Wellness Hub

The United States Surgeon General’s most recent report warns about the link between alcohol and cancer: globally, 741,300 cancer diagnoses were related to alcohol consumption in 2020.

This document aligns with the February report from the World Health Organization (WHO)’s European Region, “Alcohol health warning labels: a public health perspective for Europe,” which describes the increase in alcoholic beverage consumption, the lack of awareness, and the need to warn about this risk.

Logically, the less you drink, the lower the risk. However, the issue, according to the US official who is the country’s top health authority, is more complex.

People are drinking more and more, often exceeding two drinks a day—the threshold at which the risk of developing cancer significantly increases. Yet the data also reveal a concerning fact: 25% of global cancer cases occurred in people who reported drinking less than two drinks a day.

The report definitively concludes that the amount people drink matters and that other comorbidities may also play a role in cancer development. But the damage starts with the very act of drinking. According to the report, this means that perhaps we need to revise the guidance on the “allowed” two drinks a day for men and one for women.

In the United States, where over 90,000 alcohol‑related cancer cases are diagnosed each year, alcohol use is the third‑leading preventable cause of cancer, after tobacco use and obesity.

Despite clear evidence on the effect of alcohol use on cancer risk, there is a substantial gap in public understanding of this risk. The Surgeon General’s report reveals that only 45% of people believe that drinking alcoholic beverages increases cancer risk.

Latin America has high alcohol consumption per capita. This excessive use is a risk factor not only for cancer but also for:

Injuries
Risky sexual behavior
Infections
Cardiovascular disease
Liver disease

Approximately 35% of patients with alcohol use disorder (AUD) will develop some degree of chronic liver disease (steatohepatitis, fibrosis, cirrhosis, and/or hepatocellular carcinoma).

To determine if a causal link exists between a risk factor (a behavior, exposure, or characteristic) and a health outcome like cancer, scientists conduct comprehensive reviews of scientific evidence and apply proven scientific criteria, such as the Bradford‑Hill criteria.

According to the European report, health warning labels on alcoholic beverages are essential for raising awareness on the cancer risk associated with alcohol consumption. “This simple and inexpensive measure can empower consumers to make informed choices that can help reduce alcohol‑related harms,” says the document, underscoring the urgent need for mandatory, standardized labeling on alcoholic beverages.

A study conducted across 14 European Region countries that was included in the WHO/Europe report revealed a striking gap in awareness: only 15% of respondents knew that alcohol causes breast cancer, and just 39% were aware of its link to colon cancer. These cancers account for the highest proportion of alcohol‑related cancers in the European Union among women (breast cancer) and men (colon cancer).

The US Surgeon General’s report stresses that alcohol consumption increases the risk of at least seven types of cancer: mouth, throat, laryngeal, esophageal, breast, liver, and colorectal.

Why alcohol contributes to cancer development

Biological studies have proven that ethanol (the type of pure alcohol found in all alcoholic beverages) can cause cancer in at least four ways:

First, alcohol breaks down into acetaldehyde in the body. Acetaldehyde is a metabolite that causes cancer by binding to DNA and damaging it. When DNA is damaged, a cell can start to grow uncontrollably and create a cancerous tumor.
Second, alcohol produces reactive oxygen species, which increase inflammation and can damage DNA, proteins, and lipids in the body through a process called oxidation.
Third, alcohol alters hormone levels (including estrogen), which can play a role in the development of breast cancer.
Fourth, carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, facilitating their absorption by the body and increasing the risk of mouth and throat cancer.

While the causal link between alcohol consumption and cancer has been firmly established, more research is needed on the potential effect of alcohol consumption on increased cancer risk in other parts of the body, such as the skin, prostate, pancreas, and stomach.

More research is also needed to determine how specific alcohol use patterns (e.g., binge drinking versus non‑binge drinking) may affect cancer risk as well as how consumption at specific ages and during certain developmental periods, such as adolescence and adulthood, may influence cancer risk.