Alcoholic drinks should carry a warning about cancer risks on their label, the US Surgeon General said on Friday in a move that could signal a shift towards more aggressive tobacco-style regulation for the sector if adopted.

US Surgeon General Vivek Murthy said alcohol consumption increases the risk of at least seven types of cancer, including breast, colon and liver cancer, but most US consumers remain unaware of this.

Murthy also called for the guidelines on alcohol consumption limits to be reassessed so that people can weigh the cancer risk when deciding whether or how much to drink. US dietary guidelines currently recommend two or fewer drinks per day for men and one drink or less per day for women.

“Alcohol consumption is the third leading preventable cause of cancer in the United States, after tobacco and obesity,” Murthy’s office said in a statement accompanying the new report, adding the type of alcohol consumed does not matter.

His advisory sent shares in alcohol companies including Diageo, Pernod Ricard, Anheuser-Busch InBev, and Heineken down, in some cases over 3%.

Alcohol producers and industry associations, did not immediately share comments.

It is unclear when or if the Surgeon General’s suggestions will be adopted. US President Joe Biden’s administration is entering its final two weeks. Murthy could be succeeded by Janette Nesheiwat, a director of a New York chain of urgent care clinics and president-elect Donald Trump’s pick for the role.

Trump, whose brother died from alcoholism and who does not drink himself, has long warned about the risks of drinking. Robert F Kennedy Jr., Trump’s nominee for Secretary of Health and Human Services, has been open about his past struggles with heroin and alcohol, and says that he attends Alcoholics Anonymous meetings.

The decision to update the label will ultimately be made by Congress.

Small print

Murthy’s advisory harks back to early US Surgeon General action on tobacco, starting with a 1964 report that concluded smoking could cause cancer. The report kicked off decades of increasingly strict regulations, starting with US laws on warning labels one year later and still ongoing today.

Alcoholic drinks in the US already carry warnings on their packaging, including that drinking alcohol while pregnant can cause birth defects and that it can impair judgment when operating machinery. These appear in small print on the back of the packaging. This label has not changed since its inception in 1988.

Murthy’s recommendations call for an update to these existing labels, rather than new cigarette-style warnings that are today displayed prominently on the front of every packet.

Analysts however pointed out that cigarette warning labels did little to curb smoking and ingrained habits are hard to change.

“Warning labels won’t be an immediate deathblow to alcohol makers, but it will compound the long-term threats to the industry,” said Blake Droesch, analyst with eMarketer.

In the US, among the largest markets for many western producers, alcohol sales have been falling following a post-pandemic boom. Revenues are now further threatened by looming tariffs.

Longer term, companies face growing competition from alternatives like cannabis and the threat of lower volumes as some consumers, especially younger ones, drink less than previous generations in some markets.

Beer makers especially have, however, enjoyed benefits from a shift towards healthier lifestyles, with low- or no-alcohol products enjoying rapid growth. Heineken’s 0.0 version, for example, grew double digits in 16 markets last year.

‘Save lives’

Public health bodies like the World Health Organization (WHO) are also increasingly turning their attention towards alcohol after making progress on stronger tobacco controls.

The WHO says there is no safe level of drinking and that even a small amount of alcohol can harm health - a position that has prompted tense debate around the impact of moderate drinking and its role in society.

The current US dietary guidelines run until 2025, and companies including Diageo and Heineken have lobbied officials ahead of the change, lobbying records show, amid concerns the U.S. could adopt the WHO’s language around safe consumption.

Other countries’ guidelines already include such language, while nations like Ireland have already moved to introduce warning labels.

Industry associations like the Distilled Spirits Council of the United States (DISCUS), which represents top spirits makers, point to research showing that moderate alcohol consumption can have some health benefits, though it adds no one should choose to drink for this reason and even moderate drinking may pose risks for some.

Some scientists accused the industry of misleading people about the risks of developing cancer from drinking in a 2017 study. DISCUS said the researchers had anti-alcohol biases and their study was selective.

Bruce Scott, president of the American Medical Association, welcomed the Surgeon General’s effort to make the link between alcohol and increased cancer risk clear. He said, coupled with a push to update warning labels, it could “bolster awareness, improve health and save lives.”

The Surgeon General’s advisory said alcohol is responsible for 100,000 US cancer cases and 20,000 cancer deaths each year, more than the 13,500 alcohol-associated traffic crash deaths.