Alcohol and cancer: It's a complicated relationship
April 29, 2025
It's no secret that America has a strained relationship with alcohol. Drinking is normalized in our culture: You’ll find cocktails at all types of gatherings, from sports events and brunch with friends to grieving a loss or celebrating a big promotion.
Though 62% of U.S. adults say they drink, less than half know that alcohol use increases the risk of cancer. In the U.S. Surgeon General’s 2025 Advisory on Alcohol and Cancer Risk, seven specific types of cancer are shown to be associated with alcohol use: breast (in women), liver, mouth, throat, voice box, esophageal, and colorectal cancers.
Most people know that heavy drinking, especially long term, is bad for our health but moderate drinking is left to interpretation. How much is too much? What’s the tipping point? Confusing the matter further is past research suggesting that moderate drinking may have health benefits.
The Surgeon General’s Advisory should serve as a wake-up call to people about the cancer risks associated with drinking, empowering you with knowledge about personal risks – modifiable and not.
How much drinking is OK?
A standard drink in the U.S. is 14 grams of alcohol. That equals 5 fluid ounces of wine, 12 fluid ounces of beer, or 1.5 fluid ounces of liquor. The National Institute on Alcohol Abuse and Alcoholism recommends limiting consumption:
- Women: One drink or less a day
- Men: Two drinks or less a day
The rate at which alcohol is eliminated from the body is different in men and women. In general, it takes fewer drinks for a woman to become intoxicated, and it takes longer for her to eliminate the alcohol.
Heavy drinking carries the most risk of cancer and other serious illnesses such as heart disease. Even lower levels of drinking may increase risks of cancer, stroke, or premature death in susceptible individuals.
What is the link between alcohol and cancer?
Research suggests several ways that alcohol-containing beverages can contribute to cancer.
Hormone changes
Alcohol interferes with the endocrine system, causing stress responses, inflammation, and brain-body communication issues that disrupt hormone levels. Estrogen, the female sex hormone, can contribute to the most common type of breast cancer.
Reactive oxygen species
Drinking causes inflammation, which is the body’s response to a threat, such as a virus or harmful substances like alcohol. Reactive oxygen species (free radicals) are unstable molecules that are generated in response to inflammation.
Free radicals increase oxidative stress, which is an imbalance of harmful free radicals and helpful antioxidants. That imbalance can lead to cell mutations in the DNA. Alcohol use sends oxidative stress into overdrive, leading to rampant cell changes and overgrowth that can result in cancerous tumors.
Obesity
Although some types of cancer are associated directly with alcohol, such as head and neck cancer, most of the cancers associated with drinking are also associated with obesity, making it difficult to know which factor is more important.
Drinking alcohol adds a lot of empty calories – a 5-fluid-ounce glass of wine has about 130 calories, and a 12-ounce craft beer may have 170-350 calories. Regularly drinking non-nutritious, unnecessary calories can lead to weight gain and obesity, even if you eat a healthy diet and exercise.
Obesity is associated with an increased risk of breast cancer as well as many other cancer types, including breast, colon, esophageal, and liver cancers – all of which were noted in the Surgeon General’s Advisory.
Diabetes is a major contributor to obesity and to steatotic liver disease (fatty liver disease), a condition in which excess fat stored in the liver causes cirrhosis and inflammation. People who drink heavily and who also have obesity and diabetes face a higher risk of liver disease – and likely a higher risk of liver cancer.
Drinking also complicates cancer treatment. Alcohol use is not recommended for people who are taking chemotherapy, immunotherapy, or hormone therapy because it can make the drugs less effective. If a patient has liver damage, we cannot safely give the recommended dose of cancer medications because they are processed through the liver.
Breast cancer
Of all the cancers mentioned in the Surgeon General’s Advisory, breast cancer has the most data associated with alcohol. About 100 observational studies have shown that alcohol is a risk factor for this type of cancer. About 16% of breast cancer cases globally in 2019 were alcohol-related, and an estimated 60% of all alcohol-related cancer deaths in women are from breast cancer.
Breast cancer is common – one in eight women will have it in their lifetime. Having one or fewer drinks a day increases the risk by 5% and having one drink a day brings a 7%-10% increased risk. Women who have two to three drinks a day face a 20% increase in risk compared with non-drinkers.
Drinking can be particularly risky for women who choose hormone-replacement therapy after menopause. Research suggests that having one to two alcoholic drinks per day can nearly triple a woman’s risk of breast cancer compared with non-drinking peers who do not take hormone-replacement therapy.
Stories of strength and hope
DeLisa Johnigarn, Janeye Pritchard, and Catherine Spencer were at different points in life when they were diagnosed with breast cancer, but each chose the specialized care available at UT Southwestern Harold C. Simmons Comprehensive Cancer Center. And all three became breast cancer survivors.
Liver cancer and fatty liver disease
Alcohol and obesity both cause fat to accumulate in the liver – and the liver damage caused by these factors is nearly indistinguishable. About 30%-40% of U.S. adults have nonalcoholic fatty liver disease, and women are more prone to it.
Serious liver injury occurs in about 20% of people who either drink heavily or develop diabetes and obesity. Research conducted at UT Southwestern showed in 2008 the first gene variant, PNPLA3, proven to increase this risk. Gene variants may likely contribute to an increased risk of liver cancer in the setting of environmental triggers such as obesity.
We recently conducted a research study with eight other institutions among people with severe liver injury caused by drinking. Few health problems other than poisoning are more lethal – some patients who develop severe alcoholic hepatitis have a 25% mortality rate in the first 90 days, which is higher than acute leukemia, heart attack, and most cancers. Our research shows that prednisone, a common anti-inflammatory medication, can reduce the mortality rate in these patients to about 10%.
UT Southwestern researchers also contributed to a 2024 consensus statement in Nature Reviews calling for recommendations to improve future clinical trials of alcohol use disorder and liver disease by including more multidisciplinary experts and addressing stigmas associated with alcoholism.
Our researchers have received funding from the National Institute on Alcohol Abuse and Alcoholism for a new study on treatment of acute liver injury associated with alcohol use that will begin in July. The average age of patients with this condition has dropped from 51 to 43 in the past decade – we are even seeing it among people in their mid-20s. Our goal is to understand what impact alcohol cessation treatment can have on these patients’ short- and long-term survival.
Related reading: Holiday drinking and your heart: When should it be last call for alcohol?
Oral and digestive cancers
Alcohol can cause cellular changes throughout the mouth, throat, and digestive system. Because alcohol breaks down quickly, any tissue it touches is at risk of cell damage, which increases cancer risk:
- Mouth: Among people who have one drink daily, the relative risk of mouth cancer increases by 40% compared to those who don’t drink. The risk declines when people quit drinking.
- Throat: The risk of throat cancer starts to increase when people drink one or fewer drinks per day.
- Esophageal: Alcohol cessation or reduction decreases the risk of esophageal cancer and mouth cancer. Light drinkers have a 1.3-fold higher risk compared with non-drinkers, and heavy drinkers have a five-times greater risk.
- Voice box: Moderate drinkers have a 1.4-fold higher risk of laryngeal cancer, and heavy drinkers have more than double the risk.
- Colorectal: After alcohol is metabolized by the liver, it breaks down into metabolites, some of which are known to cause cell damage that can lead to colorectal cancer.
Sobriety is trending
After a 22% increase in alcohol-associated liver disease and a 25% increase in alcohol-related deaths in the U.S. during the height of the pandemic, a wave of sober-curiosity took hold among young adults in the U.S. Just under 23% of teens report having used alcohol in 2021 compared with over 50% in 1991. Organizations such as One Year No Beer and movements including Dry January and Sober October encourage people to embrace periods of not drinking or avoiding it entirely. They are creating communities that focus on having fun without drinking and feeling better in the process.
Positive changes
Along with reduced risks of certain cancers, you can expect many other positive changes when you quit drinking, such as:
- Weight loss
- Lower blood pressure
- Less inflammation
- Better sleep
- Lower levels of anxiety and depression
- Increased energy
- Less time hung over, with more time to spend with loved ones
Get the support you need to quit
Alcohol use, particularly heavy drinking, is common among patients with cancer. Receiving that diagnosis is incredibly stressful for many patients, and dealing with treatment on top of regular life can become emotionally taxing. Using alcohol to escape these feelings can have detrimental effects on your personal health, relationships, profession, and even cancer treatment.
UT Southwestern has a robust Addiction Medicine department, staffed by specialized psychologists and experts who help patients here and at Parkland Health minimize withdrawal symptoms and quit drinking. William P. Clements Jr. University Hospital offers inpatient and outpatient alcohol detoxification services.
Talk with a doctor about your alcohol use and be honest in your answers. We will not judge you. The answers you give can help you build a longer, healthier life.
To discuss your cancer risk or your relationship with alcohol, schedule an appointment by calling 214-645-8300 or request an appointment online.
