Frequency and quantity of alcohol consumption influence cancer risk

As Americans gear up for the holiday season, new research offers a timely reminder to reflect on the long-term health effects of raising a celebratory glass – or two. Alcohol is known to increase the risk of several cancers even at moderate levels. Yet drinking remains widespread, and important questions persist about how both the frequency and amount of alcohol people consume shape their cancer risk.

Moreover, risks differ across groups, and existing alcohol policies rarely emphasize their link to cancer.

To help close these critical gaps, researchers from Florida Atlantic University's Charles E. Schmidt College of Medicine, conducted a comprehensive systematic review to better understand how different levels of alcohol consumption – excessive, moderate and even mild – affect cancer risk in U.S. adults.

They analyzed 62 studies with sample sizes ranging from 80 to nearly 100 million participants and examined comorbid conditions such as obesity and chronic liver disease, which heighten risk. They also identified vulnerable social and demographic groups.

The study results, published in the journal Cancer Epidemiology, confirm that both the frequency and quantity of alcohol consumption significantly influence cancer risk, especially for breast, colorectal, liver, oral, laryngeal, esophageal and gastric cancers. Alcohol also worsens outcomes, as seen with alcoholic liver disease – linked to more advanced liver cancer and lower survival.

Higher alcohol intake increased risk, especially for African Americans, those with genetic predispositions, and individuals with obesity or diabetes. Race, age, education, and income further influenced exposure and vulnerability, leaving lower-socioeconomic and some racial/ethnic groups disproportionately affected despite comparable or lower consumption.

Conversely, following American Cancer Society guidelines for alcohol and healthy lifestyle choices was associated with lower cancer risk and mortality, highlighting the need for integrated lifestyle changes.

"Across 50 studies in our review, higher alcohol consumption consistently raised cancer risk, with risk increasing as intake grows," said Lea Sacca, Ph.D., senior author and an assistant professor of population health in the Schmidt College of Medicine. "Factors like type of alcohol, age of first exposure, gender, race, smoking, family history, and genetics all influence risk. Certain groups – older adults, socioeconomically disadvantaged individuals, and those with comorbidities – are especially vulnerable. Heavy, daily or binge drinking is strongly linked to multiple cancers, highlighting the importance of moderation and following cancer prevention guidelines."

Findings also revealed that the type of beverage may matter in some cases – for example, white wine or beer was linked to higher risk of certain cancers, while liquor often was not. Gender differences were also observed: frequent drinking increased risk in men, while episodic heavy drinking posed higher risk in women. Smoking amplified alcohol-related cancer risk, though effects varied by sex and drinking level. Additional factors included UV exposure (increasing melanoma risk in less-exposed sites) and family history, which can strengthen the link between alcohol and cancer.

Additional risk factors identified across studies included high or low BMI, low physical activity, carcinogenic infections (e.g. hepatitis B and C virus, HPV, HIV or H. pylori, a bacterium that infects the stomach lining), poor diet, hormone use, and specific hair or eye color.

Biologically, alcohol can damage DNA through acetaldehyde, alter hormone levels, trigger oxidative stress, suppress the immune system, and increase carcinogen absorption. These effects are compounded by pre-existing health conditions, lifestyle choices, and genetic predispositions, all of which can accelerate cancer development."

Lewis S. Nelson, M.D., co-author, dean and chief of health affairs, Schmidt College of Medicine

The researchers suggest targeted strategies such as tailored public health messaging, strengthened alcohol policies, and focused interventions for high-risk groups, which could meaningfully reduce alcohol-related cancer burden. 

"Our findings undersore that alcohol-related cancer risk is not driven by alcohol alone, but by a complex interpaly of biological, behavioral and social factors," said Maria Carmenza Mejia, M.D., co-author and a professor of population health in the Schmidt College of Medicine. "Recognizing how these forces intersect – shaping exposure, vulnerability and long-term health outcomes – is essential for building a more accurate understanding of cancer risk. This broader perspective reminds us that effective prevention goes beyond reducing alcohol consumption; it requires addressing the environments, habits and underlying health conditions that magnify its impact."

Study co-authors are FAU medical students Isabella Abraham; Gabriella Dasilva; Kayla Ernst; Alexandra Campson; Alana Starr; Christine Kamm; Morgan Decker; Sahar Kaleem; Nada Eldawy; and Paige Brinzo; and Tiffany Follin, medical liaison and outreach librarian, Schmidt College of Medicine; George Kosseifi, Case Western Reserve University; and Christine Ramdin, Ph.D., instructor, Department of Emergency Medicine, Rutgers New Jersey Medical School.