Alcohol Consumption Linked to Seven Types of Cancer

Article Summary
- The U.S. surgeon general issued an advisory on alcohol and cancer risk, including a recommendation that alcoholic beverages be labeled with warnings about their link to cancer.
- The strong association between alcohol and seven cancers noted in the report has been known for decades, but the understanding of how and why is more recent.
- Alcohol is the third-leading preventable cause of cancer, after obesity and tobacco.
- Researchers at Sylvester hope the advisory will change public behavior and the practice of oncology.
For years, researchers at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, have tracked a growing body of research that underscores why alcohol is labeled a Group 1 Carcinogen, and have incorporated this understanding into their practices.
Now, they are praising the U.S. surgeon general’s recommendation that alcoholic beverages carry updated labels warning consumers about their link to cancer. They hope this new recommendation, part of the Jan. 3 advisory on alcohol and cancer risk, will encourage the public to change what many public health experts view as worrisome habits.
“Our message has always been to monitor alcohol intake, but this does bring more awareness to the subject,” said Susan B. Kesmodel, M.D., director of Breast Surgical Oncology and co-leader of the Breast Site Disease Group at Sylvester. “Increased awareness may help to reduce alcohol consumption in more individuals.”

One example of the risks of alcohol consumption: More than 16% of breast cancer cases can be attributed to alcohol consumption. Alcohol raises estrogen levels, which can power up disease development.
Surgeon General Vivek Murthy, M.D., M.B.A., highlighted the strong association between alcohol and seven types of cancer in the report:
• Breast
• Liver
• Mouth
• Throat
A Known Association Between Alcohol and Cancer
The strong association between alcohol and these cancers has been known for decades, but the understanding of how and why has come more recently.
“Emerging data not only links alcohol to cancer, but also explains the biological and molecular processes of how it happens,” said Jashodeep Datta, M.D., assistant director of transdisciplinary research at Sylvester and a surgical oncologist. “It’s these mechanistic studies that have propelled this field forward and prompted the release of this advisory.”

The surgeon general’s advisory explains, in layman’s language, several ways alcohol can cause cancer. For example, alcohol breaks down into acetaldehyde, which damages DNA. It also induces oxidative stress, which increases inflammation, alters the levels of various hormones and leads to more absorption of carcinogens.
Alcohol is responsible for about 100,000 cases of cancer and 20,000 cancer deaths in the U.S. every year. That’s more than the annual 13,500 alcohol-associated traffic fatalities. Alcohol is the third-leading preventable cause of cancer, after obesity and tobacco.

“Unlike an unmodifiable risk factor, such as a genetic mutation we’re born with, our consumption of alcohol is a modifiable risk factor,” said Mikkael Sekeres, M.D., chief of the Division of Hematology at Sylvester and professor of hematology at the Miller School. “This is a real opportunity to change and lower that risk.”
Can an Advisory Change Behavior?
A 2020 study found that less than half of Americans know that higher alcohol consumption increases the risk of developing cancer. Alcoholic beverages already carry labels warning that consumption can impair driving ability and that pregnant women should not drink. The cancer risk warning proposed by the surgeon general, if approved by Congress, would add a warning about cancer risk. Sylvester oncologists hope this would open a much-needed debate on drinking. It could also impact clinical practices.
The surgeon general’s warning follows a 2023 World Health Organization (WHO) declaration that there is no safe limit for alcohol consumption. That came about 30 years after WHO issued a statement that alcohol was a Group 1 Carcinogen. Although 47 WHO member countries have some kind of alcohol health warning labels, only South Korea requires actual cancer warnings. Ireland is expected to add a warning by 2026.

“The recent advisory on alcohol and its link to cancer risk has the potential to significantly influence public behavior and the practice of oncology,” said Gilberto Lopes, M.D., Sylvester’s associate director and medical director for international affairs and professor and chief of the Division of Medical Oncology at the Miller School who specializes in lung and thoracic cancers. “As awareness of the connection between alcohol consumption and increased cancer risk grows, some individuals, particularly those already conscious of their health or with a family history of cancer, may take steps to reduce or eliminate alcohol from their lives.”
But Patricia Jones, M.D., a hepatologist at Sylvester and associate professor at the Miller School, cautions people don’t always change their behavior because a risk factor is identified and publicized – at least not immediately. She’d like to see a more comprehensive effort tackling the underlying reasons for binge drinking and alcohol use disorders.

“This doesn’t address the problem of drinking or why people choose to drink even when they know it’s not good for them,” Dr. Jones said. “The ability to make changes is going to depend on the resources someone has access to, and right now there is a shortage of mental health professionals who can address these issues.”
She believes the advisory will change the habits of “a select group” who are highly attuned to their health but not necessarily those with a drinking problem. Those individuals often also engage in other cancer-risk behaviors, such as smoking. She would like to see a sustained public awareness campaign that continues to focus on the damage caused by alcohol consumption.
Changing Norms Around Alcohol Consumption
Along those lines, the surgeon general’s report calls for reassessing the dietary guidelines for alcohol consumption, which currently recommend a limit of two drinks daily for men and one for women. (One drink is equivalent to 12 ounces of beer, five ounces of wine or 1.5 ounces of distilled spirits.) Five years ago, a report suggested changing the guidelines to one drink a day for men, but did not lead to a rewriting of the published recommendations.

The recent advisory also urges health experts and community groups to increase education efforts, and encourages individuals to take a hard look at how much they drink, or whether they should drink at all. A comprehensive public push can change people’s habits, said Paola Rossi, M.D., clinical program director for lifestyle medicine at Sylvester. Tracy E. Crane, Ph.D., R.D.N., director of lifestyle medicine, prevention and digital health, and co-lead of Sylvester’s Cancer Control Program, agrees. Both point to the success of anti-tobacco campaigns, which turned smoking from a hip activity featured in movies to unfashionable behavior.

“It’s going to take time,” Dr. Crane said. “It won’t happen overnight.”
After all, the first report from the Surgeon General’s Advisory Committee on Smoking and Health was released in 1964. It was based on more than 7,000 articles tracing the links of smoking to poor health outcomes. Despite its conclusions that cigarette smoking is a cause of lung and laryngeal cancer in men and a probable cause of lung cancer in women, it took decades to see significant changes in public health behavior.
The narrative around alcohol is already changing, Dr. Rossi pointed out. Dry January and Sober October are becoming popular. Recipes for mocktails – cocktails without alcohol — appear everywhere on social media, and the market for nonalcoholic beers and drinks is growing.
“The take-home message here is that alcohol is a carcinogen, like tobacco and asbestos,” she said. “But you can do something about lowering your risk.”
Catalyzing Patient Conversations About Alcohol and Cancer
Dr. Lopes acknowledged that “changing societal norms around drinking will likely be a gradual process, requiring continued public health campaigns.”
Still, he sees the advisory as a catalyst for physicians “to more actively integrate alcohol use into patient risk assessments” and to explore “the best ways to engage patients in meaningful discussions about their alcohol consumption.”
He expects more health care practices will incorporate alcohol screening and education into routine care.
Alcohol consumption is certainly a worsening public health problem and we’re going to be in trouble if people continue drinking as they are.
Dr. Patricia Jones
“Ultimately, the advisory also signals a shift toward a more comprehensive approach to cancer prevention, where lifestyle factors such as alcohol use are recognized alongside genetic and environmental risks,” Dr. Lopes added. “This could lead to more focused research on the alcohol-cancer connection, while influencing future policies around alcohol marketing and public health guidelines.”
Of course, health care providers will face the challenges of cultural resistance, as well as obtaining the tools and support to incorporate alcohol-related counseling into complex clinical workflows.
Dr. Datta, who is also a surgical oncologist specializing in pancreatic and liver cancers, has “a very strict tobacco and alcohol policy” for his patients. He explains to them how alcohol can affect the immune system, therefore hurting their recovery from surgery. Like Dr. Lopes, he views the advisory as “a pivotal turn” for medical practices, particularly primary care physicians who are the first, and sometimes the only, point of professional health information.
“Alcohol is not going to go away completely,” Dr. Datta said. “It’s built into the social fabric of our lives. But I think the advisory might caution people who are drinking at a clip that is not good for their health to finally change their habits.”
A Critical Time for Oncology

The surgeon general’s advisory comes at a critical time for the field of oncology. There’s been a steady uptick in breast and colorectal cancer cases in people under 50. One report published by the American Association for Cancer Research earlier this year revealed that, even as overall cancer deaths have declined because of improved treatment, incidence rates among young adults have increased.
Other reports have shown that women and seniors are drinking more — and suffering the consequences. As the gap between what men and women drink narrows, deaths directly linked to alcohol have grown more rapidly for women, according to a study published in 2023 by JAMA’s Substance Use and Addiction. It appears that alcohol consumption has more negative effects on women, whose typically lower body water and weight cause them to metabolize alcohol differently than men. This, in turn, raises women’s risk of cancer, as well as of cardiovascular disease and liver damage.
Older adults, who are also drinking more, metabolize alcohol more slowly because of physiological changes that come with age. Hence, their blood alcohol levels tend to stay higher, which can negatively affect balance, coordination and reaction time.
“Alcohol consumption is certainly a worsening public health problem,” Dr. Jones said, “and we’re going to be in trouble if people continue drinking as they are.”
Tags: alcohol addiction, cancer research, Dr. Gilberto Lopes, Dr. Jashodeep Datta, Dr. Paola Rossi, Dr. Patricia Jones, Dr. Susan Kesmodel, Dr. Tracy Crane, lifestyle medicine, Sylvester Comprehensive Cancer Center