Even moderate drinking carries a bigger cancer risk than you think

In addition, risk is not the same for everyone, and current alcohol policies rarely highlight the connection between drinking and cancer.

Large Review of Alcohol Use and Cancer Risk

To address these gaps, researchers from Florida Atlantic University's Charles E. Schmidt College of Medicine conducted an extensive systematic review to explore how different levels of alcohol use -- excessive, moderate and even mild -- affect cancer risk in U.S. adults.

They evaluated 62 studies, with sample sizes ranging from 80 people to nearly 100 million participants. The team also examined co-existing health conditions, such as obesity and chronic liver disease, which are known to increase risk, and they identified social and demographic groups that appear particularly vulnerable.

The findings, published in the journal Cancer Epidemiology, show that both how often people drink and how much alcohol they consume play a significant role in cancer risk. The association was especially strong for breast, colorectal, liver, oral, laryngeal, esophageal and gastric cancers. Alcohol use also made outcomes worse in conditions such as alcoholic liver disease, which was linked to more advanced liver cancer and lower survival rates.

Who Faces the Greatest Cancer Risk from Alcohol?

Higher levels of alcohol use were associated with greater risk, particularly among African Americans, people with genetic predispositions, and individuals with obesity or diabetes. Factors such as race, age, education and income further shaped exposure and vulnerability. As a result, lower-socioeconomic groups and some racial/ethnic communities experienced a disproportionate burden, even when their overall alcohol consumption was similar to or lower than that of other groups.

In contrast, people who followed American Cancer Society recommendations on alcohol and other healthy lifestyle behaviors had lower cancer risk and reduced mortality. This pattern underscores the value of integrated lifestyle changes rather than focusing on alcohol in isolation.

"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."

Beverage Type, Gender Differences, and Other Risk Multipliers

The review also suggested that the kind of alcoholic drink may sometimes matter. In several studies, white wine or beer was associated with higher risk of certain cancers, while liquor often was not. Clear gender differences emerged as well: in men, frequent drinking increased risk, whereas in women, episodic heavy drinking was especially concerning. Smoking further amplified alcohol-related cancer risk, though its impact varied by sex and by level of alcohol use. Other contributing factors included UV exposure (increasing melanoma risk in less-exposed sites) and family history, which can intensify the connection between alcohol and cancer.

Across the studies, additional risk factors included high or low BMI, low levels of 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," said Lewis S. Nelson, M.D., co-author, dean and chief of health affairs, Schmidt College of Medicine. "These effects are compounded by pre-existing health conditions, lifestyle choices, and genetic predispositions, all of which can accelerate cancer development."

Prevention, Policy, and a Broader View of Cancer Risk

Based on their findings, the researchers recommend targeted strategies to reduce alcohol-related cancer burden. These include tailored public health messages, stronger alcohol-related policies, and focused interventions for groups at highest risk.

"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.