"While it’s true that overall cancer mortality has declined, we found the percentage of cancer deaths proportionally attributable to alcohol doubled in people 20 and older over the last 33 years," Jani said.

The age-standardized mortality rate for alcohol-attributable cancer among adults ages 55 and older increased from 15.8 per 100,000 in 1990 to 19.2 per 100,000 in 2023. Alcohol-related cancer mortality in older males climbed nearly 24% over the 33-year period. The percentage of age-standardized mortality rates attributable to alcohol for adults ages 20 to 54 increased from 4.5% in 1990 to 6.6% in 2023. For adults ages 55 and older, this percentage rose from 1.7% in 1990 to 3.0% in 2023.

Colorectal cancer was the leading alcohol-attributable cause of death among males aged 20 to 54 in 2023. Among females aged 20 to 54, colorectal cancer was the second most common alcohol-attributable cause of death in 2023, surpassing liver cancer. Colorectal cancer was the third most common alcohol-attributable cause of death among males aged 55 and older in 2023, after liver and esophageal cancers.

The highest percentage increases in alcohol-attributable mortality were seen in stomach cancer (57.2%), pancreatic cancer (40.5%), and colorectal cancer (39.7%). For men, liver cancer deaths showed the strongest link to alcohol, followed by esophageal and colorectal cancers. For women 55 and older, breast cancer was the top alcohol-attributable killer, followed by liver and colorectal cancers. Up to one-fourth of head and neck cancers have alcohol as a risk factor.

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. Former Surgeon General Vivek Murthy stated that alcohol use was the third-leading preventable cause of cancer in the U.S. behind tobacco and obesity. Elevated cancer risk from alcohol has been linked to intake levels of just 5 to 15 grams per day, which is approximately one standard drink in the U.S.

Alcohol contributes to cancer growth by altering hormone levels, including estrogen. The liver breaks down ethanol into acetaldehyde, a probable human carcinogen, which can damage DNA and interfere with DNA repair. Alcohol contributes to oxidative stress, which damages DNA, proteins, and cell function and creates inflammation.

Drinking alcohol weakens cells in the mouth and throat, making them more susceptible to carcinogens. Alcohol interferes with the breakdown and absorption of vitamins A, C, D, E, and folates, which are thought to decrease cancer risk.

For women of any age and for men younger than 55, it takes less alcohol to raise the risk of cancer compared with men older than 55. Only 45% of American adults recognize alcohol as a risk factor for cancer, compared with 89% who recognize tobacco as such. Alcohol consumption remains deeply rooted in culture despite its well-documented carcinogenicity.

"An important message that we are trying to deliver is that this study does not say that you should completely stop drinking alcohol.. but that it is a preventable cause of cancer mortality," Jani said. "As individuals, people can identify if they have any other risk factors, like tobacco or family history, or any other diseases that could potentially lead to cancer. In those cases, they should identify themselves as a higher-risk individual and try to reduce alcohol intake as much as possible."

"The findings emphasize the need for sustained national efforts to reduce alcohol consumption as a risk factor for cancer mortality." The U.S. Surgeon General issued a 2025 advisory recommending cancer risk warning labels on alcoholic beverages. In January 2025, the Trump administration removed federal guidelines limiting drinking to two standard drinks a day for men and one for women, instead suggesting people consume less alcohol for better overall health. "What we used to think about alcohol continues to be eroded as modern science has shown us that there is no safe amount of alcohol consumption," said Andrew Freeman, MD.

The study had limitations inherent to the Global Burden of Disease framework and its observational design, including incompleteness of exposure data and delays in data reporting. A separate global study published in npj Science of Food analyzed alcohol-attributable mortality from 1990 to 2023 using Global Burden of Disease 2023 data. Global mortality rates for alcohol-attributable cirrhosis, alcoholic cardiomyopathy, and alcohol use disorders declined from 1990 to 2023. Global alcohol-attributable liver cancer mortality reversed from a pre-pandemic decline to an increase during 2020–2023.

Why It Matters

The doubling of alcohol-attributable cancer deaths in the U.S. from 1990 to 2023 reflects a shifting landscape in cancer mortality, where alcohol's role has grown even as overall cancer deaths have fallen. This trend affects males and females across age groups, with colorectal cancer emerging as a leading cause among younger adults. The disparity in recognition, with only 45% of adults linking alcohol to cancer compared to 89% for tobacco, indicates a gap in public awareness that may hinder prevention efforts.

Recent policy changes, including the removal of specific federal drinking limits in January 2025 and the Surgeon General's 2025 advisory for warning labels, reflect ongoing debates about how to address alcohol as a carcinogen. With alcohol classified as a Group 1 carcinogen and linked to biological mechanisms such as DNA damage and hormonal changes, the study's call for reduced consumption aligns with broader public health goals. The findings provide a basis for evaluating future interventions and public education strategies aimed at mitigating this preventable cause of cancer mortality.

Timeline

Among females aged 55 and older, colorectal cancer was the third most common alcohol-attributable cause of death in 2023, after breast and liver cancers.

What's New

Additional reporting noted that 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. It was also reported that while overall cancer mortality has declined, the percentage of cancer deaths proportionally attributable to alcohol doubled in people 20 and older over the last 33 years. Further statements indicated that while the study does not have the data to show people should completely stop drinking alcohol, the message is that lowering alcohol use to the lowest possible level will be best for health.

Additional context included that alcohol is closely related to liver cancer mortality and that in women, the leading cause was alcohol-related breast cancer. It was also stated that what was previously thought about alcohol continues to be eroded as modern science has shown there is no safe amount of alcohol consumption.

How Sources Differ

The Lancet Regional Health-Americas study by Chinmay T. Jani et al. analyzed alcohol-attributable cancer mortality trends in the U.S. from 1990 to 2023 using data from the Global Burden of Disease database.

On the topic of colorectal cancer, Chinmay Jani noted it was the leading cause of alcohol-attributable cancer mortality in men aged 20 to 54 and second in women. reported that from 1990 to 2023, the alcohol-attributable cancer mortality rate increased by 14.3% among males and declined by 16% among females.

Concerning colorectal cancer, Chinmay Jani showed its status as a leading cause of alcohol-attributable mortality in younger adults.

Regarding colorectal cancer, Chinmay Jani emphasized its prominence in alcohol-attributable deaths for those aged 20 to 54. reported that the age-standardized mortality rate for alcohol-attributable cancer increased from 3.8 per 100,000 population in 1990 to 4.1 per 100,000 in 2023.

On colorectal cancer, Chinmay Jani stated it was the leading cause of alcohol-attributable cancer mortality in men and second in women aged 20 to 54. noted that the percentage of cancer deaths attributable to alcohol increased across most cancer types, age groups, and sexes between 1990 and 2023.

Regarding colorectal cancer, Chinmay Jani identified it as a leading cause of alcohol-attributable mortality in younger adults. reported that in 2023, the age-standardized mortality rate for alcohol-attributable cancer was 6.4 per 100,000 for males and 2.1 per 100,000 for females.