Yes. The World Health Organization's International Agency for Research on Cancer classifies alcohol in Group 1, "carcinogenic to humans", the same group as tobacco and asbestos [1, 2]. Alcohol causes at least seven cancers: mouth, throat (pharynx), larynx, oesophagus, liver, bowel and breast [1, 3]. The type of drink makes no difference and no safe amount has been found for cancer; the less you drink, the lower the risk [1, 2].
Key points
- Alcohol is a proven carcinogen (Group 1), in the same group as tobacco and asbestos [1, 2].
- At least seven cancers: mouth, throat (pharynx), larynx, oesophagus, liver, bowel and breast [1, 3].
- No safe amount has been found: even light and moderate drinking causes part of the cancers due to alcohol [1, 4].
- Breast cancer: each extra drink a day raises the risk a little [5, 6].
- Alcohol together with smoking raises the risk of cancers of the mouth, throat and oesophagus much more [6, 7].
- Cutting down or stopping helps: it lowers the risk of mouth and oesophageal cancer [8].
How does alcohol cause cancer?
The body turns alcohol (ethanol) into a substance called acetaldehyde. Acetaldehyde is toxic and damages DNA, the genetic material of cells [6]. Alcohol also raises blood levels of the hormone oestrogen, which increases the risk of breast cancer, and interferes with the absorption of some nutrients such as folate [6].
Because the cause is the alcohol itself, the type of drink (beer, wine or spirits), its price and its quality make no difference [2]. What matters is how much alcohol you drink [3].
Which cancers become more likely?
In the largest review, covering 572 studies, the more alcohol people drank, the higher the risk of these cancers [3]. The table shows the risk in people who drink a little or a lot, compared with people who do not drink:
| Cancer | Up to one drink a day | More than 4 drinks a day |
|---|---|---|
| Mouth and throat | Slightly higher [3] | About 5 times [3] |
| Oesophagus (squamous cell type) | Slightly higher [3] | About 5 times [3] |
| Larynx | No clear increase seen [3] | More than two and a half times [3] |
| Breast | Slightly higher [3] | About one and a half times [3] |
| Bowel | No clear increase seen [3] | Nearly one and a half times [3] |
| Liver | – | About twice [3] |
In this review, one drink was counted as 12.5 grams of pure alcohol [3]. A standard drink in the United States contains 14 grams of alcohol: about one bottle of beer, one glass of wine or one shot of spirits [6].
Is light drinking risky too?
Yes. The World Health Organization says the risk starts from the first drop and no level below which drinking is safe has been found [1, 2]. The more you drink, the higher the risk; the less you drink, the lower it is [2].
- Worldwide, about 740,000 new cancers in 2020, or 1 in every 25 cancers, were due to alcohol [4]. Most were in heavy drinkers, but about 100,000 were in people who drank less than 20 grams of alcohol a day [4].
- In Europe, about half of all alcohol-related cancers occur in people whose drinking does not count as "heavy" [2].
- Light drinking is sometimes said to be good for the heart; but no study has shown that this possible benefit outweighs the cancer risk for an individual [1, 2].
Alcohol and breast cancer
Breast cancer is one of the cancers that become more likely even with light and moderate drinking [3]. In Europe, most alcohol-related breast cancers occur in women who drink lightly or moderately [2].
A large reanalysis of 53 studies including more than 58,000 women with breast cancer found that each extra drink a day (about 10 grams of alcohol) raised breast cancer risk a little, in smokers and non-smokers alike [5]. In women who drink heavily, the risk is about one and a half times higher [6]. To find it early, see At what age should mammograms start? and symptoms of breast cancer.
Alcohol together with smoking
Someone who both drinks and smokes has a much higher risk of cancers of the mouth, throat, larynx and oesophagus than someone who uses only one of the two; for mouth and throat cancer, the combined effect is even greater than the two effects added together [6]. In a review of 17 studies of more than 11,000 patients with head and neck cancer, about 7 in every 10 of these cancers were due to smoking, alcohol or both [7]. Giving up both is the best step; see How much does quitting smoking lower cancer risk?
What are the benefits of cutting down or stopping alcohol?
It is never too late to cut down or stop drinking [6]. After reviewing all the evidence, the International Agency for Research on Cancer concluded that cutting down or stopping drinking lowers the risk of mouth and oesophageal cancer; for cancers of the larynx, bowel and breast there is some evidence of benefit, but it is not yet conclusive [8]. It may take years for the risk to fall to that of people who have never drunk [6].
What should I do? One important step: the less, the better
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If you do not drink, do not start
Drinking alcohol is not recommended for health; the US dietary guidelines advise people who do not drink not to start for any reason [6].
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Do not forget screening
Have tests for early detection of breast and bowel cancer on time: Cancer screening and At what age is a screening colonoscopy needed?
Frequently asked questions
Isn't a glass of wine a day good for the heart?
Is red wine less risky than beer or spirits?
How much alcohol is safe?
I have been drinking for years. Is it worth stopping now?
If I have cancer or am having treatment, can I drink alcohol?
Why does alcohol increase the risk of breast cancer?
One reason is that alcohol raises blood levels of the hormone oestrogen, and high levels of oestrogen can cause breast cancer [6].
Details of the evidence (for physicians)
For physicians
Classification and mechanisms. IARC: alcoholic beverages are Group 1, causally linked to seven cancers (oral cavity, pharynx, larynx, oesophagus, liver, colorectum and female breast) [1, 3]. Mechanisms: acetaldehyde (a probable carcinogen), reactive oxygen species, raised blood oestrogen, and disturbed one-carbon metabolism and folate absorption [6]. WHO: no threshold at which the carcinogenic effect of alcohol begins has been shown [1].
Dose–response (Bagnardi 2015; 572 studies, 486,538 cases). Light ≤12.5, moderate ≤50 and heavy >50 g per day vs non-drinkers and occasional drinkers: oral cavity and pharynx RR 1.13, 1.83 and 5.13; oesophageal SCC 1.26 (1.06 to 1.50), 2.23 and 4.95; breast 1.04 (1.01 to 1.07), 1.23 and 1.61; colorectal (moderate and heavy only) 1.17 and 1.44; larynx 1.44 and 2.65; liver with heavy drinking 2.07 (1.66 to 2.58); the effect of light drinking on oral/pharyngeal cancer and oesophageal SCC was significant only in studies of Asian populations [3]. Breast: risk rises by 7.1% per 10 g per day, equally in smokers and non-smokers (58,515 cases in 53 studies) [5].
Global burden (2020). 741,300 new cancers (4.1%) attributable to alcohol; largest contributions: oesophagus (189,700), liver (154,700) and breast (98,300); moderate drinking (less than 20 g per day) accounted for 103,100 cases (13.9%) and drinking up to 10 g per day for 41,300 [4]. Absolute risk (NCI fact sheet, citing the Surgeon General's Advisory): per 100 women, alcohol-related cancer in about 17 with less than one drink a week, 19 with one drink a day and 22 with two drinks a day; in men 10, 11 and 13 per 100 [6].
Interaction with tobacco. INHANCE (17 case-control studies, 11,221 head and neck cancer cases): greater-than-multiplicative interaction (psi 2.15; 1.53 to 3.04); PAR for tobacco or alcohol 72% (alcohol alone 4%, tobacco alone 33%, both 35%) [7].
Cessation (IARC Handbooks, Volume 20A). Sufficient evidence that reducing or stopping drinking lowers the risk of oral cavity and oesophageal cancer; limited evidence for the larynx, colorectum and breast [8].
In practice. Ask about alcohol use without judgement and in grams per day, and inform patients objectively about the cancer risk [1].
Scientific evidence
Scientific evidence
1 itemInteraction between Tobacco and Alcohol Use and the Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium
Related cancer types
Related questions
References
8 referencesShow all references, 1 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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