When people think about the long-term health effects of alcohol, liver disease is usually one of the first risks that comes to mind. Cancer may be further down the list, and when it does come up, liver cancer can seem like the obvious connection.
But alcohol is linked to several different cancers, and new research suggests the cancers carrying the greatest burden aren’t always the ones people might expect.
A major study published in The Lancet Regional Health – Americas examined alcohol-attributable cancer deaths in the United States between 1990 and 2023. Among men ages 20 to 54, colorectal cancer was the leading cause of alcohol-attributable cancer death, surpassing liver cancer. Among women in the same age group, breast cancer ranked first.
The broader trend was striking too. Researchers estimated that annual alcohol-attributable cancer deaths increased from 11,361 in 1990 to 23,126 in 2023. The findings don’t mean alcohol alone caused every one of those deaths, but they highlight just how widely its cancer burden can extend beyond the liver.
The Scope of Alcohol’s Cancer Connection
Alcohol has been classified as a Group 1 carcinogen by the International Agency for Research on Cancer, placing it in the same category as tobacco smoke and asbestos. Group 1 is the highest classification, indicating sufficient evidence that a substance causes cancer in humans. The direct link between alcohol consumption and cancer risk is well-established for at least seven cancer types: breast, colorectal, esophageal, liver, oral cavity, pharyngeal, and laryngeal cancers – regardless of whether the alcohol comes from beer, wine, or spirits.
Worldwide, an estimated 741,300 new cancer cases were attributable to alcohol consumption in 2020. In the United States, an estimated 20,216 cancer deaths were alcohol-attributable annually during 2020 – 2021.
What Alcohol Actually Does Inside the Body
When the body processes alcohol, it converts it into acetaldehyde – a toxic compound that can damage DNA and impair normal cell repair mechanisms. Cells with corrupted genetic instructions begin replicating incorrectly, and without reliable repair, those errors accumulate over time.
Alcohol also affects hormone levels. A 2024 study published in Cancer found that alcohol intake is associated with measurable increases in sex hormone concentrations, including estrogen – a driver of hormone-receptor-positive breast cancers. For breast cancer specifically, consuming one alcoholic drink per day can increase risk by 7 – 10%, according to the Breast Cancer Research Foundation.
When drinking and smoking occur together, the cancer risk compounds rather than simply adds up. Research published in Oral Oncology found that alcohol and tobacco increase oral cancer risk synergistically, and people who drink and smoke are 15 times more likely to develop mouth and throat cancer than nondrinkers and nonsmokers.
Who Bears the Heaviest Burden
Men and adults aged 55 and older experienced the greatest overall burden, but increases were seen across most cancer types, age groups, and regions. Among older men, liver cancer and esophageal cancer remain significant contributors. Heavy esophageal alcohol consumption – defined as more than 20 years of heavy drinking – is associated with an esophageal squamous cell carcinoma risk seven times higher than in non-drinkers, according to research published in Carcinogenesis.
For women, breast cancer dominates the picture. Among women aged 20 to 54, breast cancer ranked first in alcohol-attributable cancer deaths, with colorectal cancer ranking second. Among women of all ages, alcohol-related breast cancer was the leading cause of alcohol-attributable cancer deaths overall.
Among men aged 20 to 54, the Lancet data showed colorectal cancer overtaking liver cancer as the primary alcohol-linked cancer killer. Alcohol-attributable cancer deaths were recorded across breast, liver, colorectal, and head and neck cancers, indicating the burden extends well beyond a single cancer type.
You can explore how regular alcohol consumption affects your body in broader terms, including its impacts beyond cancer risk.
The Geography of Risk
The study found substantial geographic variation. In 2023, Washington, D.C., recorded the highest alcohol-attributable cancer mortality rates, while Utah had the lowest. Utah’s low rates are consistent with its demographic profile – a large proportion of the state’s population belongs to the Church of Jesus Christ of Latter-day Saints, whose members typically abstain from alcohol entirely. D.C.’s elevated rates likely reflect a combination of drinking culture, population density, and socioeconomic factors that are difficult to fully disentangle from the mortality data.
Although the study examined national trends, the findings have particular relevance for states with large populations of older adults – the age group that experienced the highest alcohol-attributable cancer mortality rates. The researchers note that any state with a large and growing aging population should treat these findings as a meaningful public health signal.
Read More: Scientists Find Unexpected Conflicting Results Between Alcohol and Alzheimer’s
A Public Warning That’s Been Building
In January 2025, then-Surgeon General Vivek Murthy issued an advisory calling on Congress to require updated cancer warning labels on alcoholic beverages – labels that do not currently exist. The advisory identified alcohol as a leading preventable cause of cancer in the United States.
Dr. Chinmay Jani, corresponding study author and chief fellow in hematology and oncology at Sylvester, noted that the most surprising finding was the breadth of alcohol’s potential impact across cancer types. While alcohol’s relationship with liver cancer is widely recognized, its contribution to colorectal, esophageal, breast, and other cancers is less understood by the public.
The Lancet study carries limitations that matter when reading its headline figures. The authors acknowledged that the observational design of the database framework may have resulted in some incomplete data. Population growth and aging naturally push up absolute death counts over time, and the study relies on modeled estimates rather than direct individual tracking. The trend over 33 years across multiple cancer types is too consistent and too large to attribute to methodology alone, but the numbers should be read as approximations of a genuine burden rather than a precise count.
What This Means for People Who Drink
Perhaps the most useful takeaway from three decades of data is therefore a change in how we think about alcohol itself. Its cancer burden isn’t confined to heavy drinkers, older adults, or diseases of the liver. For younger men in this analysis, the leading alcohol-attributable cancer death was colorectal cancer. That is a very different picture from the one many people still associate with drinking.
The most important message from the study isn’t that everyone who drinks is destined to develop cancer. Individual risk depends on many factors, and these population-level estimates cannot predict what will happen to any one person.
What they do show is that alcohol’s relationship with cancer extends well beyond the liver. Breast, colorectal, esophageal, and head and neck cancers all contribute to the burden, including among adults younger than 55.
Alcohol is also one cancer risk factor people can change. The American Cancer Society states that avoiding alcohol is best for cancer prevention, while people who choose to drink can reduce their exposure by drinking less. That doesn’t mean an occasional drink guarantees harm, nor does it mean cutting out alcohol eliminates cancer risk. Risk generally changes with exposure, rather than switching on at a particular number of drinks.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.
Read More: Is This the “Ozempic of Alcohol”? the $2-a-Pill Drug That Can Reduce Drinking