What to know

• You can lower your risk for cancer by drinking less alcohol or not drinking at all.
• All alcoholic drinks, including red and white wine, beer, and liquor, are linked with cancer.

Overview

Drinking alcohol raises your risk of getting several kinds of cancer:

• Mouth and throat.
• Voice box (larynx).
• Esophagus.
• Colon and rectum.
• Liver.
• Breast (in women).

Some studies show that drinking three or more alcoholic drinks per day increases the risk of stomach and pancreatic cancers. Drinking alcohol may also increase prostate cancer risk. All alcoholic drinks—including red and white wine, beer, and liquor—are linked with cancer. Drinking less alcohol is better for your health than drinking more.

Health advice for people who drink alcohol or are thinking of drinking alcohol

The Dietary Guidelines for Americans recommends that adults of legal drinking age (21 years or older) choose not to drink alcohol or to drink alcohol in moderation (2 drinks or less in a day for men, 1 drink or less in a day for women).

If you're taking prescription medicine, including cancer treatment, ask your doctor if it's safe to drink alcohol.

Frequently asked questions

Why does drinking alcohol raise cancer risk?

When you drink alcohol, your body breaks it down into a chemical that damages your DNA. DNA is the cell's "instruction manual" that controls how a cell grows and does its job. When DNA is damaged, a cell can grow out of control and become cancer. For more information, see the National Cancer Institute's Alcohol and Cancer Risk web page.

How many people die from cancers linked to alcohol use?

Each year, about 20,000 adults in the United States die from alcohol-related cancers. It is estimated most of these deaths may have been avoided if all adults had followed the recommended limits on alcohol use in the Dietary Guidelines for Americans instead of drinking above them.

How can I lower my cancer risk?

You can drink less alcohol or choose not to drink. Talk with your doctor if you have concerns about your drinking.

How can doctors help their patients?

Doctors can tell their patients that drinking alcohol increases cancer risk. Doctors can ask adult patients about their alcohol use and offer behavioral counseling to those who drink excessively.

How can communities develop environments that reduce alcohol-related cancer risk?

Communities can create social and physical environments that support people in drinking less alcohol.

Alcohol is the common term for ethanol or ethyl alcohol, a chemical substance found in alcoholic beverages such as beer, hard cider, malt liquor, wines, and distilled spirits (liquor). Alcohol is produced by the fermentation of sugars and starches by yeast. Alcohol is also found in some medicines, mouthwashes, and household products (including vanilla extract and other flavorings). This fact sheet focuses on cancer risks associated with the consumption of alcoholic beverages.

According to the National Institute on Alcohol Abuse and Alcoholism, a standard alcoholic drink in the United States contains 14.0 grams (0.6 ounces) of pure alcohol. Generally, this amount of pure alcohol is found in

• 12 ounces of beer
• 8–9 ounces of malt liquor
• 5 ounces of wine
• 1.5 ounces, or a "shot," of 80-proof distilled spirits (liquor)

These amounts are used by public health experts in developing health guidelines about alcohol consumption and to provide a way for people to compare the amounts of alcohol they consume. However, they may not reflect the typical serving sizes people may encounter in daily life.

According to the federal government’s Dietary Guidelines for Americans, 2020–2025, individuals who do not drink alcohol should not start drinking for any reason. The Dietary Guidelines also recommends that people who drink alcohol do so in moderation by limiting consumption to 2 drinks or less in a day for men and 1 drink or less in a day for women. Heavy alcohol drinking is defined as having 4 or more drinks on any day or 8 or more drinks per week for women and 5 or more drinks on any day or 15 or more drinks per week for men.

There is a strong scientific consensus that alcohol drinking can cause several types of cancer. In its Report on Carcinogens, the National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen.

The evidence indicates that the more alcohol a person drinks—particularly the more alcohol a person drinks regularly over time—the higher his or her risk of developing an alcohol-associated cancer. Even those who have no more than one drink per day and binge drinkers (those who consume 4 or more drinks for women and 5 or more drinks for men in one sitting) have a modestly increased risk of some cancers. Based on data from 2009, an estimated 3.5% of cancer deaths in the United States (about 19,500 deaths) were alcohol related.

Clear patterns have emerged between alcohol consumption and the development of the following types of cancer:

• Head and neck cancer: Moderate to heavy alcohol consumption is associated with higher risks of certain head and neck cancers. Moderate drinkers have 1.8-fold higher risks of oral cavity (excluding the lips) and pharynx (throat) cancers and 1.4-fold higher risks of larynx (voice box) cancers than non-drinkers, and heavy drinkers have 5-fold higher risks of oral cavity and pharynx cancers and 2.6-fold higher risks of larynx cancers. Moreover, the risks of these cancers are substantially higher among persons who consume this amount of alcohol and also use tobacco.

• Esophageal cancer: Alcohol consumption at any level is associated with an increased risk of a type of esophageal cancer called esophageal squamous cell carcinoma. The risks, compared with no alcohol consumption, range from 1.3-fold higher for light drinking to nearly 5-fold higher for heavy drinking. In addition, people who inherit a deficiency in an enzyme that metabolizes alcohol have been found to have substantially increased risks of esophageal squamous cell carcinoma if they consume alcohol.

• Liver cancer: Heavy alcohol consumption is associated with approximately 2-fold increased risks of two types of liver cancer (hepatocellular carcinoma and intrahepatic cholangiocarcinoma).

• Breast cancer: Epidemiologic studies have consistently found an increased risk of breast cancer with increasing alcohol intake. Pooled data from 118 individual studies indicates that light drinkers have a slightly increased (1.04-fold higher) risk of breast cancer, compared with nondrinkers. The risk increase is greater in moderate drinkers (1.23-fold higher) and heavy drinkers (1.6-fold higher). An analysis of prospective data for 88,000 women participating in two US cohort studies concluded that for women who have never smoked, light to moderate drinking was associated with a 1.13-fold increased risk of alcohol-related cancers (mostly breast cancer).
• Colorectal cancer: Moderate to heavy alcohol consumption is associated with 1.2- to 1.5-fold increased risks of cancers of the colon and rectum compared with no alcohol consumption.

Numerous studies have examined whether there is an association between alcohol consumption and the risk of other cancers. For cancers of the ovary, prostate, stomach, uterus, and bladder, either no association with alcohol use has been found or the evidence for an association is inconsistent. However, evidence is accumulating that alcohol consumption is associated with increased risks of melanoma and of prostate and pancreatic cancers.

Alcohol consumption has also been associated with decreased risks of kidney cancers, and non-Hodgkin lymphoma in multiple studies. However, any potential benefits of alcohol consumption for reducing the risks of some cancers are likely outweighed by the harms of alcohol consumption. In fact, a recent study that included data from more than 1000 alcohol studies and data sources, as well as death and disability records from 195 countries and territories from 1990 to 2016, concluded that the optimal number of drinks to consume per day to minimize the overall risk to health is zero. That study did not include data on kidney cancer or non-Hodgkin lymphoma.

Alcohol consumption may also be associated with an increased risk of second primary cancers. For example, a meta-analysis of data from 19 studies showed that among patients with cancer of the upper aerodigestive tract (UADT)—which includes the oral cavity, pharynx, larynx, and esophagus—for every 10 grams of alcohol consumed per day before the first UADT cancer diagnosis there was a 1.09-fold higher risk of a second primary UADT cancer. It is less clear whether alcohol consumption increases the risk of second primary cancers at other sites, such as the breast.

Researchers have hypothesized multiple ways that alcohol may increase the risk of cancer, including:

• metabolizing (breaking down) ethanol in alcoholic drinks to acetaldehyde, which is a toxic chemical and a probable human carcinogen; acetaldehyde can damage both DNA (the genetic material that makes up genes) and proteins
• generating reactive oxygen species (chemically reactive molecules that contain oxygen), which can damage DNA, proteins, and lipids (fats) in the body through a process called oxidation
• impairing the body’s ability to break down and absorb a variety of nutrients that may be associated with cancer risk, including vitamin A; nutrients in the vitamin B complex, such as folate; vitamin C; vitamin D; vitamin E; and carotenoids
• increasing blood levels of estrogen, a sex hormone linked to the risk of breast cancer

Alcoholic beverages may also contain a variety of carcinogenic contaminants that are introduced during fermentation and production, such as nitrosamines, asbestos fibers, phenols, and hydrocarbons.

The mechanisms by which alcohol consumption may decrease the risks of some cancers are not understood and may be indirect.

Epidemiologic research shows that people who use both alcohol and tobacco have much greater risks of developing cancers of the oral cavity, pharynx (throat), larynx, and esophagus than people who use either alcohol or tobacco alone. In fact, for oral and pharyngeal cancers, the risks associated with using both alcohol and tobacco are multiplicative; that is, they are greater than would be expected from adding the individual risks associated with alcohol and tobacco together.

A person’s risk of alcohol-related cancers is influenced by their genes, specifically the genes that encode enzymes involved in metabolizing (breaking down) alcohol.

For example, one way the body metabolizes alcohol is through the activity of an enzyme called alcohol dehydrogenase, or ADH, which converts ethanol into the carcinogenic metabolite acetaldehyde, mainly in the liver. Recent evidence suggests that acetaldehyde production also occurs in the oral cavity and may be influenced by factors such as the oral microbiome.

Many individuals of East Asian descent carry a version of the gene for ADH that codes for a "superactive" form of the enzyme. This superactive ADH enzyme speeds the conversion of alcohol (ethanol) to toxic acetaldehyde. Among people of Japanese descent, those who have this form of ADH have a higher risk of pancreatic cancer than those with the more common form of ADH.

Another enzyme, called aldehyde dehydrogenase 2 (ALDH2), metabolizes toxic acetaldehyde to non-toxic substances. Some people, particularly those of East Asian descent, carry a variant of the gene for ALDH2 that encodes a defective form of the enzyme. In people who produce the defective enzyme, acetaldehyde builds up when they drink alcohol. The accumulation of acetaldehyde has such unpleasant effects (including facial flushing and heart palpitations) that most people who have inherited the ALDH2 variant are unable to consume large amounts of alcohol and therefore have a low risk of developing alcohol-related cancers.

However, some individuals with the defective form of ALDH2 can become tolerant to the unpleasant effects of acetaldehyde and consume large amounts of alcohol. Epidemiologic studies have shown that such individuals have a higher risk of alcohol-related esophageal cancer, as well as of head and neck cancers, than individuals with the fully active enzyme who drink comparable amounts of alcohol. These increased risks are seen only among people who carry the ALDH2 variant and drink alcohol—they are not observed in people who carry the variant but do not drink alcohol.

The plant secondary compound resveratrol, found in grapes used to make red wine and some other plants, has been investigated for many possible health effects, including cancer prevention. However, researchers have found no association between moderate consumption of red wine and the risk of developing prostate cancer or colorectal cancer.

Most of the studies that have examined whether cancer risk declines after a person stops drinking alcohol have focused on head and neck cancers and on esophageal cancer. In general, these studies have found that stopping alcohol consumption is not associated with immediate reductions in cancer risk. The cancer risks eventually decline, although it may take years for the risks of cancer to return to those of never drinkers.

For example, ex-drinkers still had higher risks of oral cavity and pharyngeal cancers than never drinkers even 16 years after they stopped drinking alcohol, although it was lower than before they stopped drinking. One study estimated that it would take more than 35 years for the higher risks of laryngeal and pharyngeal cancers associated with alcohol consumption to decrease to the level of never drinkers.

As with most questions related to a specific individual’s cancer treatment, it is best for patients to check with their health care team about whether it is safe to drink alcohol during or immediately following chemotherapy treatment. The doctors and nurses administering the treatment will be able to give specific advice about whether it is safe to consume alcohol while undergoing specific cancer treatments.

More than half of adults in the United States drink alcohol. Alcohol use increases the risk of cancers of the female breast, liver, colon, rectum, mouth, pharynx, larynx, and esophagus. There are evidence-based community strategies and clinical strategies that work to reduce excessive alcohol use.

Cancer Risks Linked with Alcohol Use

Excessive alcohol use is associated with many health and social problems. Alcohol is a carcinogen (something that can cause cancer). Regardless of drink type (beer, wine, or liquor), the risk of cancer increases with the number of drinks consumed, and even one drink a day increases the risk of developing cancers of the female breast, mouth, and esophagus. Reducing alcohol use may reduce the risk of cancer.

How Is Alcohol Use Defined?

Moderate alcohol use is defined as limiting intake to one drink or less in a day for women and two drinks or less in a day for men.

Excessive alcohol use includes binge drinking, heavy drinking, any alcohol use by individuals under the age of 21 years (minimum legal drinking age), and any alcohol use by pregnant women.

Binge drinking is a pattern of alcohol use that generally brings blood alcohol concentration levels to 0.08% or more. This is usually defined as consuming four drinks or more for women, or five drinks or more for men, on an occasion.

Heavy drinking is defined as consuming eight drinks or more per week for women and 15 drinks or more per week for men.

Source: Frequently Asked Questions About Alcohol and Public Health

What Are the Guidelines for Alcohol Use?

According to the Dietary Guidelines for Americans,—

• To reduce the risk of alcohol-related harms, adults of legal drinking age can choose not to drink, or to drink in moderation by limiting intake to two drinks or less in a day for men or one drink or less in a day for women, on days when alcohol is consumed.
• Don’t drink at all if you are younger than age 21, pregnant or may be pregnant, have health problems that could be made worse by drinking, or are engaging in activities for which alcohol is dangerous (like driving).
• The Guidelines also do not recommend that you start drinking for any reason. Even moderate intake is associated with increased risks, including some cancers.