Graphic Labels About Alcohol Cancer Risk in Canada

Kristin Jenkins

November 27, 2017

Large, graphic labels warning about the health risks of drinking alcohol, including the link between alcohol and breast and colon cancers, have been introduced in the Yukon, Canada.

For the next 8 months, all containers of alcohol purchased at the sole liquor store in the city of Whitehorse ― which account for 65% of total alcohol sales in the northern territory ― will carry a variety of labels. They feature a bright yellow background and red borders, similar to those seen on cigarette packages.

 

These labels about cancer risk on bottles of alcoholic drinks are a first for Canada, and indeed, they may be the first such labels anywhere in the world.

They appeared in the Whitehorse liquor store on November 22 as part of an ongoing Health Canada research project. They represent the intervention phase of the multiyear Northern Territories Alcohol study.

 

Researchers predict that the results will have international implications for public health policy makers by helping to identify the most effective harm reduction strategies for consumers of wine, beer, and spirits.

"This study presents a unique opportunity to study the value of health advisory labels on alcoholic beverages," Brendan Hanley, MD, the Yukon's chief medical officer of health, told Medscape Medical News. "If results demonstrate an effect on consumer behavior, there is potential for some important policy changes, not just locally but nationally and internationally, to address responsible alcohol consumption."

Rates of alcohol consumption, particularly by youth, are high in the Yukon compared with the rest of Canada, as are alcohol-related cancer rates in both men and women, Dr Hanley noted.

"We commend the Yukon Liquor Corporation for having the courage to be the first jurisdiction in Canada to provide more detailed labels for its residents," Tim Stockwell, PhD, one of the project's coinvestigators, said in a statement.

Dr Stockwell is director of the Canadian Institute for Substance Use Research (CISUR) at the University of Victoria in British Columbia. As previously reported by Medscape Medical News, he recommends that prominent health messages be placed on all alcohol containers and that they include information on the multiple health risks associated with even moderate alcohol use.

There has been an increase in publicity in recent years regarding the increased risk for cancer associated with alcohol. The American Society of Clinical Oncology highlighted this risk only a few weeks ago.

The new labels in the Yukon will also carry messaging based on Canada's low-risk drinking guidelines, which were published in 2011. The guidelines were developed by the Canadian Center for Substance Abuse. As per the guidelines, the labels advise that women drink no more than two standard drinks per day and that men drink no more than three. They also encourage consumers to plan 2 or more nondrinking days each week.

More Labels Planned

In January 2018, a third label will be rolled out that graphically illustrates a "standard" drink: 5 ounces of wine with an alcohol content of 12%; 11.5 ounces of beer with an alcohol content of 5%; and 1.5 ounces of spirits with an alcohol content of 40% by volume.

The labels will appear on bottles and cans of alcohol in a rotating sequence to avoid consumer messaging fatigue, said lead scientist Erin Hobin, PhD, of Public Health Ontario in Toronto. She noted that 65% of total alcohol sales in the Yukon go through the Whitehorse liquor store.

"The demographics of our northern territories skew younger males," she explained in an interview. "Not only does the Yukon have the highest alcohol sales per capita in the country, it also has a relatively high prevalence of cancer when compared to the rest of Canada. We are interested in finding out to what extent these labels support safer alcohol consumption and get people to rethink their drinking."

Prior to the intervention phase of the trial, Dr Hobin and colleagues from the CISUR spent more than 2 years traveling to the Yukon to conduct focus groups. Results showed that 66% of consumers and others strongly supported the use of labels. They were also more likely to correctly estimate how much they were drinking when presented with labels containing guideline information on standard drinks and low-risk drinking. Accuracy increased from 12.6% to 58.9% across different beverage types.

"Stakeholders in the health and alcohol sectors as well as the general public gave us a resounding 'yes' when we asked if they wanted more health information on alcohol containers," Dr Hobin told Medscape Medical News. "They wanted more information about the health risks on the labels, and they wanted new information, including how alcohol is linked to various types of cancer. Consumers also wanted tools to better support how to track and monitor their alcohol consumption."

Small, 1-inch square warning labels about the risks of consuming alcohol while pregnant have been displayed on liquor sold in the Yukon since 1991. However, the effectiveness of these labels has never been assessed, noted Dr Hobin.

The new labels, which reflect what consumers said they wanted to know, were developed in partnership with David Hammond, PhD, from the University of Waterloo, in Ontario, Canada. Dr Hammond has been an advisor to the World Health Organization and other governmental and regulatory agencies on tobacco control policy, including the development of warning labels on cigarette packaging.

To assess the labels' effectiveness at changing drinking behavior, the researchers will survey liquor store customers in the spring of 2018 and compare their findings to prelabel survey data from May 2017.

"We'll also be looking at sales data to see if sales of alcohol overall, as well as different types of alcohol, shift before and after the labels," said Dr Hobin. Survey and sales data from the Yukon will also be compared with similar data from the Northwest Territories where the labels are not being used.

Repeated exposure to the labels may reinforce the alcohol-cancer connection, "which is something that not everyone knows," pointed out Dr Hanley. He recommended that health warnings about alcohol be studied following the 2015 Health Status Report on rates of substance abuse in the Yukon.

The Yukon also has relatively high rates of alcohol-related violence compared to the rest of Canada, Dr Hanley said. He noted that reduced alcohol consumption could lower the risk for other alcohol-related outcomes. These include impaired driving, injury due to cold exposure and falls, chronic disease, dementia, liver disease, cirrhosis, and other cancers and health problems.

"The question is, can the use of labeling, in combination perhaps with other deliberate policies, shift the attitudes and habits of our population? Can we move the curve from risker drinking patterns to healthier ones?" Dr Hanley pondered.

It is likely that health labels on alcohol containers "will be most effective when combined with a range of other measures that encourage safer use of alcohol," Dr Hanley said. These include high taxes and "continued strong government oversight on control and distribution of alcohol."

Funding for the study was provided by Health Canada, the Canadian Center on Substance Use and Addiction, and Public Health Ontario. The investigators have disclosed no relevant financial relationships.

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