Alcohol-Related Cancer Deaths Have Doubled Since 1990: What Clinicians Need to Know

Alcohol and cancer risk is back in the headlines after a major new study found that alcohol-related cancer deaths in the United States more than doubled between 1990 and 2023. Published in The Lancet Regional Health – Americas by researchers at the Sylvester Comprehensive Cancer Center (University of Miami Miller School of Medicine), the analysis of more than three decades of Global Burden of Disease data is a powerful reminder that alcohol is a leading modifiable cancer risk factor — and that its toll extends far beyond the liver.

Alcohol-related cancer deaths have doubled: the numbers

The study found that annual alcohol-attributable cancer deaths in the US rose from 11,361 in 1990 to 23,126 in 2023 — more than a doubling over three decades. Men and adults aged 55 and older carried the greatest burden, but increases were seen across most cancer types, age groups and regions.

“The most surprising finding was the breadth of alcohol’s potential impact across cancer types,” said corresponding author Dr Chinmay Jani, chief fellow in haematology and oncology at Sylvester. Senior author Dr Gilberto Lopes, chief of the Division of Medical Oncology, said the findings reinforce how important it is to give people clear information about lifestyle factors that influence cancer risk. The research was first presented as an oral presentation at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting.

Beyond the liver: which cancers are linked to alcohol?

Alcohol is classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC) — the same category as tobacco smoke and asbestos. Yet public awareness of the alcohol–cancer connection remains far lower than awareness of smoking risks.

Key findings from the study on cancer types:

• Among older men, liver cancer accounted for the highest alcohol-attributable mortality rate, followed by oesophageal and colorectal cancers.
• Among women, breast cancer was the leading source of alcohol-attributable cancer death at every age.
• Other cancers with a growing alcohol-attributable burden included colorectal, oesophageal, pancreatic and prostate cancers, as well as several head and neck sites.
• Substantial geographic variation was seen: in 2023, Washington DC recorded the highest alcohol-attributable cancer mortality rate in the US, while Utah had the lowest.

A concerning pattern in younger adults

One of the most striking findings was the impact in people under 55. Among men aged 20 to 54, colorectal cancer was the leading cause of alcohol-attributable cancer death; among women in the same age group, breast cancer ranked first followed by colorectal cancer — with both surpassing liver cancer.

“Notably, among adults aged 20 to 54, colorectal cancer was the leading cause of alcohol-attributable cancer mortality in men and the second leading cause in women, surpassing liver cancer in both groups,” Dr Jani said. The finding challenges the perception that alcohol-related cancer is an older person’s disease.

Why alcohol increases cancer risk

Alcohol can damage DNA and body tissues through several mechanisms:

• Alcohol is metabolised into acetaldehyde, a toxic compound that damages DNA and prevents cells from repairing it.
• Alcohol generates oxidative stress, which can injure cells and promote mutations.
• It alters hormone levels, particularly oestrogen, which is one reason for the strong link with breast cancer.
• It acts as a solvent, helping other carcinogens such as tobacco toxins penetrate the lining of the mouth, throat and oesophagus.

What this means for Australian patients and practice

The US data echo global trends and carry clear lessons for Australian clinicians. Alcohol use is common in Australia, and the evidence increasingly shows that the lowest safe level of drinking may be very low indeed — recent analyses have linked even light drinking (around one drink a day or less) to elevated risk of several cancers, including of the breast, colorectum, oesophagus and head and neck.

Australian guidelines recommend healthy adults drink no more than 10 standard drinks per week and no more than 4 on any single day, and that less is better for cancer risk. For health professionals, the practical takeaway is that alcohol should be discussed as a modifiable risk factor in the same conversation as smoking, diet and physical activity — not only when liver disease is on the differential.

Practical steps to reduce alcohol-related cancer risk

• Ask and advise: screen alcohol intake routinely and offer brief advice linking drinking levels to cancer risk.
• Support reduction: for people who drink, reducing to the lowest level feasible — not necessarily zero — may still lower risk. “The lowest safe dose is not yet known,” Dr Jani noted, “but reducing consumption to the lowest amount feasible for each individual may help.”
• Target younger patients: rising colorectal and breast cancer links in under-55s make alcohol a relevant prevention topic well before middle age.
• Flag higher-risk patterns: regular drinking above guideline levels, binge episodes and combined alcohol-tobacco use all warrant targeted discussion.

Frequently asked questions

Does one drink a day increase cancer risk?

Emerging evidence, including recent analyses, suggests even low-level drinking — around one standard drink a day or less — is associated with a small increase in the risk of several cancers, including breast, colorectal and oesophageal cancers. Risk rises with the amount consumed over time.

Which cancers are most strongly linked to alcohol?

The strongest evidence links alcohol to cancers of the breast, liver, colorectum, oesophagus, mouth, pharynx and larynx. The new study also found growing alcohol-attributable burdens in pancreatic and prostate cancers.

Is any amount of alcohol safe?

Researchers say the lowest safe dose is not yet known. Current Australian guidelines recommend no more than 10 standard drinks per week and no more than 4 on any one day, with less being better for cancer prevention.

Does the type of alcohol matter?

The evidence indicates it is the ethanol itself that drives cancer risk, so wine, beer and spirits all carry risk. No type of alcoholic drink has been shown to be “safe” for cancer.

Can quitting or cutting down reverse the risk?

Risk is related to cumulative lifetime exposure, so cutting down or stopping earlier in life reduces long-term risk. People who stop drinking lower their risk of alcohol-related cancers over time compared with continuing drinkers.

Sources: Jani C et al., The Lancet Regional Health – Americas (2026); Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine; IARC; National Health and Medical Research Council (Australia).