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High Demand for Drug to Prevent Covid in the Vulnerable, Yet Doses Go Unused

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High Demand for Drug to Prevent Covid in the Vulnerable, Yet Doses Go Unused

Sasha Mallett, Sue Taylor and Kimberly Cooley all have immune deficiencies that make them particularly susceptible to Covid-19, and all have tried to get the identical factor: a brand new therapy that may forestall the illness in individuals who both can’t produce antibodies after receiving a coronavirus vaccine or can’t get vaccinated in any respect.

Ms. Cooley, a liver transplant recipient in Duck Hill, Miss., obtained the antibody drug, known as Evusheld, from her transplant crew on the College of Mississippi Medical Heart with no hassle. However Ms. Taylor, of Cincinnati, was denied the therapy by two hospitals close to her house. And Dr. Mallett, a doctor in Portland, Ore., needed to drive 5 hours to a hospital prepared to present her a dose.

As a lot of the nation unmasks amid plummeting caseloads and contemporary hope that the pandemic is fading, the Biden administration has insisted it should proceed defending the greater than seven million Individuals with weakened immune methods who stay susceptible to Covid. Evusheld, which was developed by AstraZeneca with monetary assist from the federal authorities, is crucial to its technique.

However there may be a lot confusion in regards to the drug amongst well being care suppliers that roughly 80 p.c of the accessible doses are sitting unused in warehouses and on pharmacy and hospital cabinets — whilst sufferers like Ms. Taylor, 67, and Dr. Mallett, 38, go to nice lengths, usually with out success, to get them.

As a result of they’ve a weakened response to the coronavirus vaccine and should not be capable to battle off Covid-19, many immunocompromised folks have continued to isolate themselves at house and really feel left behind because the nation reopens. Evusheld, which is run in two consecutive injections, seems to supply long-lasting safety — maybe for half a 12 months — giving it appreciable enchantment for this group.

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For now, although, the drug is in brief provide. As a result of it’s approved just for emergency use, it’s being distributed by the federal authorities. The Biden administration has bought 1.7 million doses — sufficient to completely deal with 850,000 folks — and had almost 650,000 doses prepared for distribution to the states as of this previous week, based on a senior federal well being official. However solely about 370,000 doses have been ordered by the states, and fewer than 1 / 4 of these have been used.

“There’s so many different people who find themselves scrapping and driving for hours to get Evusheld,” Ms. Cooley, 40, mentioned, “when in Mississippi it’s sitting on the cabinets.”

Interviews with medical doctors, sufferers and authorities officers counsel the explanations the drug goes unused are assorted. Some sufferers and medical doctors have no idea Evusheld exists. Some have no idea the place to get it. Authorities pointers on who ought to be prioritized for the drug are scant. In some hospitals and medical facilities, provides are being reserved for sufferers on the highest threat, reminiscent of latest transplant recipients and most cancers sufferers, whereas doses in different areas of the nation are being given out by means of a lottery or on a first-come, first-served foundation.

Hesitance can be a difficulty. Some medical doctors and different suppliers have no idea learn how to use Evusheld and are thus loath to prescribe it. The truth that it’s an antibody therapy will be complicated, as a result of most such remedies are used after somebody will get Covid quite than for preventive care.

Including to the confusion are revised Meals and Drug Administration pointers for Evusheld, launched final month, that known as for doubling the preliminary really useful dose after information confirmed the drug could also be much less efficient towards sure variants.

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“It’s overwhelming and it’s all new,” mentioned Dr. Mitchell H. Grayson, chief of the allergy and immunology division at Nationwide Kids’s Hospital in Columbus, Ohio. “Suppliers are undoubtedly making an attempt to maintain up, it’s simply — I don’t understand how properly everybody’s doing with that.”

Roughly 3 p.c of Individuals are characterised by well being professionals as immunocompromised as a result of they’ve a illness that weakens their physique’s immune response or are receiving a therapy that does so. They embrace transplant recipients and folks with circumstances like most cancers, lupus and rheumatoid arthritis.

Evusheld’s arrival in December instantly set off a scramble. In Fb teams and on-line messages, sufferers and their family members started swapping details about learn how to get it. Authorities information units about Evusheld’s availability have been so advanced and complicated {that a} software program developer within the Seattle space, Rob Relyea, developed his personal mapping instrument that tracks how a lot of the drug is accessible and which suppliers have it.

“Individuals ought to know the place to go to get in line,” he mentioned.

Mr. Relyea, 51, had a vested curiosity: His spouse, Rebecca, is in remission from most cancers. They tried 10 hospitals unsuccessfully however then obtained the drug by means of luck, as Ms. Relyea’s identify was picked in a lottery for Evusheld at a hospital close to their house in early February, he mentioned.

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However they haven’t heard something but about scheduling a second dose, which Ms. Relyea wants primarily based on the brand new suggestions.

Dr. Mallett, in Oregon, was one in all many who have been determined to get the drug. She has frequent variable immunodeficiency, a situation that retains her immune system from making sufficient antibodies. Her son began attending kindergarten in individual final fall, and when the Omicron variant surged, his instructor and classmates started testing constructive for Covid.

To seek out Evusheld, Dr. Mallett scoured a web based authorities database of shipments and spent weeks cold-calling hospitals, pharmacies and well being organizations that acquired the drug.

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When she lastly discovered a hospital in La Grande, Ore., prepared to present her a dose, she labored together with her doctor to enroll as a affected person there. Then she dropped the whole lot and drove to the hospital within the rain, acquired the pictures and instantly turned again — an 11-hour journey in whole.

Dr. Mallett is extremely educated, medically savvy, rich and simply capable of take time away from her job — privileges that helped her get a dose, however that many others don’t have.

“I undoubtedly have lots of lingering moral qualms about how I went about getting this remedy,” she mentioned. “Did I make the most of our damaged system?”

Most of the well being staff Dr. Mallett known as whereas she was looking for a dose had not even heard of Evusheld — even when their workplaces had the drug in inventory.

Some consultants argue that Evusheld ought to go first to individuals who can’t get vaccinated due to extreme allergic reactions and to those that produce the fewest antibodies in response to coronavirus vaccines. However antibodies are just one part of the immune system, and the Facilities for Illness Management and Prevention nonetheless recommends towards utilizing exams that decide antibody ranges to evaluate somebody’s immunity.

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“The most important drawback is that there’s completely no steering or prioritization or any rollout in place in any respect, and it’s been a large number,” mentioned Dr. Dorry Segev, a transplant surgeon at N.Y.U. Langone Well being who has been finding out coronavirus vaccines in transplant sufferers. “With out formal pointers, you actually can’t do something.”

The Biden administration is making an attempt to handle the confusion. Prime federal well being officers have been working to lift consciousness amongst state well being officers, suppliers and sufferers. They convened a name this previous week with advocates for the disabled to debate the revised dosing steering; in addition they urged affected person teams to companion with the administration on outreach and schooling efforts.

“I really feel actually strongly that this remedy has nice potential to assist the immune suppressed who don’t all the time reply to vaccinations,” mentioned Dr. Rachel Levine, the assistant secretary for well being within the Division of Well being and Human Companies, who spoke on the decision. However Dr. Levine mentioned she didn’t anticipate that the C.D.C.’s steering on antibody exams would change.

Sufferers who can’t be vaccinated are apparent candidates for Evusheld. However among the many vaccinated, Dr. Segev and different consultants say, the calculations turn into far murkier — and might contain assessments of different underlying circumstances or threat elements.

For sufferers who handle to get Evusheld, consultants say it’s nonetheless unclear precisely how a lot safety the remedy provides. It’s tough to gauge the affect of the drug in defending immunocompromised sufferers, as a result of many recruited for research have been avoiding dangerous behaviors and it will have been unethical to ask them to not. Researchers could not know the precise effectiveness of the drug for a lot of months.

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Evusheld was discovered to supply safety akin to vaccines in a medical trial, however the variety of members who have been immunocompromised was by no means disclosed. Including to the uncertainty, AstraZeneca studied the drug earlier than Omicron surfaced. Analysis over the previous few months exhibits that Evusheld protects towards the variant, however it’s unclear to what diploma.

The shortage of strong data has annoyed Ms. Cooley, the liver transplant recipient in Mississippi. She continues to be taking the identical precautions as she did earlier than receiving Evusheld, reminiscent of getting groceries delivered, staying at house and seeing just a few trusted relations with masks on. That’s as a result of she cares for her aged mom and has seen numerous different aged folks, together with her grandmother, die from Covid-19 in her neighborhood, the place many individuals have chosen to not get vaccinated.

Some who can’t discover a dose of Evusheld have turned to on-line communities as an alternative of well being care organizations. They’re in search of assist from different immunocompromised folks, reminiscent of Dr. Vivian G. Cheung, 54, a doctor in Bethesda, Md., who has a genetic situation that impacts her immune system.

Dr. Cheung obtained a dose in January after calling numerous medical establishments for 2 weeks, and he or she has been serving to others navigate the method since then. She receives as much as 10 requests for assist daily, however she estimates that solely 1 / 4 of those that have reached out have succeeded in getting Evusheld.

Ms. Taylor, the girl in Cincinnati, has frequent variable immunodeficiency. However proper now, one hospital close to her is limiting its provide of Evusheld to its transplant sufferers, whereas one other just isn’t but accepting sufferers from outdoors its system. She is unable to look elsewhere; she mentioned she was uncomfortable driving lengthy distances due to her underlying well being circumstances.

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Ms. Taylor mentioned that she didn’t wish to take a dose away from somebody who may want it extra, however that she would really feel much less “panic-stricken” if she might get Evusheld. She may be capable to begin seeing her youngsters indoors once more and inch again to the life she had earlier than Covid.

For now, she is in a holding sample of isolating, masking and hoping a dose will turn into accessible quickly.

Rebecca Robbins contributed reporting.

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After Fierce Lobbying, Treasury Sets Rules for Billions in Hydrogen Subsidies

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After Fierce Lobbying, Treasury Sets Rules for Billions in Hydrogen Subsidies

The Biden administration on Friday made final its long-awaited plan to offer billions of dollars in tax credits to companies that make hydrogen, in the hopes of building up a new industry that might help fight climate change.

When burned, hydrogen mainly emits water vapor, and it could be used instead of fossil fuels to make steel or fertilizer or to power large trucks or ships.

But whether or not hydrogen is good for the climate depends on how it is made. Today, most hydrogen is produced from natural gas in a process that emits a lot of planet-warming carbon dioxide. The Biden administration wants to encourage companies to make so-called clean hydrogen by using wind, solar or other low-emission sources of electricity.

In 2022, Congress approved a lucrative tax credit for companies that make clean hydrogen. But the Treasury Department needed to issue rules to clarify what, exactly, companies had to do to claim that credit. The agency released proposed guidance in 2023 but many businesses have been waiting for the final rules before making investments.

The final guidelines that were released Friday followed months of intense lobbying from lawmakers, industry representatives and environmental groups and roughly 30,000 public comments. They include changes that make it somewhat easier for hydrogen producers to claim the tax credits, which could total tens of billions of dollars over the next decade.

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“Clean hydrogen can play a critical role decarbonizing multiple sectors across our economy, from industry to transportation, from energy storage to much more,” said David Turk, the deputy secretary of energy. “The final rules announced today set us on a path to accelerate deployment.”

Initially, Treasury had imposed strict conditions on hydrogen subsidies: Companies could claim the tax credit if they used low-carbon electricity from newly built sources like wind or solar power to run a machine called an electrolyzer that can split water into hydrogen and oxygen. Starting in 2028, those electrolyzers would have to run during the same hours that the wind or solar farms were operating.

Without those conditions, researchers had warned, electrolyzers might draw vast amounts of power from existing electric grids and drive a spike in greenhouse gas emissions if coal- or gas-fired power plants had to run more often to meet the demand.

Yet many industry groups and lawmakers in Congress complained that the proposed rules were so stringent, they could throttle America’s nascent hydrogen industry before it even got going.

Among the concerns: The technology to match hydrogen production with hourly fluctuations in wind and solar power is still in its infancy. Owners of nuclear reactors also said that they had been left out.

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So the final rules contain several significant tweaks:

  • Hydrogen producers will get two extra years — until 2030 — before they are required to buy clean electricity on an hourly basis to match their output. Until then, they can use a looser annual standard and still claim the tax credit.

  • In certain states that require utilities to use more low-carbon electricity each year, hydrogen producers will now have an easier time claiming the credit, on the theory that those laws will prevent a spike in emissions. For now, Treasury said, only California and Washington meet this criterion, but other states could qualify in the future.

  • Under certain conditions, companies that own nuclear reactors that are set to be retired for economic reasons can now claim the credit to produce hydrogen if it would help the plants stay open. Existing reactors that are profitable would not be able to claim the credit.

  • The final rules also lay out criteria under which companies could use methane gas from landfills, farms or coal mines to produce hydrogen — if, for instance, the methane would have otherwise been emitted into the atmosphere.

The guidelines “incorporate helpful feedback from companies planning investments,” said Wally Adeyemo, the deputy Treasury secretary.

Some hydrogen producers said that many, though not all, of their biggest concerns had been addressed in the final guidance, which runs nearly 400 pages.

“There’s a degree of relief that the rules are, on balance, an improvement from the original draft,” said Frank Wolak, chief executive of the Fuel Cell and Hydrogen Energy Association, a trade group. “But there’s a lot in the details that needs to be evaluated.”

The lack of clear guidance had been holding up investment, said Jacob Susman, chief executive of Ambient Fuels, a clean hydrogen developer that is planning roughly $3 billion in projects across the United States. “Now that we actually have something solid, we can get down to the business of building,” he said.

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Environmentalists said that most of the safeguards in the original proposal to prevent emissions from surging had been kept in place.

“The extra flexibilities granted to the green hydrogen industry are not perfect from a climate perspective,” said Erik Kamrath at the Natural Resources Defense Council. “But the rule maintains key protections that minimize dangerous air and climate pollution from electrolytic hydrogen production.”

The Energy Department estimates that the use of cleaner forms of hydrogen could grow to 10 million tons per year by 2030, up from virtually nothing today.

But political uncertainty looms. A new Congress could repeal the tax credits, although hydrogen generally enjoys support from both Democrats and Republicans and a number of oil and gas companies have invested in hydrogen technologies. The Trump administration could also revise the rules around the credits, although that could take years.

Economics are another hurdle. Producing cleaner hydrogen still costs $3 to $11 per kilogram, according to data from BloombergNEF. By contrast, it costs about $1 to $2 per kilogram to make hydrogen from natural gas.

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The new tax credit will be worth up to $3 per kilogram, which could bridge the gap in some cases but not all. Technology costs would have to decline sharply.

Even with hefty subsidies to produce hydrogen, it’s not clear that enough buyers will emerge. Around the world, hydrogen companies have canceled several major projects over the last few years because of lack of demand. Steel makers and electric utilities that might have interest in the fuel often balk at the costly equipment required to use it.

“These new rules will probably help, even if they don’t go as far as many in industry wanted,” said Aaron Bergman, a fellow at Resources for the Future, a nonpartisan Washington research organization. “But there’s still the challenge of finding the people to consume the hydrogen you produce.”

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Why the U.S. surgeon general wants cancer warning labels on alcoholic drinks

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Why the U.S. surgeon general wants cancer warning labels on alcoholic drinks

Alcoholic drinks are a leading cause of cancer and should carry a warning about that risk on their labels, the U.S. surgeon general said Friday.

Alcohol is a factor in nearly 100,000 newly diagnosed cancers each year and roughly 20,000 deaths from the disease, U.S. Surgeon General Vivek Murthy said in an advisory intended to focus the public’s attention on the health risk. By comparison, traffic accidents tied to drinking kill about 13,500 Americans each year.

“Alcohol consumption is the third leading preventable cause of cancer in the United States, after tobacco and obesity,” the 22-page advisory said. “While scientific evidence for this connection has been growing over the past four decades, less than half of Americans recognize it as a risk factor for cancer.”

Labels on bottles and cans of alcoholic beverages already warn about drinking while pregnant. They also warn about drinking before driving or operating other machinery. In California, the voter-approved Proposition 65 also requires businesses that serve or sell alcoholic beverages to provide a warning about health risks, including cancer.

Any decision to update or expand the label would require congressional approval, an uncertain prospect. Murthy was appointed by President Biden, who has a little more than two weeks left in office. President-elect Donald Trump has picked Janette Nesheiwat, an executive at a New York-based chain of urgent care clinics, as his nominee for surgeon general.

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Executives in the beer, wine and spirits industry said Friday that the scientific data linking alcohol to cancer are mixed.

Amanda Berger, senior vice president at the Distilled Spirits Council, noted that a recent report by the National Academies of Sciences, Engineering, and Medicine found that alcohol was associated with a higher risk of breast cancer but did not find such associations with other types of cancer.

That report also concluded that moderate alcohol consumption is associated with lower risks of all-cause mortality and cardiovascular disease, compared with never consuming alcohol.

“The current health warning on alcohol products has long informed consumers about the potential risks of the consumption of alcohol,” Berger said. “Many lifestyle choices carry potential risks, and it is the federal government’s role to determine any proposed changes to the warning statements based on the entire body of scientific research.”

The surgeon general’s advisory said that cancers of the colorectum, esophagus, liver, mouth, throat and larynx are all tied to drinking, as is breast cancer in women. The risk of developing breast, mouth or throat cancers may increase with less than one drink per day, it said.

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(Office of the U.S. Surgeon General)

Yet more than half of Americans are unaware that their drinking behavior affects their cancer risk. A survey by the American Institute for Cancer Research found that 89% of Americans recognized that smoking causes cancer and 53% knew that obesity was a risk factor, but only 45% realized that alcohol could cause cancer as well.

Nearly half of alcohol-related cancers in the U.S. are breast cancers in women, according to a study published by the American Cancer Society. About 1 in every 6 female breast cancers is due to alcohol, and the disease accounts for about 60% of all alcohol-related cancer deaths in women.

As a result, drinking is a bigger cancer risk for women than men. In 2019, about 54,330 women were diagnosed with a cancer that resulted from drinking, as were roughly 42,400 men. About 60% of alcohol-related cancer deaths in women are due to breast cancer, while liver cancer and colorectal cancer are responsible for about 54% of alcohol-related cancer deaths in men.

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For women who consume less than one drink a week, the absolute risk of developing an alcohol-related cancer is 16.5%. Having one drink per day increases that risk to 19%, and having two drinks each day raises it to 21.8%, according to the advisory.

For men, drinking once a week is tied to a 10% absolute risk of an alcohol-related cancer. That risk rises to 11.4% by having one drink per day, and to 13.1% by having two drinks per day, the advisory says.

The World Health Organization’s International Agency for Research on Cancer says alcohol is a Group 1 carcinogen, putting it in the company of tobacco, asbestos and ultraviolet radiation. The U.S. National Toxicology Program declared in 2000 that alcohol causes cancer in humans, and organizations including the Centers for Disease Control and Prevention, the National Cancer Institute, the American Cancer Society and the American Assn. for Cancer Research agree that at least seven kinds of cancer are related to drinking.

There is also evidence to suggest that drinking contributes to skin, prostate, pancreatic and stomach cancers, though more research is needed, the surgeon general’s advisory says.

Scientists first linked alcohol consumption to certain cancers nearly 50 years ago, and the evidence showing that drinking is a risk factor for at least seven types of cancer has grown since then, the advisory says.

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For instance, an observational study of 28 million people in 195 countries and territories found that the more alcohol a person consumed, the higher their risk of cancer. A study involving more than 1 million women found that those who had up to 1 drink per day were 10% more likely to get breast cancer compared with those who abstained. Likewise, a study with 36,000 people found that those who consumed about a drink per day were 40% more likely to develop mouth cancer than people who didn’t drink.

Laboratory experiments have shown how alcohol leads to cancer.

When alcohol is metabolized in the body, it breaks down into a chemical called acetaldehyde that can attach itself to DNA. The resulting damage can trigger the uncontrolled cell growth that leads to cancer.

Drinking also creates unstable molecules called reactive oxygen species that can interfere with DNA, proteins and essential fats. They also increase inflammation, which makes the body more hospitable to cancer.

There is also evidence that alcohol fuels breast cancers by affecting levels of estrogen and other hormones, and that other kinds of carcinogens — such as those found in tobacco smoke — are more easily absorbed in the body when they are dissolved in alcohol.

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The companies selling alcoholic beverages say they have long urged consumers to drink the beverages safely.

“The U.S. beer industry has been a champion of responsible consumption for decades,” a spokesperson for the Beer Institute said Friday. “We encourage adults of legal drinking age to make choices that best fit their personal circumstances, and if they choose to drink, to consume alcohol beverages in moderation.”

Dr. Laura Catena, a winemaker and physician, said that she would “welcome any kind of alert or communication from the surgeon general about the cancer risks of heavy alcohol drinking,” but that it shouldn’t go beyond the established science.

The American Assn. for Cancer Research says alcohol use is responsible for 5.4% of all cancer cases in the U.S. That makes it a bigger risk factor than exposure to UV radiation, poor diet, and infections from pathogens like hepatitis and the human papillomavirus. (For comparison, 19.3% of U.S. cancers are attributable to smoking, according to the association.)

Studies suggest that people who cut back on alcohol or eliminate it can reduce their risk of these cancers by 8%, and reduce their overall cancer risk by 4%.

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The Dietary Guidelines for Americans from the U.S. Departments of Agriculture and Health and Human Services say there is no health reason for nondrinkers to start consuming alcohol. Those who do drink can minimize their risk by limiting their intake to no more than one drink per day for women and no more than two drinks per day for men.

A 5-ounce glass of wine, 12-ounce bottle of beer or 1.5-ounce tumbler of distilled spirits count as a single drink.

The surgeon general’s advisory says about 83% of alcohol-related cancer deaths occur in people who exceed those limits. But that means 17% of deaths were in people who engaged in moderate drinking.

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U.S. Surgeon General Calls for Cancer Warnings on Alcohol

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U.S. Surgeon General Calls for Cancer Warnings on Alcohol

Alcohol is a leading preventable cause of cancer, and alcoholic beverages should carry a warning label as packs of cigarettes do, the U.S. surgeon general said on Friday.

It is the latest salvo in a fierce debate about the risks and benefits of moderate drinking as the influential U.S. Dietary Guidelines for Americans are about to be updated. For decades, moderate drinking was said to help prevent heart attacks and strokes.

That perception has been embedded in the dietary advice given to Americans. But growing research has linked drinking, sometimes even within the recommended limits, to various types of cancer.

Labels currently affixed to bottles and cans of alcoholic beverages warn about drinking while pregnant or before driving and operating other machinery, and about general “health risks.”

But alcohol directly contributes to 100,000 cancer cases and 20,000 related deaths each year, the surgeon general, Dr. Vivek Murthy, said.

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He called for updating the labels to include a heightened risk of breast cancer, colon cancer and at least five other malignancies now linked by scientific studies to alcohol consumption.

“Many people out there assume that as long as they’re drinking at the limits or below the limits of current guidelines of one a day for women and two for men, that there is no risk to their health or well-being,” Dr. Murthy said in an interview.

“The data does not bear that out for cancer risk.”

Only Congress can mandate new warning labels of the sort Dr. Murthy recommended, and it’s not clear that the incoming administration would support the change.

Still, President-elect Donald J. Trump does not drink, and his choice to head the Health and Human Services Department, Robert F. Kennedy Jr., swore off alcohol and drugs decades ago, and says he regularly attends AA meetings.

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There is no question that heavy consumption is harmful. But supporters of moderate drinking — including makers of wine, beer and spirits, and some physicians and scientists — argue that a little alcohol each day may reduce cardiovascular disease, the No. 1 killer in the United States.

Newer scientific studies have criticized the methodology of earlier studies, however, and have challenged that view, which was once a consensus.

While most cancer deaths occur at drinking levels that exceed the current recommended dietary guidelines, the risk for cancers of the breast, the mouth and the throat may rise with consumption of as little as one drink a day, or even less, Dr. Murthy said on Friday.

Overall, one of every six breast cancer cases is attributable to alcohol consumption, Dr. Murthy said. More recent studies have also linked moderate alcohol consumption to certain forms of heart disease, including atrial fibrillation, a heart arrhythmia.

Two scientific reviews will be used to inform the updated recommendations about alcohol consumption in the federal dietary guidelines.

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Five years ago, the scientific report that informed the writing of the 2020-2025 dietary guidelines acknowledged that alcohol is a carcinogen and generally unhealthy and suggested “tightening guidelines” by capping the recommendation for men at one standard drink, or 14 grams of alcohol a day.

When the final guidelines were drafted, however, there was no change in the advice that moderate drinking of up to two drinks a day for men was acceptable.

But the government acknowledged emerging evidence indicating that “even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease.”

Since then, even more studies have linked alcoholic beverages to cancer. Yet any attempt to change the warning labels on alcoholic beverages is likely to face an uphill battle.

The current warning label has not been changed since it was adopted in 1988, even though the link between alcohol and breast cancer has been known for decades.

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It was first mentioned in the 2000 U.S. Dietary Guidelines. In 2016, the surgeon general’s report on alcohol, drugs and health linked alcohol misuse to seven different types of cancer.

More recently, a scientific review of the research on moderate drinking, carried out under the auspices of the National Academies of Sciences, Engineering and Medicine, was commissioned by Congress.

That analysis found a link between alcohol consumption and a slight increase in breast cancer, but no clear link to any other cancers. The report also revived the theory that moderate drinking is linked to fewer heart attack and stroke deaths, and fewer deaths overall, compared with never drinking.

The World Health Organization says there is no safe limit for alcohol consumption, however, and 47 nations require warnings on alcoholic beverages. But cancer is rarely mentioned.

To date, only South Korea has a label warning about liver cancer, though manufacturers can choose alternative labels that don’t mention cancer. Ireland is currently slated to introduce labels that say there is a “direct link between alcohol and fatal cancers” in 2026.

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The industry has a strong history of fighting warning labels that mention cancer, and alcohol-producing nations have also challenged warning labels under international trade law.

Industry opposition led to the premature termination of a federally funded Canadian study of the impact of warning labels that mentioned cancer.

The surgeon general’s advisory provided a brief overview of research studies and reviews published in the past two decades, including a global study of 195 countries and territories involving 28 million people.

They all found that higher levels of alcohol consumption were associated with a greater risk of cancer.

Other studies looked at specific cancers, like breast cancer and mouth cancer, finding the risks increased by 10 percent and 40 percent, respectively, for those who had just one drink a day, when compared with those who did not drink.

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The report described the biological mechanisms by which alcohol is known to induce cancerous changes at the cellular level.

The most widely accepted theory is that inside the body, alcohol breaks down into acetaldehyde, a metabolite that binds to DNA and damages it, allowing a cell to start growing uncontrollably and creating a malignant tumor.

Animal experiments have shown that rodents whose drinking water was spiked with either ethanol, the alcohol used in alcoholic beverages, or with acetaldehyde developed large numbers of tumors all over their bodies.

Research has shown that alcohol generates oxidative stress, which increases inflammation and can damage DNA.

It also alters levels of hormones like estrogen, which can play a role in breast cancer development, and makes it easier for carcinogens like tobacco smoke particles to be absorbed into the body, increasing susceptibility to cancers of the mouth and the throat.

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The surgeon general’s report also goes into detail about the increase in risk associated with drinking, differentiating between the increases in absolute risk and in relative risk.

For example, the absolute risk of breast cancer over a woman’s life span is about 11.3 percent (11 out of 100) for those who have less than a drink a week.

The risk increases to 13.1 percent (13 of 100 individuals) at one drink a day, and up to 15.3 percent (15 of 100) at two drinks per day.

For men, the absolute risk of developing an alcohol-related cancer increases from about 10 percent (10 of every 100 individuals) for those who consume less than one drink a week to 11.4 percent (11 per 100) for those who have a drink every day on average. It rises to 13 percent (13 of 100 individuals) for those who have two drinks a day on average.

Many Americans don’t know there is a link between alcohol and cancer.

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Fewer than half of Americans identified alcohol use as a risk factor for cancer, compared with 89 percent who recognized tobacco as a carcinogen, according to a 2019 survey of U.S. adults aged 18 and older carried out by the American Institute for Cancer Research.

Yet alcohol consumption is the third leading preventable cause of cancer, after tobacco and obesity, according to the surgeon general’s report.

Dr. Murthy said it was important to know that the risk rises as alcohol consumption increases. But each individual’s risk of cancer is different, depending on family history, genetic makeup and environmental exposures.

“I wish we had a magic cutoff we could tell people is safe,” he said. “What we do know is that less is better when it comes to reducing your cancer risk.”

“If an individual drinks occasionally for special events, or if you’re drinking a drink or two a week, your risk is likely to be significantly less than if you’re drinking every day,” he added.

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