 study by Dr. H. Daniel Roth, who
was then helping Philip Morris reach a settlement with lung cancer
victims, that disputed the link between alcohol and breast cancer.
“You’re looking at industries that are adept at creating doubt when
it comes to protecting their profits,” says Robert S. Pezzolesi,
the founding director of the public health group New York Alcohol
Policy Alliance.

In the early 1990s, the beer foundation funded research by
George Koob, who served as a foundation adviser between 1999 and
2003. In 2014, he became director of the National Institute on
Alcohol Abuse and Alcoholism (NIAAA), the only federal agency
devoted exclusively to alcohol research.

Washington’s revolving door sends people in both directions. At
least a half-dozen government officials working on alcohol policy
have left for gigs with the industry over the past 20 years. Among
the most prominent is Dr. Samir Zakhari, the former director of the
Division of Metabolism and Health Effects at the NIAAA. In 2012, the Distilled Spirits Council hired him
to head its science office.

The NIAAA has long recognized that alcohol increases breast
cancer risk, and literature on the Distilled Spirits Council’s
website acknowledged this, too, although it appears to have been
taken down. But in 2015, Zakhari published a scientific journal article
asserting that “there is no solid evidence associating moderate
alcohol consumption with an increased incidence of breast cancer.”
He advised women worried about cancer to consult a doctor because
“moderate alcohol consumption has been associated with potential
health benefits, including decreased risk of coronary artery
disease and overall mortality, protection against congestive heart
failure, decreased risk of ischemic stroke, and protection against
type 2 diabetes and rheumatoid arthritis.” An industry group
recently cited the paper to try to fend off
restrictive government recommendations about alcohol consumption in
the United Kingdom.

Zakhari keeps in touch with his old colleagues at the NIAAA,
according to emails Mother Jones obtained
through a public records request. In 2014, the Baltimore
Sun ran an op-ed by the industry-supported Competitive
Enterprise Institute that complained tax dollars were paying for
“anti-alcohol advocacy” and cited an NIAAA-funded study about
industry marketing to underage drinkers that had been conducted by
David Jernigan, the director of the Johns Hopkins University Center
on Alcohol Marketing and Youth. An email circulated among NIAAA
employees alerting them to the article. Koob, the NIAAA director,
forwarded the email thread to Zakhari and wrote, “Sam: For the
record. This will NOT happen again. I will NOT be funding this kind
of work under my tenure.” Zakhari responded that some researchers
advocated these types of studies “out of shear [sic]
ignorance or because they are sympathetic,” but that he was
confident Koob would “spend research money on real science.”

Zakhari takes issue with the idea that he is emblematic of
Washington’s revolving door and says the 2015 paper “reflects my
personal scientific opinion.” In a statement to Mother
Jones, he said, “I came to the Council, after my retirement
from NIH, because I share their commitment to responsible alcohol
consumption. My dedication to evidence-based research remains the
same regardless of where I am employed.”

My discovery that alcohol
consumption was a risk factor for my breast cancer contradicted
everything I thought I knew about drinking. Like 76 percent of
Americans surveyed by the American Heart Association in 2011, I
believed a little wine was good for the ticker. The fact is,
people want to believe that drinking is good for
them, and the science in this field is easy to manipulate to
convince them.

Scientists have long known that heavy drinking causes high blood
pressure, strokes, and heart attacks. That’s why early studies
investigating drinking and heart disease started with the logical
supposition that people who abstain from alcohol should have low
rates of heart disease compared with moderate or heavy drinkers. As
it turned out, they didn’t. When plotted on a curve, drinkers fell
into a J-shaped pattern: Abstainers in the studies had rates of
cardiovascular disease similar to those of heavy drinkers.

But this J-curve is deceptive. Not all the nondrinkers in these
studies were teetotalers like the ones I grew up with in Utah. The
British epidemiologist A. Gerald Shaper began a wide-ranging men’s
heart health study in the late 1970s, and when he examined the
data, he found that 71
percent of nondrinkers in the study were actually former
drinkers who had quit. Some of these ex-drinking men were as likely
to smoke as heavy drinkers. They had the highest rate of heart
disease of any group and elevated rates of high blood pressure,
peptic ulcers, diabetes, gallbladder disease, and even bronchitis.
Shaper concluded that ex-drinkers were often sicker than heavy
drinkers who hadn’t quit, making them a poor control group.

Yet for decades, researchers continued to include them and
consequently found an implausible number of health benefits to
moderate drinking, including lower rates of deafness and liver
cirrhosis. The industry has helped promote these studies to
doctors.

That’s one reason why, until recently, alcohol’s heart health
benefits have been treated as incontrovertible science. But in the mid-2000s, Kaye Middleton Fillmore,
a researcher at the University of California-San Francisco, decided
to study Shaper’s ex-drinkers. When no one in the United States
would fund her work, she persuaded Tim Stockwell, then the director
of Australia’s National Drug Research Institute, to help her secure
Australian government funding.

Stockwell and Fillmore analyzed decades’ worth of studies on
alcohol and heart disease. Once they excluded studies with
ex-drinkers—which was most of them—the heart benefits of alcohol
largely disappeared. Since then, a host of other studies have found
that drinking does not provide any heart benefits. (Some studies
have found that drinking small amounts of alcohol—sometimes less
than one drink per day—can be beneficial for certain people at risk
of heart disease.) Robert Brewer, who runs an alcohol program at
the Centers for Disease Control and Prevention, says, “Studies do
not support that there are benefits of moderate drinking.” The
Agriculture Department removed language suggesting that alcohol may
lower the risk of heart disease in the most recent US Dietary
Guidelines.

Yet the debate rages on, in part because the industry continues
to fund and promote studies indicating that alcohol helps the
heart. The NIAAA is currently embarking on another one with $100
million in funding, most of which was solicited directly from the
industry, according to the New York Times. The study was planned
in consultation with industry leaders and pitched as a way to prove
that moderate drinking can be healthy. It is being billed as the
most definitive study on moderate drinking to date, but it will
likely understate the risks, partly because it won’t run long
enough to track any increases in cancer rates. At least five
researchers on the project are past recipients of industry
money.

“What is the point of this [pro-alcohol] research?” asks a public
health professor. “Even if it turns out that there are true
benefits, we’re not going to start recommending that people who
have never had alcohol before start drinking.”

Public health experts say that even if there is a small heart
benefit from alcohol, it will never outweigh the risks. Alcohol
“would never be approved as a medicine,” says Jennie Connor, a
preventive- and social-medicine professor at the University of
Otago in New Zealand who wrote one of the landmark papers linking
alcohol to cancer. “It’s addictive, like opioids. If you give
medication to people that could affect their unborn child or make
them aggressive and hit their wife, what kind of medicine is that?
From a public health standpoint, using alcohol for heart disease is
utterly wrong. It goes against everything medical people do.”

“From a pure scientific perspective, what is the point of this
[pro-alcohol] research?” asks Michael Siegel, a professor at the
Boston University School of Public Health. “How is it going to
change policy or practice? It’s not. Even if it turns out that
there are true benefits, we’re not going to start recommending that
people who have never had alcohol before start drinking.”

There are far safer ways than drinking to reduce the risk of
heart disease—walking, for instance—that also won’t give you
cancer. That’s why the American Heart Association strongly warns
people not to start drinking if they don’t already.

I drank my first beer
when I was 13. My dad and I had been out pheasant hunting on a cold
day. After we bagged our birds, we got into the Jeep to warm up,
and my dad handed me a Mickey’s Big Mouth. It was nasty, but I
drank it to prove my worthiness of the adult gesture. When I was
done, he said, “You wanna drive?” That was Utah in the ’80s, at
least if you weren’t Mormon.

Later, I went to a Catholic high school, where we distinguished
ourselves from the future missionaries in the public schools with
excessive drinking. Even in Utah, booze was easy to come by. There
was Doug at Metro Mart, who sold us beer from the drive-thru
window. When he wasn’t around, we stole it from our parents,
siphoning off small amounts of bourbon, rum, gin, and vodka and
then dumping the whole awful mix into a cola-flavored Slurpee and
sucking it down through a straw.

I went off to the University of Oregon, where Animal
House had been filmed 10 years earlier. During my time
there, the university decided to crack down on underage drinking on
campus. Riots broke out, and the local police had to deploy tear
gas.

I’ve never drunk as heavily as I did before I could legally buy
a drink. My experience isn’t unusual. Ninety percent of alcohol
consumption by underage Americans is binge drinking, defined as
four or more drinks on one occasion, according to the CDC. I’ll
never know for sure, but all the drinking I did in my adolescence
may have helped pave the way for the cancer I got at 47.

Human breast tissue doesn’t fully mature until a woman becomes
pregnant. Before then, and particularly during puberty, breast
cells proliferate rapidly, which may make them especially
vulnerable to carcinogens. That’s one reason why never getting
pregnant is itself a risk factor for breast cancer. Scientists have
understood this for nearly 40
years, thanks to studies of women in Nagasaki exposed to
radiation from the atomic bomb. Japanese women who’d been exposed
before age 20 had the highest rates of breast cancer. Other studies
suggest that the risk of premenopausal breast cancer goes up
34 percent for every daily drink consumed before the
age of 30. And the longer women go between their first period and
their first baby, the riskier drinking becomes.

With a first pregnancy at 33, I had a good 20 years of drinking
to damage my breasts, and my adolescent binge drinking may have
been especially devastating. Dr. Graham Colditz, a cancer
prevention specialist and epidemiologist at Washington University
in St. Louis, wrote in the British medical journal Women’s
Health in 2015 that “women who report seven drinks on the
weekend but no alcohol consumption on the weekdays may have higher
risk of breast cancer as compared with those who consistently have
one drink every day.” One study Colditz cited found a nearly 50
percent increase in breast cancer risk among women who consumed 10
to 15 drinks over a typical weekend compared with those who had no
more than three.

Colditz says cancer prevention efforts haven’t kept up with
demographic trends. As women across the globe have delayed
childbearing, he says, “We’ve really extended this period of life
when the breast is most susceptible, and we haven’t mounted a
prevention strategy to counter the marketing of alcohol.”

Liquored Up

US per-capita alcohol consumption, in gallons of ethanol per
year

Source: National Institute on Alcohol Abuse and Alcoholism

In fact, just as the evidence was becoming clear that women are
disproportionately vulnerable to alcohol’s cancer risks, the
industry mounted a campaign to get them to drink even more. “Women
all over the world are underperforming consumers,” explains
Jernigan, the Johns Hopkins researcher who is now a professor at
the Boston University School of Public Health. The distilled
spirits industry, facing flagging sales, created
“alcopops”—sweetened alcoholic beverages such as Zima, Smirnoff
Ice, and Skyy Blue that are packaged in childlike bright colors.
Marlene Coulis, director of new products at Anheuser-Busch,
explained in 2002, “The beauty of this category is that it
brings in new drinkers, people who really don’t like the taste of
beer.”

Just who were those “new drinkers” who didn’t like beer? Federal
data shows the median age for the first consumption of alcohol is
about 14, and Jernigan says the people who don’t like the taste of
beer tend to be young women. The alcopop-makers managed to convince state and federal regulators that the
products were “flavored malt beverages” like beer, even though the
main ingredient was distilled spirits. The designation allowed
companies to sell these products in convenience stores that also
sold beer, at a much lower tax rate than hard liquor required,
making them more accessible to underage drinkers. The liquor
companies then blasted the youth market with ads for the new
products.

The distilled spirits industry had voluntarily given up
advertising on the radio back in 1936 and on TV in 1948 to avoid
regulation by Congress, but it jettisoned those pledges in 1996. Still, TV
liquor ads didn’t fully take off until the advent of alcopops. In
2001, says Jernigan, there were fewer than 2,000 ads for spirits on
cable TV. In 2009, that figure had jumped to more than 60,000, and
many ads targeted TV audiences with large numbers of viewers too
young to drink legally. (In 2012, all the major TV broadcast
networks also abandoned their ban on liquor ads.) In an email
to Mother Jones, Coulis said the idea that alcopops
were intended to appeal to underage drinkers is a “gross
mischaracterization and absolute falsehood.”

“They’re marketing a carcinogen. Can you imagine if Philip Morris
did a pink tobacco pack? People would be up in arms.”

Traditionally, young people in the United States have been beer
drinkers, but in the early 2000s, surveys showed that women were
increasingly turning to harder stuff, and they’ve remained there.
Ads and products now push alcohol as a salve for the highly
stressed American woman. There are wines called Mother’s Little
Helper, Happy Bitch, Mad Housewife, and Relax. Her Spirit vodka
comes with swag emblazoned with girl-power slogans like “Drink
responsibly. Dream recklessly.” Johnnie Walker recently came out
with Jane Walker scotch, to market a liquor “seen as particularly
intimidating by women,” according to the company. (Johnnie Walker is
owned by Diageo, a multinational alcohol conglomerate. One
of Mother Jones‘ board members is also an executive
at Diageo.)

Booze-makers have also “pinkwashed” products targeted at women,
literally draping the ads in pink ribbons, with promises to donate
some proceeds to breast cancer charities. In 2015, Alcohol Justice,
a California-based policy advocacy group, found 17 brands of pinkwashed booze. “They’re
marketing a carcinogen,” says the New York Alcohol Policy
Alliance’s Pezzolesi. “Can you imagine if Philip Morris did a pink
tobacco pack? People would be up in arms.”

The campaigns seem to have worked. An NIAAA study found that
drinking by women jumped 16 percent between 2001 and 2013, more
than twice the increase among men. The change is greatest among
white women, 71 percent of whom drink today, compared with 64
percent in 1997, according to a Washington
Post analysis. The alcohol-related death rate for white
women more than doubled between 1999 and 2015.

The ad is graphic: A
glass of red wine spills onto a white tablecloth and starts to form
the image of a woman. “Alcohol is carcinogenic,” the narrator says.
“Once absorbed into the bloodstream, it travels through the body.
With every drink, the risk of cell mutations in the breast, liver,
bowel, and throat increases. These cell mutations are also known as
cancer.” The wine pools around the woman like blood, and the
narrator advises limiting cancer risk by not having more than two
drinks on any day. The ad campaign aired in 2010 in Western
Australia.

In England in 2013, a public health charity broadcast an ad campaign
featuring a man drinking a beer with a tumor at the bottom of the
glass, which he ultimately swallows as the narrator explains, “The
World Health Organization classifies alcohol as a Group 1
carcinogen. Like tobacco and asbestos, it can cause cancer.”

Other countries have begun to take heed of alcohol’s cancer
risks. For the first time, in 2010, the World Health Organization
issued a global strategy for reducing the harms of alcohol. It
recognized cancer as one of those harms and called on countries to
implement measures to lower consumption. Many have done so. South
Korea has tightened its recommended alcohol limits, and new Dutch
guidelines urge people not to drink at all, but if they do, to
consume no more than one drink a day. In December, Ireland’s upper
house of parliament approved a cancer warning label for alcohol
that is now being debated in the lower house. Even the Russians
raised their alcohol taxes. (Canada recently launched an experiment to test cancer
warning labels on alcohol in the Yukon but stopped the project a
month later amid intense pressure from alcohol companies.)

“If you take 1,000 women, 110 will get breast cancer without
drinking,” said England’s chief medical officer. “Drink up to these
guidelines and an extra 20 women will get cancer because of that
drinking.”

In 2016, Britain reduced its recommended alcohol
consumption limit for men to the same level as for women, about six
pints of beer a week. Sally Davies, the chief medical officer for
England, told the BBC, “If you take 1,000 women, 110
will get breast cancer without drinking. Drink up to these
guidelines and an extra 20 women will get cancer because of that
drinking. Double the guideline limit and an extra 50 women per
1,000 will get cancer…That’s not scaremongering. That’s fact.”

It’s not the kind of straight talk you’re likely to hear in the
United States, where the industry is fighting to prevent cancer
fears from hurting its bottom line. In spring 2016, the American
Beverage Institute’s Longwell told a brewers’ conference that
public health officials “want to tell you that alcohol causes
cancer,” according to the Wall Street Journal. Such
public health activism, she suggested, was a threat to the
industry’s “health halo.” At another 2016 conference, Jim McGreevy, president of the
Beer Institute, an industry lobbying group, said of public health
advocates, “We can’t let them gain traction.” He did not respond to
a request for comment.

Pinkwashing

Alcohol companies have tried to persuade consumers they can
help fight breast cancer by purchasing “pinkwashed” products that
benefit cancer charities, obscuring alcohol’s proven breast cancer
risk.

For more than a decade, the alcohol industry has bulldozed
long-standing public health regulations designed to reduce harmful
consumption. It has mounted successful campaigns to allow the sale
of liquor in supermarkets and on Sundays and to loosen restrictions
on the hours liquor can be served in restaurants and bars. Not
surprisingly, alcohol consumption per capita in the United States,
which hit a 34-year low in 1997, has shot up to levels not seen in
two decades.

Alcohol companies are enormous multinational corporations. AB
InBev controls nearly 50 percent of the US beer market, including
the all-American brand Budweiser. Jernigan analyzed Nielsen data
and estimated that the industry spent $2.1 billion on advertising
in 2016, a figure that doesn’t include online ads or those in
stores. It also spent $30.5 million last year to lobby Congress. The
Distilled Spirits Council, which alone spent $5.6 million on
federal lobbying last year, holds whiskey tastings on Capitol Hill
attended by Democrats and Republicans alike. “Alcohol is the drug
of choice of the people who make the laws,” observes Jernigan.

While other countries are considering World Health Organization
recommendations to impose steeper alcohol taxes, the tax law
President Donald Trump signed in December further slashed US
alcohol excise taxes, which, thanks to inflation, were already down
as much as 80 percent since the 1950s.

Under the Influence

Alcohol industry spending on lobbying

Source: OpenSecrets

Koob, the NIAAA director, has attended events at the Distilled
Spirits Council and met with its representatives, according to
documents obtained through a public records request. He gets
holiday party invites from the Beer Institute and meets with its
CEO. In 2015, Koob and the NIAAA’s director of global alcohol
research appeared in a promotional video for AB InBev’s “global smart drinking goals,” filmed at an AB
InBev Global Advisory Council meeting.

“We went through the normal procedures here at NIH for approval,
and we were given approval to do it,” says Koob. “Under no
circumstances are we promoting alcohol beverages or any product.
That’s not our nature. But if people want to help prevent alcohol
misuse, we’re all for it.”

Boston University’s Siegel counters, “The whole idea [behind the
campaign] is that if you drink properly, not to excess, it’s okay.
That’s not true. If you drink moderately, you’re increasing your
risk of cancer, and that’s the part of it they don’t want people to
know.”

After I had surgery to
remove my tumor, my oncologist sent me to see the cancer dietitian
last June. The dietitian outlined a joyless regimen so complex it
required a spreadsheet for compliance. Along with more fish and
flaxseed, she recommended five weekly servings of cruciferous
vegetables like broccoli, as well as loads of beans for additional
fiber. She put the kibosh on bacon and sausage—processed meats are
considered carcinogenic. She instructed me to eat natural soy like
tofu at least three times a week but not processed soy like that
found in garden burgers because it can boost cancer-causing
estrogen levels. And she sternly admonished me to lay off the cream
in my coffee.

Not once did the subject of alcohol come up. “There’s more data
for counseling you to decrease alcohol than to eat broccoli or
tofu,” says Noelle K. LoConte, an oncologist and associate
professor at the University of Wisconsin. But she says the message
about alcohol and cancer hasn’t gotten out, even to cancer doctors,
which may be one reason not a single one of my doctors raised the
issue with me before or after I was diagnosed.

To address this problem, in November LoConte co-authored a statement from the
American Society of Clinical Oncology that officially declared
alcohol a cancer risk. (The society also commissioned a poll, which
found that 70 percent of Americans had no idea alcohol can cause
cancer.) In its statement, the group called for policy measures to
reduce alcohol consumption and prevent cancer, the same ones
recommended by the US surgeon general, the federal Community
Preventive Health Task Force, and the World Health Organization.
They’re similar to strategies that brought down smoking rates:
higher excise taxes, limits on the number of outlets selling
alcohol in a particular area, stricter enforcement of underage
drinking laws, and caps on the numbers of days and hours when
alcohol can be sold.

There’s a huge body of research supporting the effectiveness of
these policies, yet there is not a single public health group in
Washington lobbying for any of them. The few groups that once
battled with the alcohol industry have abandoned the effort in
recent years. The American Medical Association, which used to focus
on alcohol-related harm and campus binge drinking, stopped working
on alcohol policy in 2005. The Ralph Nader-linked Center for
Science in the Public Interest stopped during a budget crunch in
2009. That same year, the Robert Wood Johnson Foundation, which for
decades had been one of the biggest funders of efforts to reduce
underage drinking, largely pulled out of the field.

“It’s astounding that one of the leading causes of premature
death and illness is ignored by almost every foundation that works
in the health area,” says Richard Yoast, who ran the AMA’s alcohol
programs until they ended in 2005.

Pop Culture

In the early 2000s, the alcohol industry sought to attract new
drinkers—often young and female—with “alcopops,” sweetened drinks
in bright childlike colors. The industry has also tried to brand
alcohol as healthy with ads featuring athletes.

Government funding for alcohol harm reduction has also dried up.
In 2009, the Justice Department budget for grants to states to
enforce underage drinking laws was $25 million. By 2015, it was
zero. At the request of the Obama White House,
Congress also eliminated an Education Department program that
combated underage drinking, among other initiatives.

Without independent funding for public health work on alcohol
policy, the industry has filled the void, creating nonprofits to
promote “responsible” drinking. Industry groups have used these to
respond to the news about alcohol and cancer. When I asked the Beer
Institute to comment for this story, a spokesman sent me a link to
a report from the International Alliance for
Responsible Drinking, a nonprofit funded by the world’s largest
alcohol companies, and quoted one line from the report: “The most
clear association of cancer risk is with heavy drinking,
particularly regular heavy drinking over extended periods of
time.”

“The female consumer is seen as part of the alcohol market that
needs to be marketed to more. The female drinker is the last person
you want to be a fully informed consumer.”

Mark Petticrew, a professor of public health at the London
School of Hygiene and Tropical Medicine, recently published a study
finding that many alcohol industry websites and nonprofits have
actively misled the public about the link between alcohol and
cancer. They suggest that only problem drinkers have an elevated
risk of cancer and present long lists of other risk factors to
confuse readers, particularly when it comes to breast cancer.
“Female consumers are more health conscious than male consumers,”
Petticrew explains. “The female consumer is seen as part of the
alcohol market that needs to be marketed to more. The female
drinker is the last person you want to be a fully informed
consumer.”

Over the past 30 years, breast cancer survivors have become a
powerful political force in their own right, raising millions of
dollars for research and education. But wine tastings are a staple
of breast cancer fundraising events. The Lombardi Comprehensive
Cancer Center at Georgetown University has been holding a “women and wine” fundraiser annually for breast
cancer research for more than a decade. “Brews for Breast Cancer”
events have proliferated. In October, the American Cancer Society
threw its 40th annual Wine and Spirits Industry Gala in New York
City “to support the Society’s mission of eliminating cancer
as a major health problem.”

In response to questions from Mother Jones, Dr.
Richard Wender, the chief cancer control officer for the American
Cancer Society, says alcohol is much less risky than tobacco. “Our
goal is to find the right balance that allows companies to engage
with us, while staying true to our values and our public health
mission,” he says.

The more I looked into the conflicts of interest among those
responsible for informing the public of alcohol’s health risks, the
more I began to recognize my own industry’s entanglement. The
press, which starting with Morley Safer has flooded readers with
stories declaring that drinking is good for your health, has
repeatedly accepted alcohol companies’ largesse. In 2016,
the Wall Street Journal sponsored a party with the Distilled Spirits
Council at the Republican National Convention. In April 2017, the
council and the Beer Institute helped pay for a “Toast to the First
Amendment” party with RealClearPolitics.

In 2016, the president of the Distilled Spirits Council, Kraig
Naasz, wrote in an email newsletter that the group had recently
treated writers from a wide range of publications to cocktails at a
New York bar during a lunch briefing on alcohol and health. On hand
to chat up the journalists was Zakhari, the former NIAAA scientist.
“The presenters underscored that moderate alcohol consumption can
be incorporated into a healthy adult diet,” Naasz reported.

The Foundation for Advancing Alcohol Responsibility, funded by
companies such as Bacardi and Diageo, paid for journalists to
attend workshops last year held by the Poynter Institute, the
self-appointed watchdog of journalism ethics. “The conflict of
interest is so big it makes me gasp,” New York University
nutritionist Marion Nestle told Health News Review when it broke
the story on Poynter. “The alcohol industry wants journalists to
extol the (purported) health benefits of drinking alcohol and to
minimize the risks.”

Kelly McBride, Poynter’s vice president, says the foundation’s
involvement did not affect the content of the workshops and the
institute may collaborate with the foundation again. “They are a
non-profit foundation that promotes responsible consumption of
alcohol,” she said in an email. “They funded workshops where we
taught journalists to apply the skills of fact-checking to
scientific research. That seems like a consistent overlap of
purpose.”

Susan Sontag once wrote
that telling people about your cancer diagnosis tends to fill them
with mortal dread. But when I’ve disclosed my illness to friends
and told them that alcohol can cause breast cancer, I’ve never
invoked enough mortal dread to deter anyone from ordering a second
drink. Most women have no idea drinking causes breast cancer, and
they really don’t want to be told that it does.

Marisa Weiss, a breast oncologist and the founder of
BreastCancer.org, gives talks on college campuses, where she
explains to young women the cancer risks they face from drinking.
“I see the same people get completely trashed that night,” she
laments. But she understands why. “It’s because life is a bitch,”
she says. “We work long hours, and alcohol becomes like
self-medication. It’s relaxing. It’s fun.”

I get it. But you know what’s not fun? Watching your 10-year-old
daughter keen and hyperventilate after you tell her you have
cancer. Or having six-inch needles full of radioactive dye plunged
repeatedly through your nipple, without anesthesia, so a surgeon
can see if the cancer has spread to your lymph nodes. Or leaving
work early while awaiting biopsy results because your hands are
shaking so badly you can’t type. Cancer isn’t fun, in ways far
beyond the obvious. And in relative terms, I’ve had it easy so far.
I’m still alive.

A few months ago, I plugged my data into the National Cancer
Institute’s breast cancer risk calculator to see what my odds had
been before I discovered my tumor. The bare-bones assessment showed
I had a 1.1 percent risk of getting breast cancer in the next five
years. The calculator doesn’t account for my alcohol consumption
(or the protective effects of exercise and breastfeeding), but the
experts I’ve spoken with say booze probably bumped up my risk.

I’ll never know for certain whether alcohol caused my cancer.
There are so many factors: Just in December, a Danish study found that being on
birth control raises the risk of breast cancer more than previously
thought. What I do know is that cutting back on drinking,
particularly when I was young, is virtually the only thing I could
have changed about my lifestyle to try to prevent this cancer if
I’d been fully informed. Now I’ve mostly given up alcohol to hedge
my bets against a recurrence. I can’t be sure I would have done the
same thing if someone had told me when I was 15 or 20 that drinking
could give me breast cancer. I’d like to think so—I never
smoked—but there’s no guarantee I wouldn’t have been just like the
students Weiss talks to. At least they have a choice—they’ve been
told the risk they’re taking. Like most women, I didn’t have that
choice, and a powerful industry worked to keep it that way.

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