Alcohol and Cancer

Ealena Callender, MD, MPH, & Meg Seymour, PhD, Cancer Prevention and Treatment Fund


The link between alcohol and cancer may surprise you. The American Society of Clinical Oncology reports that drinking alcohol increases the risk of cancer of the mouth and throat, vocal cords, esophagus, liver, breast, and colon. The risks are greatest in those with heavy and long-term alcohol use. Even so, moderate drinking can add up over a lifetime, which could be harmful.1

What is Moderate Drinking? Heavy Drinking?

The 2020-2025 Dietary Guidelines for Americans recommends that Americans can reduce their risk of alcohol-related health problems by drinking in moderation, which means 1 drink per day or less for women and 2 drinks per day or less for men.2 However, not all “drinks” are equal. A drink is defined as approximately 0.6 fluid ounces of alcohol, which equals: 1.5 ounces of distilled spirits (e.g., vodka, gin, tequila, etc), 5 ounces of wine, 12 ounces of beer, and 8 ounces of malt liquor.3 (Click here to see the CDC’s fact sheet.) The guidelines define moderate drinking as two drinks or less per day for men and one drink or less per day for women.

The CDC describes heavy drinking as having more than eight drinks per week for women and more than 15 drinks per week for men. Binge drinking refers to consuming multiple drinks on a single occasion – four or more drinks for women and five or more drinks for men.

Drinking and Cancer

In January 2023, the Canadian Centre on Substance Use and Addiction (CCSA) published updated guidelines that recommend limiting alcohol use to two or fewer drinks per week to reduce the risk of harm from alcohol.4 At that level, they say risk of harm from alcohol is low. Risk is moderate for those who drink three to six servings of alcohol per week and “increasingly high” for those who drink seven or more. The report warns that drinking three to six alcoholic beverages per week is associated with increased risk of several types of cancer.

These guidelines may surprise many people, especially those who assumed moderate drinking was not anything to be concerned about.  But research indicating the risk of cancer from drinking even small amounts of alcohol has been published for years.  For example, Alcohol is known to cause at least six types of cancer: mouth and throat cancer, larynx (voice box) cancer, esophageal cancer, colon and rectal cancer, liver cancer, and breast cancer in women.5 A 2021 study found that 4% of all new cancer cases diagnosed throughout the world in 2020 were attributable to alcohol consumption, and the researchers say that may be a low estimate.6

Depending on the amount a person drinks, they can increase their chances for developing even rare cancers. For example, moderate drinkers can almost double their lifetime risk of mouth and throat cancer to almost 2%, while heavy drinkers increase their risk of having mouth or throat cancer, from 1% to 5%.1 A 2020 study from Australia found that the heaviest drinkers (drinking more than 14 drinks per week) had an overall higher likelihood of developing cancer, compared with those who drank the least (1 or 0 drinks per week). The men who drank the most had a 4.4% higher overall likelihood of developing cancer than the men who drank the least, and the women who drank the most had a 5.4% higher overall chance of developing cancer.7

Women need to be more cautious about drinking any amount of alcohol because the alcohol is even more likely to cause cancer in women than in men. Research has shown that women who drink even 1 drink per day have a 5-9% higher chance of developing breast cancer, compared with women who do not drink.8 The risk is even higher for women who drink more. One reason may be that alcohol affects the amounts of certain sex hormones circulating in the body. For women who have had hormone receptor-positive breast cancer, seven or more weekly drinks increased the chances of having a new cancer diagnosed in the other breast from about 5% to about 10%.1

Heavy drinking is also risky for those who currently have or have had other types of cancer. Among all cancer survivors, heavy drinking caused an 8% increased risk in dying and a 17% increased risk of cancer recurrence. Patients with cancer who abuse alcohol do worse because alcohol causes poorer nutrition, a suppressed immune system, and a weaker heart.1

In 2020, an estimated 100,000 cases of cancer globally were caused by light to moderate drinking (fewer than two alcoholic beverages per day).6 A study of alcohol use in the European Union found that a drinking level of less than one drink per day was linked to 40% of alcohol-related cancers in women and 32% in men.9

Individuals who increase their alcohol use may also increase their chance of getting cancer, according to a large 2022 study.10 Compared with men and women who maintained the same level of drinking over about six years, the study found that those who increased their alcohol consumption were more likely to get cancer. While those who increased their alcohol consumption most dramatically saw a more significant increase in their risk of cancer, even those who only increased their consumption by a small amount had a higher risk of cancer than those who did not change their level of drinking.

How Alcohol Causes Cancer

Scientists believe that alcohol causes cancer in several ways:1

  • Alcohol (ethanol) is broken down into a toxic substance called acetaldehyde, which is directly toxic to the body’s cells.
  • Alcohol causes damage to cells through a process called free-radical oxidation.
  • Alcohol causes the body to absorb less folate (an important B vitamin) and other nutrients (antioxidant vitamins A, C, and E), which naturally repair damage and fight off cancers.
  • Alcohol increases the body’s level of estrogen (a sex hormone associated with breast cancer)

What You Can Do to Lower Cancer Risk for You and Your Family

  • If you drink alcohol, limit drinks to an average of 1 a day for women and 2 a day for men.
  • Recognize heavy drinking in a loved one,because the more a person drinks, the greater his or her chances of developing cancer. The “CAGE” questionnaire provided here can help spot heavy drinking.
    1.   Has the person tried to Cut back?
    2.   Has the person been Annoyed when asked about drinking?
    3.   Has the person felt bad or Guilty?
    4.   Has the person needed a drink first thing in the morning (Eye opener)? Each “yes” counts as 1 point. A score of 2 or more suggests problem drinking.
  • Talk with your doctor about your risk.Doctors can refer or offer counseling and treatment services to patients with risky drinking habits.
  • Seek help early. Problem drinking can’t be wished away. There are many resources to access information and help. The Substance Abuse and Mental Health Services Administration (SAMHSA), which is part of the U.S. Department of Health and Human Services (HHS) has a toll free hot-line and website. Call 1-800-662-HELP (4357) or visit https://findtreatment.samhsa.gov/
  • Practice healthy habits. Eating a diet rich in cancer-fighting nutrients (i.e., fruits and vegetables), exercising, maintaining a healthy weight, reducing stress, and getting restful sleep can all help to lower cancer risk. Don’t smoke, and quit if you do. Drinking and smoking increases cancer risk more than either one alone.

The Bottom Line

To decrease your chances of cancer and other serious health problems, try to limit your drinking.  If you drink alcohol, try to drink less often and aim for a maximum average of 1 a day if you’re a woman and 2 a day if you’re a man.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.

 

References

1. LoConte NK, Brewster AM, Kaur JS, Merrill JK, Alberg AJ. Alcohol and cancer: a statement of the American Society of Clinical Oncology. Journal of Clinical Oncology. 2018;36(1):83-93.

2. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov

3. Centers for Disease Control and Prevention. Dietary Guidelines for Alcohol. Cdc.gov. https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm. Updated December 2020.

4. https://www.ccsa.ca/canadas-guidance-alcohol-and-health

5. Centers for Disease Control and Prevention. Alcohol and Cancer. Cdc.gov. https://www.cdc.gov/cancer/alcohol/index.htm. Updated July 2019.

6. Rumgay H, Shield K, Charvat H, Ferrari P, Sornpaisarn B, Obot I, Islami F, Lemmens VE, Rehm J, Soerjomataram I. Global burden of cancer in 2020 attributable to alcohol consumption: A population-based study. The Lancet Oncology. 2021;22(8):1071-80.

7. Sarich P, Canfell K, Egger S, Banks E, Joshy G, Grogan P, Weber MF. Alcohol consumption, drinking patterns and cancer incidence in an Australian cohort of 226,162 participants aged 45 years and over. British Journal of Cancer. 2021;124(2):513-23.

8. National Institute on Alcohol Abuse and Alcoholism. Women and Alcohol. Niaaa.nih.gov. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/women-and-alcohol. Updated April 2021.

9. Rovira, P., & Rehm, J. (2021). Estimation of cancers caused by light to moderate alcohol consumption in the European Union. European journal of public health31(3), 591–596. https://doi.org/10.1093/eurpub/ckaa236

10. Yoo, J. E., Han, K., Shin, D. W., Kim, D., Kim, B. S., Chun, S., Jeon, K. H., Jung, W., Park, J., Park, J. H., Choi, K. S., & Kim, J. S. (2022). Association Between Changes in Alcohol Consumption and Cancer Risk. JAMA network open5(8), e2228544. https://doi.org/10.1001/jamanetworkopen.2022.28544