HHS cites “strong association” between drinking and increased cancer risk regardless of alcohol type.
Alcohol is the third-most preventable cause of cancer in the United States, after obesity and tobacco, according to a new advisory published by U.S. Surgeon General Vivek Murthy.
Alcohol consumption, regardless of the type of alcohol, is strongly associated with increased risk of developing cancer, according to the report. And although the risk of cancer increases with greater alcohol consumption, even consumption of one or fewer drinks per day may increase someone’s risk of developing breast, mouth, and throat cancers.
The Surgeon General recommended that Congress update the label on alcoholic beverages to warn that alcohol consumption causes several types of cancers, including breast cancer and colon cancer. The current label on alcohol warns of risks to pregnancies, operating cars or heavy machinery, and about unspecific “health problems.”
An advisory review of scientific research and evidence published by the Surgeon General in January 2025 concluded that consumption of alcohol increases a person’s risk of developing types of deadly cancer. The new recommendations align with the conclusions of several U.S. and international health organizations that rate alcohol as a highest-risk carcinogen, which was also noted by the U.S. National Toxicology Program as far back as 2000. Dr. Murthy also made key recommendations to promote awareness of alcohol consumption and increased cancer risk.
In his report, Dr. Murthy notes that alcohol use contributes to almost 100,000 cancer cases and about 20,000 cancer deaths each year in the United States. Current public health guidelines recommend consumption at or below one alcoholic drink a day for women and two for men. And although most cancer deaths are associated with drinking above those guideline amounts, breast, mouth, and throat cancers may increase with one drink per day or less.
The surgeon general’s report shows how alcohol increases one’s absolute risk of cancer. For example, the absolute risk of a woman developing alcohol-related breast cancer is about 11.3 percent for those who have less than one drink a week. That risk increases to 13.1 percent with one drink per day and rises to 15.3 percent with two drinks per day or 14 drinks each week.
Governments that have tried to warn citizens about alcohol’s carcinogenic properties have met resistance by alcohol trade and industry groups questioning the validity of studies and guidelines, such as in Canada and Ireland. The Surgeon General wrote that the conclusions in the advisory are based upon “comprehensive assessments of scientific evidence,” including reviews of observational studies, meta-analyses, and animal studies. The approaches to determining a causal relationship between alcohol and cancer were the same used to conclude that cigarette smoking causes lung cancer.
The Surgeon General identified four ways by which ethanol—a type of pure alcohol found in all alcoholic beverages—causes cancer. First, the body breaks down alcohol into acetaldehyde, a compound that causes cancer by binding to DNA and damaging it, leading to uncontrolled and tumorous growth. Alcohol also causes “oxidative stress” in the body, which increases inflammation and damages DNA, proteins, and lipids.
Third, carcinogens from other sources, especially from tobacco smoke, can dissolve in alcohol. Dissolved carcinogens are more easily absorbed and can cause mouth and throat cancer. Finally, alcohol alters hormone levels, which can impact breast cancer development as some forms of breast cancer grow in response to estrogen. Dr. Murthy noted in an interview that one of every six breast cancer cases is attributable to alcohol consumption.
International organizations have found strong associations between alcohol and cancer in humans regardless of the type of alcohol. The World Cancer Research Fund, the Centers for Disease Control, and the National Institute for Health agree that alcohol can cause at least seven types of cancer, including colorectum, esophagus, liver, mouth, throat, voice box, and breast cancer in women. The cancer research arm of the World Health Organization classified alcohol as the highest-risk carcinogen, ranking among tobacco, asbestos, and formaldehyde.
The annual 20,000 alcohol-related cancer deaths in America is almost double the number of annual alcohol-involved car crash deaths, yet a 2019 study found that less than half of Americans are aware that alcohol consumption increases cancer risk.
Along with updating the warning label on alcoholic beverages, Dr. Murthy recommended that the U.S. reassess recommended limits for alcohol consumption that account for new cancer research. He also proposed an expanded education and awareness campaign about alcohol and cancer, noting that alcohol consumption is a preventable cancer risk factor.
The Surgeon General recommended informing patients in clinical settings about alcohol consumption and increased cancer risk and promoting alcohol screening, brief intervention, and referral to treatment in those settings.
Dr. Murthy concluded his report with an argument for health warning labels as effective tools to increase awareness of health risks and to change behavior. For example, just two months of new labeling in Canada lead to a 10 percent population-wide increase in awareness about the association between alcohol and cancer.
While noting that the power to change the wording of the label lies with Congress, Dr. Murthy cited evidence that prominent, pictorial messages are more effective at influencing awareness and behavior than less conspicuous, text-only messages, suggesting that the form of the label, not just the language, will be reassessed in light of new evidence.
Alcohol consumption is ubiquitous in the U.S., especially since the COVID-19 pandemic, so although there is no “magic cutoff,” Dr. Murthy stated that “less is better when it comes to reducing your cancer risk.”
