Alcohol-associated cancer deaths have doubled in the United States, disproportionately affecting men and those aged 55 or older, according to the results of an observational study presented at the 2025 ASCO Annual Meeting.1 Over the study period of 30 years, proportional mortality rates increased for all cancer types associated with alcohol use for both sexes and in all age groups studied.
“We need to have a focused effort and create awareness to reduce the rising impact of alcohol-associated cancer mortality,” said lead study author Chinmay T. Jani, MBBS, Chief Fellow, Hematology and Oncology, University of Miami, Sylvester Comprehensive Cancer Center.
Background
Alcohol metabolism produces acetaldehyde, which is a tumor carcinogen that leads to DNA damage and oxidative stress. Alcohol also modulates hormonal pathways, particularly estrogen levels, which especially increases the burden for breast cancer. Heavy alcohol consumption can heighten mutagenic processes and impair tumor suppressor pathways.
“We need to have a focused effort and create awareness to reduce the rising impact of alcohol-associated cancer mortality.”
— CHINMAY T. JANI, MBBS
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Alcohol was associated with about 741,000 new cases of cancer globally in 2020, accounting for 4.1% of all cancer cases.2 Therefore, the U.S. Surgeon General issued an advisory in 2025 linking alcohol use to seven cancers: oral cavity, pharyngeal, laryngeal, esophageal, breast, liver, and colorectal.3
A population-based survey conducted in 2022 showed that about 39% of respondents (n = 5,937) were unaware of the effect of alcohol on cancer risk, according to recently published study findings.4 A 2019 survey from the American Institute for Cancer Research showed that up to 55% of respondents were unaware of the effects of alcohol on cancer risk.5
Study Design
The researchers sought to analyze the trends of alcohol-associated cancer mortality in the United States by age, sex, and state. They focused on data from the Global Burden of Disease database between 1990 and 2021, looking at absolute and proportional age-standardized mortality rates and crude mortality rates linked to heavy alcohol use. Then they analyzed annual percentage changes based on age-standardized mortality rates at state and national levels, and data were stratified by age groups and gender.
The Global Burden of Disease defined heavy alcohol use as consumption above the theoretical minimum risk exposure level, which is between 0 and 0.8 standard drinks per day for women and 0 to 1.1 standard drinks per day for men, where a standard drink contains 0.6 ounces of pure alcohol (ie, 12-ounce can of regular beer, a 5-ounce glass of wine, or 1.5 ounces of 80-proof spirits). The theoretical minimum risk exposure levels are age-dependent.
Study Results
Rates of alcohol-associated cancer deaths have doubled in the United States from 11,896 in 1990 to 23,207 in 2021. The age-standardized mortality rate increased from 3.9 to 4.1. The proportion of cancer deaths attributable to alcohol use increased by 70% for men and 15% for women. In 2021, the majority of alcohol-associated cancer deaths occurred among men (n = 16,555) and those in the 55-plus age group (n = 20,360), which was seven times higher than that seen in this age group in 1990.
The most common alcohol-associated cancers observed were liver cancer, with an age-standardized mortality rate of 1.28 (n = 7,408); colorectal cancer, with a rate of 0.84 (n = 4,687); and esophageal cancer, with a rate of 0.69 (n = 3,948). Proportional increases were seen across all cancer types, amounting to an increase of 47.8%. The highest increases by cancer type were in colorectal cancer (32%) and esophageal cancers (20.1%).
The most alcohol-associated cancer deaths were reported in the District of Columbia for both men and women, followed by Texas, but the fewest deaths were reported in Utah. A total of 44 states had increased age-standardized mortality rates for men, whereas 16 states had increased rates for women. The highest alcohol-associated cancer deaths by sex and state were in New Mexico, Oklahoma, and Tennessee for men and in West Virginia, New Mexico, and Tennessee for women.
For men aged 55 and older, cancer mortality rates were highest for liver cancer followed by esophageal and colorectal cancers; four cancer types were linked to an increase in mortality rates over the past decade. For women aged 55 and older, breast cancer was the most common alcohol-associated cancer followed by colorectal and liver cancers. Liver cancer was associated with the greatest increase in mortality rates for women over the past 20 years.
For men aged 20 to 54, colorectal cancer has recently surpassed liver cancer as the most common alcohol-associated cancer for this population, with esophageal cancer being the third most common. Reductions in mortality rates have been seen for most cancer types for this group in recent years. For women aged 20 to 54, the most common cancer types were the same as for the older female population.
Dr. Jani noted that although an overall reduction was observed in absolute mortality rates for alcohol-associated cancer deaths, proportional mortality rates are increasing for all cancers and all age/sex groups. Among all men between the ages of 20 and 54, 4.3% of all cancers were attributable to alcohol use in 1990 compared with 6.8% in 2021, amounting to a percentage change of 56.2%. For women in this age group, the rate in 1990 was 3.3% vs 3.6% in 2021, for a percentage change of 7.7%.
In the 55-plus age group, only the rates of liver cancers attributable to alcohol use decreased over time by –4.5% in men (40.3% in 1990 to 38.5% in 2021) and by –2.82% in women (14.1% in 1990 to 13.7% in 2021). The greatest increases seen were in breast cancer for men, from 5.9% in 1990 to 7.8% in 2021, for a change of 33.2%, and in colorectal cancer for women, from 2.7% in 1990 to 3.9% in 2021, for a change of 44.8%.
Otherwise, the total rate of cancers attributable to alcohol use was 2.4% for men in 1990 and 4.3% in 2021, for a percentage change of 75.9%. In women aged 55 or older, the rate in 1990 was 1.5% and 1.9% in 2021, amounting to a percentage change of 26.5%.
Next Steps
Based on these findings, the study authors suggested there may be a dose-response relationship according to age. “Do people drink in earlier age, and that accumulates carcinogens leading to cancer in older age?” Dr. Jani posited. He also suggested that further research should analyze the difference between types of alcohol and the underlying mechanisms for each type of cancer to identify higher-risk groups.
Finally, Dr. Jani noted that given the observational nature of the study, further inferences separate from risk factors cannot be made. More data on the histology and stage of each cancer type would also have made an impact on the takeaways from this study.
DISCLOSURE: Dr. Jani reported no conflicts of interest. For full disclosures of other study authors, visit coi.asco.org.
REFERENCES
1. Jani C, Edwards K, Paudel A, et al: Escalating impact of alcohol-related cancer mortality in the U.S.: A call for action. 2025 ASCO Annual Meeting. Abstract 10519. Presented May 31, 2025.
2. Rumgay H, Shield K, Charvat H, et al: Global burden of cancer in 2020 attributable to alcohol consumption: A population-based study. Lancet Oncol 22:1071-1080, 2021.
3. S. Department of Health and Human Services Office: Alcohol and cancer risk. Available at https://www.hhs.gov/surgeongeneral/reports-and-publications/alcohol-cancer/index.html. Accessed July 14, 2025.
4. Domgue JF, Yu R, Hawk E, et al: Public awareness of the association between alcohol and cancer in the US. JAMA Oncol. May 29, 2025 (early release online).
5. American Institute for Cancer Research: 2019 AICR Cancer Risk Awareness Survey. Available at https://www.aicr.org/assets/can-prevent/docs/2019-Survey.pdf. Accessed July 14, 2025.
EXPERT POINT OF VIEW
“The results of this study on alcohol-related cancer mortality are very consistent with recent reports by the National Academy of Medicine and the U.S. Surgeon General, indicating alcohol consumption is a leading preventable cause of cancer,” said Joseph A. Sparano, MD, FACP, the Ezra M. Greenspan, MD, Professor in Clinical Cancer Therapeutics; Chief of the Division of Hematology Oncology; and Deputy Director of the Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai in New York. “I’m especially concerned that this may be contributing to increasing cancer rates in individuals 50 years of age or younger observed over the past 20 years, and there is a need for greater awareness of the risks in adolescence and early adulthood.”
DISCLOSURE: Dr. Sparano reported no conflicts of interest.