Alcohol Use and Cancer
Most people know that heavy alcohol drinking can cause health problems. But many people might not know that drinking alcohol can raise their cancer risk.
Types of cancer linked to alcohol use
Alcohol is a known cause of cancers of the:
Alcohol may also increase the risk of cancer of the pancreas.
For each of these cancers, the risk increases with the amount of alcohol consumed.
Cancers of the mouth, throat, voice box, and esophagus: Alcohol use clearly raises the risk of these cancers. Drinking and smoking together raises the risk of these cancers far more than the effects of either drinking or smoking alone. This might be because alcohol can act as a solvent, helping harmful chemicals in tobacco to get inside the cells that line the digestive tract. Alcohol may also slow down these cells’ ability to repair damage to their DNA caused by chemicals in tobacco.
Liver cancer: Long-term alcohol use has been linked to an increased risk of liver cancer. Regular, heavy alcohol use can damage the liver, leading to inflammation. This, in turn, might raise the risk of liver cancer.
Colon and rectal cancer: Alcohol use has been linked with a higher risk of cancers of the colon and rectum. The evidence for such a link is generally stronger in men than in women, although studies have found the link in both sexes.
Breast cancer: Even a few drinks a week is linked with an increased risk of breast cancer in women. This risk may be especially high in women who do not get enough folate (a B vitamin) in their diet or through supplements. Alcohol can affect estrogen levels in the body, which may explain some of the increased risk. Drinking less alcohol may be an important way for many women to lower their risk of breast cancer.
Does the type of alcohol matter?
Ethanol is the type of alcohol found in alcoholic drinks, whether they are beers, wines, or liquors (distilled spirits). These drinks contain different percentages of ethanol, but in general a standard size drink of any type — 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor — contains about the same amount of ethanol (about half an ounce). Of course, larger or ‘stronger’ drinks can contain more ethanol than this.
Overall, the amount of alcohol consumed over time, not the type of alcoholic beverage, seems to be the most important factor in raising cancer risk. Most evidence suggests that it is the ethanol that increases the risk, not other things in the drink.
How does alcohol raise cancer risk?
The exact way alcohol affects cancer risk isn’t completely understood. In fact, there might be several different ways it can raise risk, and this might depend on the type of cancer.
Damage to body tissues: Alcohol can act as an irritant, especially in the mouth and throat. Cells that are damaged may try to repair themselves, which could lead to DNA changes in the cells that can be a step toward cancer.
In the colon and rectum, bacteria can convert alcohol into large amounts of acetaldehyde, a chemical that has been shown to cause cancer in lab animals.
Alcohol and its byproducts can also damage the liver, leading to inflammation and scarring. As liver cells try to repair the damage, they can end up with mistakes in their DNA, which could lead to cancer.
Effects on other harmful chemicals: Alcohol can act as a solvent, helping other harmful chemicals, such as those in tobacco smoke, enter the cells lining the upper digestive tract more easily. This might explain why the combination of smoking and drinking is much more likely to cause cancers in the mouth or throat than either smoking or drinking alone. In other cases, alcohol may slow the body’s ability to break down and get rid of some harmful chemicals.
Lower levels of folate or other nutrients: Folate is a vitamin that cells in the body need to stay healthy. Alcohol use can lower the body’s ability to absorb folate from foods. This problem can be worse in heavy drinkers, who often do not get enough nutrients such as folate in their diet. Low folate levels may play a role in the risk of breast and colorectal cancers.
Effects on estrogen or other hormones: Alcohol can raise body levels of estrogen, a hormone important in the growth and development of breast tissue. This could affect a woman’s risk of breast cancer.
Effects on body weight: Too much alcohol can add extra calories to the diet, which can contribute to weight gain in some people. Being overweight or obese is known to increase the risks of many types of cancer.
Along with these mechanisms, alcohol may contribute to cancer in other, as of yet unknown, ways.
Are there other long-term health effects from drinking alcohol?
Most people know about the short-term effects of drinking alcohol, such as its effects on mood, concentration, judgment, and coordination. But alcohol can also have longer-term health effects. These can vary a great deal from person to person.
For some people, alcohol is addictive. Drinking can become heavier over time, leading to serious health and social problems. Heavy drinkers who stop drinking suddenly can have physical withdrawal symptoms such as tremors, confusion, hallucinations, seizures, and other serious problems over the next few days. In some people these can be life-threatening. This doesn’t mean that heavy drinkers should not stop drinking. It does mean that heavy drinkers should talk with their health care team about the safest way to stop drinking.
Over time, heavy drinking can cause inflammation (hepatitis) and heavy scarring (cirrhosis) in the liver. This can lead to liver failure. Heavy drinking can also damage other organs, such as the pancreas and the brain, and can raise blood pressure.
In pregnant women, alcohol use, especially heavy drinking, may lead to birth defects or other problems in the fetus.
On the other hand, low to moderate alcohol use has been linked with a lower risk of heart disease. Low to moderate use is usually defined as 1 or 2 drinks a day for a man or 1 drink a day for a woman. The potential benefit of lowering heart disease risk has to be weighed against the other possible health risks for each person. It’s also important to know that the risk of heart disease and stroke actually increases with heavy drinking.
What does the American Cancer Society recommend?
As part of its guidelines on nutrition and physical activity for cancer prevention, the American Cancer Society recommends that people who drink alcohol limit their intake to no more than 2 drinks per day for men and 1 drink a day for women. The recommended limit is lower for women because of their smaller body size and because their bodies tend to break down alcohol more slowly. These daily limits do not mean it’s safe to drink larger amounts on fewer days of the week, which can still lead to health, social, and other problems.
Alcohol use has been linked to several types of cancer and other health risks, but this is complicated by the fact that low-to-moderate alcohol intake has been linked with a lower risk of heart disease. Still, lowering the risk of heart disease is not a compelling reason for adults who don’t drink alcohol to start. There are many ways to reduce heart disease risk, including avoiding smoking, eating a diet low in saturated and trans fats, staying at a healthy weight, staying physically active, and controlling blood pressure and cholesterol.
According to the 2010 US Dietary Guidelines for Americans, some groups of people should not drink alcoholic beverages at all. These include:
- Children and teens
- People who cannot limit their drinking or who are recovering from alcoholism
- Women who are or may become pregnant
- People who plan to drive or operate machinery
- People who take part in other activities that require attention, skill, or coordination or in situations where impaired judgment could cause injury or death
- People taking prescription or over-the-counter medicines that interact with alcohol
- People with certain medical conditions (such as liver disease or pancreatitis)
Alcohol use during and after cancer treatment
As noted above, many studies have found a link between alcohol intake and the risk of developing certain cancers. But it is not clear whether alcohol use after treatment might increase the risk of these cancers coming back (recurring). In theory, it’s possible that alcohol use might raise the risk of recurrence. For example, alcohol can increase the levels of estrogens in the body, which might increase the risk for breast cancer recurrence. But there is no strong evidence from studies to support this.
In people who have already been diagnosed with cancer, alcohol intake could also affect the risk of developing a new cancer.
There are some cases during cancer treatment in which alcohol clearly should be avoided. For example, alcohol – even in very small amounts – can irritate mouth sores caused by some cancer treatments, and can even make them worse. Alcohol can also interact with some drugs used during cancer treatment, which might increase the risk of harmful side effects. It’s important to talk with your doctor about this if you are being treated for cancer.
But for people who have completed cancer treatment, the effects of alcohol on cancer recurrence risk are largely unknown. It’s important to discuss this with your doctor. Factors that can be important include the type of cancer, your risk of recurrence, the treatment(s) you’ve had, your overall health, and the other possible risks and benefits of drinking.
Along with the American Cancer Society, other sources of patient information and support include:
For more on the link between alcohol and cancer
American Institute for Cancer Research (AICR)
Toll-free number: 1-800-843-8114
Helps people make informed choices about body weight, physical activity, and diet (including alcohol use) that may reduce their risk of cancer.
Has a wide variety of fact sheets and other information about the health problems linked to alcohol use.
For help with and information about alcohol problems
Alcoholics Anonymous (AA)
Phone number: 1-212-870-3400
Makes referrals to local AA groups and provides informational materials on the AA
program. Many cities and towns also have a local AA office listed in the phone book.
Toll-free number: 1-888-4AL-ANON (1-888-425-2666)
Web site: www.al-anon.alateen.org
Makes referrals to local Al-Anon groups, which are support groups for spouses and other significant adults in an alcoholic person's life. Also makes referrals to Alateen groups, which offer support to children of alcoholics.
National Council on Alcoholism and Drug Dependence (NCADD)
Toll-free number: 1-800-NCA-CALL (1-800-622-2255)
Provides telephone numbers of local NCADD affiliates (who can provide information on local treatment resources) and educational materials on alcoholism.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Phone number: 1-301-443-3860
We site: www.niaaa.nih.gov
Publications available from NIAAA feature information on a wide variety of topics, including fetal alcohol syndrome, the dangers of mixing alcohol with medications, family history of alcoholism, and preventing underage drinking.
Substance Abuse and Mental Health Services Administration (SAMHSA)
Substance Abuse Treatment Facility Locator
Toll-free number: 1-800-662-HELP (1-800-662-4357)
Provides alcohol and drug information and treatment referral assistance. (Part of the US Department of Health and Human Services.)
*Inclusion on this list does not imply endorsement by the American Cancer Society.
American Cancer Society. Cancer Facts & Figures 2014. Atlanta, Ga: American Cancer Society; 2014.
Allen NE, Beral V, Casabonne D, et al. Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst. 2009;101:296-305.
Centers for Disease Control & Prevention (CDC). Alcohol and Public Health: Frequently Asked Questions. 2013. Accessed at www.cdc.gov/alcohol/faqs.htm on December 9, 2013.
Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA. 2011;306:1884-1890.
International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 96: Alcohol Consumption and Ethyl Carbamate. 2010. Accessed at http://monographs.iarc.fr/ENG/Monographs/vol96/mono96.pdf on December 9, 2013.
Kushi LH, Doyle C, McCullough M, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: Reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62:30-67.
Lew JQ, Freedman ND, Leitzmann MF, et al. Alcohol and risk of breast cancer by histologic type and hormone receptor status in postmenopausal women: The NIH-AARP Diet and Health Study. Am J Epidemiol. 2009;170:308-317.
Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62:243-274.
US Department of Agriculture and US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: US Government Printing Ofice, December 2010. Accessed at www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm on January 3, 2014.
World Cancer Research Fund / American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. Washington DC: AICR, 2007.
Last Medical Review: February 12, 2014 Last Revised: February 12, 2014