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Alcohol is a leading cause of cancer. Yet much of the public does not know about this danger or the full extent of it. In efforts to raise awareness, former Surgeon General, Dr. Vivek Murthy, M.D., issued a public advisory in January 2025. It called for cancer warnings on all alcoholic beverages, much like labels on cigarette packages.
Just how effective might such a campaign be in raising public awareness about alcohol’s links to cancer? And what are the real cancer risks of alcohol, anyway?
We reached out to Medical Director Dr. Albert Castellon for his take and insights. Dr. Castellon has been practicing medicine and psychiatry for more than two decades. During that time, he has specialized in addiction medicine, inpatient psychiatry, and emergency psychiatry. He is also an active member of the American Psychiatric Association, American Medical Association, American Association of Psychiatric Medicine, Association for Convulsive Therapy and American Society of Addiction Medicine.
In the below Q&A, Dr. Castellon shared his expertise regarding the debate about the effectiveness of public health warnings, scientific evidence into the link between alcohol and cancer, lifestyle tips that can help reduce the risks of alcohol-related cancers, and more….
Debate About the Effectiveness of Mandated Public Health Warnings
Q: Do you think adding labels to alcohol will increase public awareness about the cancer risks of alcohol?
A: Yes, adding warning labels about alcohol’s link to cancer could increase public awareness, similar to how tobacco warnings have helped educate the public. However, the effectiveness would depend on the design, placement, and messaging of the labels. Studies suggest that clear, direct warnings — especially those with visual cues — are more likely to impact behavior.
The Scientific Evidence on Alcohol and Cancer
Q: How would you characterize the link between alcohol and cancer, based on your overview/summary of major studies and research findings?
A: There is a well-established, causal relationship between alcohol consumption and several types of cancer. The International Agency for Research on Cancer (IARC) classifies alcohol as a Group 1 carcinogen, meaning there is sufficient evidence linking it to cancer in humans. Multiple large-scale epidemiological studies show that even moderate alcohol consumption increases cancer risk.
Q: What specific cancers are most associated w/ alcohol, and how significant is the risk?
A: The most well-documented alcohol-related cancers include:
- Head and neck cancers (oral cavity, pharynx, larynx)
- Esophageal cancer
- Liver cancer
- Breast cancer (even at moderate drinking levels)
- Colorectal cancer
The risk varies depending on drinking patterns, but studies suggest that even light drinking (one drink per day) can increase cancer risk. Heavy drinkers (more than three drinks per day) face a significantly greater risk, particularly for head and neck cancers and esophageal cancer. For example, alcohol use is responsible for approximately 5.5 percent of global cancer cases and 5.8 percent of cancer deaths.
Q: Does the risk of cancer vary with the type of alcohol?
A: No, the risk is primarily due to ethanol, the active ingredient in all alcoholic beverages. Whether it’s beer, wine, or liquor, the cancer risk is associated with the total alcohol consumption, not the type.
Alcohol’s Carcinogenic Effects on the Body
Q: What’s the role of acetaldehyde as a carcinogen?
A: When alcohol is metabolized in the body, it is converted into acetaldehyde, a toxic and carcinogenic substance. Acetaldehyde damages DNA and interferes with cellular repair mechanisms, increasing the likelihood of mutations that can lead to cancer.
Q: Are there other aspects of how alcohol is metabolized that increase the risks of cancer?
A: Yes, beyond acetaldehyde:
- Oxidative stress: Alcohol metabolism generates reactive oxygen species (ROS), which cause DNA damage.
- Hormonal changes: Alcohol increases estrogen levels, which is linked to breast cancer.
- Nutritional deficiencies: Chronic alcohol use can lead to deficiencies in folate and other vitamins, further increasing cancer risk.
Q: How do alcohol’s effects on DNA and cellular function increase cancer risks?
A: Alcohol can:
- Directly damage DNA in cells.
- Interfere with the body’s ability to repair DNA damage.
- Promote inflammation, which creates an environment that supports cancer growth.
- Suppress the immune system, making it harder to destroy cancerous cells.
How Drinking Patterns Influence Risks of Cancer
Q: Is it possible to assess one’s risks of cancer based on drinking patterns? How might light, moderate, and heavy drinking compare in terms of the level of risk they pose?
A: Yes, risk increases with higher alcohol consumption:
- Light drinking (≤1 drink/day) → Slight increase in cancer risk, especially breast and esophageal cancer.
- Moderate drinking (1–2 drinks/day) → More noticeable increase in risk.
- Heavy drinking (≥3 drinks/day) → Significantly higher risk for multiple cancers.
Q: How influential are a person’s drinking patterns (in causing cancer) as compared to their genetic predisposition for cancer?
A: Both factors play a role, but drinking patterns are a modifiable risk factor, whereas genetic predisposition is not. Some individuals have genetic variations (e.g., ALDH2 mutation) that make them more susceptible to acetaldehyde buildup, increasing cancer risk even with low alcohol intake.
Tips for Mitigating the Cancer Risks of Alcohol
Q: What lifestyle changes can reduce the impact of alcohol on cancer risk? (Can quitting or reducing one’s drinking mitigate these risks? What about other factors like diet and exercise?)
A: Certain lifestyle changes can decrease the cancer risk of drinking:
- Reducing alcohol intake (or quitting altogether) significantly lowers risk.
- A balanced diet rich in fruits, vegetables, and folate may help counteract alcohol-related risks.
- Regular exercise can mitigate some effects of alcohol and help maintain a healthy weight.
- Avoiding smoking—alcohol and tobacco together have a synergistic effect that dramatically increases cancer risk.
Q: What preventative health measures would you recommend (for example, medical screenings, etc.)?
A: I’d recommend:
- Regular screenings for cancers linked to alcohol (e.g., mammograms, colonoscopies, liver function tests).
- Genetic counseling for individuals with a family history of cancer.
- Routine check-ups to monitor liver health and other alcohol-related risks.
Q: What tips would you offer for reducing alcohol intake?
A: I’d suggest the following:
- Set clear drinking limits (e.g., no more than 1–2 drinks per week).
- Opt for alcohol-free alternatives (e.g., mocktails, kombucha).
- Identify triggers for drinking and find healthier coping mechanisms (like exercise or mindfulness meditation).
- Seek support from a healthcare provider or support groups, if reducing intake is challenging.
With the right tools, education, and help, many people have been successful at reducing their alcohol intake or eliminating it entirely.
If you or a loved one is struggling with alcohol, we may be able to help. Contact us today to begin the journey to better health.
