A new systematic review finds that even moderate alcohol consumption is associated with increased cancer risk, shaped by how often and how much people drink, as well as biological, behavioral and social factors. Researchers from Florida Atlantic University analyzed 62 studies of U.S. adults and highlighted how genetics, health conditions and socioeconomic status can amplify these dangers, underscoring the need for tailored prevention strategies during the holiday drinking season and beyond.
Researchers at Florida Atlantic University's Charles E. Schmidt College of Medicine have carried out an extensive systematic review examining how alcohol use is linked to cancer risk among U.S. adults.
Published in the journal Cancer Epidemiology, the review drew on 62 studies with sample sizes ranging from 80 participants to nearly 100 million. According to Florida Atlantic University, the findings show that both how often people drink and how much alcohol they consume significantly affect cancer risk, with elevated risks observed even at moderate levels of intake.
The studies reviewed consistently identified alcohol as a risk factor for several cancers, particularly of the breast, colorectum, liver, mouth, larynx, esophagus and stomach. The review also found that alcohol use can worsen outcomes in related conditions: for example, alcoholic liver disease was associated with more advanced liver cancer and lower survival rates.
Risk was not evenly distributed. Higher alcohol intake was linked with especially elevated risk among African Americans, people with genetic susceptibilities, and individuals with obesity or diabetes. Race, age, education and income shaped exposure and vulnerability, leaving some lower‑socioeconomic and racial or ethnic groups with a disproportionate burden of alcohol‑related cancer risk even when their overall consumption was similar to or lower than that of other groups.
In contrast, individuals who adhered to American Cancer Society recommendations on alcohol and other healthy lifestyle behaviors tended to have lower cancer incidence and mortality, the review reported. This pattern highlights the importance of broader lifestyle changes, not just focusing on drinking in isolation.
Beverage type and drinking patterns also appeared to matter in some of the studies. Several investigations cited in the review found that white wine or beer was associated with higher risk of certain cancers, while liquor often was not, although the authors noted that findings were not uniform across all research. Gender differences emerged as well: frequent drinking was more strongly associated with risk in men, whereas episodic heavy drinking was particularly concerning in women. Smoking further amplified alcohol‑related cancer risk, with effects varying by sex and level of consumption.
Other factors that modified risk included ultraviolet exposure, which was linked to melanoma at less sun‑exposed body sites in some studies, as well as family history of cancer. Across the body of evidence, additional risk modifiers included both high and low body mass index, low levels of physical activity, infections with carcinogenic agents such as hepatitis B and C viruses, human papillomavirus (HPV), HIV or Helicobacter pylori, poor diet and hormone use. A small number of studies also reported associations with specific hair or eye colors.
The authors outlined several biological pathways through which alcohol may contribute to cancer. These include DNA damage from acetaldehyde, a toxic byproduct of alcohol metabolism; alterations in hormone levels; oxidative stress; suppression of the immune system; and increased absorption of other carcinogens.
"Across 50 studies in our review, higher alcohol consumption consistently raised cancer risk, with risk increasing as intake grows," said senior author Lea Sacca, Ph.D., an assistant professor of population health in FAU's 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."
Co‑author Lewis S. Nelson, M.D., dean and chief of health affairs at the Schmidt College of Medicine, added that these biological effects "are compounded by pre‑existing health conditions, lifestyle choices, and genetic predispositions, all of which can accelerate cancer development."
Based on their findings, the researchers recommend targeted strategies to reduce alcohol‑related cancer burden. These include tailored public health messaging, stronger alcohol‑related policies, and focused interventions for groups at highest risk.
"Our findings underscore that alcohol‑related cancer risk is not driven by alcohol alone, but by a complex interplay of biological, behavioral and social factors," said co‑author Maria Carmenza Mejia, M.D., a professor of population health at FAU. She noted that effective prevention requires addressing not only how much people drink, but also the environments, habits and underlying health conditions that magnify alcohol's impact.
Taken together, the review adds to growing evidence from other large analyses that cancer risks extend beyond heavy drinking to light and moderate consumption as well, suggesting there may be no completely "safe" level of alcohol use when it comes to cancer risk.
