There is growing evidence that the current U.S. dietary guidelines for alcohol consumption may be too high. The surgeon general’s warning about alcohol and cancer risk may add more weight to this perspective. So how much is too much? Well, the answer is not as precise as you might think, but all signs seem to point toward a less is more approach.
Recent studies reveal that increased alcohol consumption leads to a higher risk of depression, cancer, stroke, and premature death. While alcohol use is common among U.S. adults (72% of the population report having at least one drink per week), over half the population is not aware of the relationship between alcohol and cancer risk.
First the Facts
Alcohol is the third leading preventable cause of death in the U.S. after tobacco and obesity. In 2019, 96,730 cancer cases were related to alcohol consumption, adding up to over 1 million preventable cases in the U.S. within the last 10 years.
In the U.S., alcohol-related cancer deaths account for more deaths annually (about 20,000) than alcohol-associated traffic crash fatalities (about 13,500).
According to the National Cancer Institute, there is strong evidence that drinking alcohol can cause several types of cancer, including mouth, throat, larynx, esophageal, breast, liver, and colorectal cancer.
How much alcohol increases the risk of cancer?
In 2020, 741,300 cancer cases globally were attributed to alcohol consumption.
- 2 drinks or less daily—185,100 cases
- 2–4 drinks daily—209,800 cases
- 4–6 drinks daily—153,400 cases
- 6 drinks or more daily—192,900 cases
While risk is lower at lower levels of consumption, many more people drink 2 drinks or fewer per day, leading to a similar number of overall cancer cases at lower levels as higher levels of consumption. For certain cancers, however, research shows that cancer risk may start to increase around one or fewer drinks per day.
Around 83% of alcohol-related cancer deaths occur from consuming more than the 2020–2025 U.S. dietary guidelines (two drinks daily for men, one drink daily for women). What’s interesting is that the remaining 17% of deaths occurred within the recommended limit of consumption.
How does alcohol cause cancer?
Alcohol can damage cells and alter hormone levels, making it easier for carcinogens and other harmful pathogens to enter our bodies and cause further harm. How exactly does this process work? Check this out:
- Alcohol breaks down into a compound called acetaldehyde, which damages the body’s DNA. When DNA is damaged, a cell can grow uncontrollably and create a cancerous tumor.
- Alcohol induces what’s called oxidative stress, which further damages DNA and also negatively affects proteins and lipids in your body. Your cells become inflamed and weaken as a result of this stress, allowing for cancerous cells to form and multiply.
- Alcohol alters hormone levels, including estrogen. Unstable estrogen levels increase the risk of breast cancer.
- Alcohol makes it easier for your cells to absorb carcinogens, especially particles from tobacco smoke, which easily dissolve in alcohol. This means that your body more easily absorbs cancer-causing particles.
What are the next steps for providers and healthcare professionals?
While this is a lot of information, it’s important to recognize how this information affects recommendations, guidelines, and laws regarding alcohol consumption.
While we wait for these updates, further research, and more data, consider these tips for how to prepare for the road ahead:
- Update others on current research to increase awareness
- Re-assess recommendations and guidance
- Strengthen education about alcohol and its effects on the body
- Promote alcohol screenings into your practice or assessments
- Highlight alcohol consumption when discussing cancer prevention strategies
- Be aware of the risk when considering how much alcohol to drink
What resources can I use to get more informed or answer patient questions?
There are several great resources out there you can use for your practice, including AFMC’s Alcohol Use Disorder page, which includes managing patients’ high-risk consumption, knowing the facts, improving office systems, and educating patients and their families about alcohol use disorder.
Additionally, the National Institute on Alcohol Abuse and Alcoholism’s Rethinking Drinking page provides some great information that may make you re-evaluate the effects of drinking.
The Substance Abuse and Mental Health Services Administration manages a 24/7 national helpline available 365 days per year. They offer confidential help for a variety of health issues, including alcohol use disorder. Anyone needing assistance can simply call 1-800-662-HELP (4357).
Additionally, SAMHSA started the Talk. They Can Hear You. Underage Drinking Campaign, which helps community members, parents, caregivers, educators, and healthcare professionals get informed, be prepared, and take action to prevent underage drinking and other substance use.
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