The number of alcohol-related cancer deaths has doubled in three decades, with the burden particularly high among men and people over 55.

The number of cancer deaths statistically attributed to alcohol consumption in the United States roughly doubled between 1990 and 2023, from 11,361 to 23,126 cases per year. This is the conclusion reached by researchers at the Sylvester Comprehensive Cancer Center at the University of Miami after analyzing more than three decades of data from the Global Burden of Disease project. The results were published on September 2, 2026, in The Lancet Regional Health - Americas.

The study shows that the cancer burden of alcohol is far from limited to liver cancer. Colorectal, esophageal, breast, and oral cavity and pharyngeal cancers also played a significant role among alcohol-related deaths. The updated Global Burden of Disease 2023 methodology also assesses links to pancreatic, prostate, and stomach cancers.

Age distribution proved particularly important. The highest absolute burden was observed among people 55 years and older, especially men. However, even among younger adults, the picture was unexpected: among men aged 20-54, colorectal cancer was the leading cause of alcohol-attributable cancer mortality, while among women of this age, it was breast cancer; colorectal cancer ranked second.

However, this study should not be understood as a count of people whose death certificates listed "alcohol-related cancer." It is a model-based population risk assessment: the Global Burden of Disease combines mortality data, alcohol consumption levels, and dose-dependent relative risks for various diseases to calculate the proportion of deaths that would statistically have been avoided at minimal exposure levels. Therefore, the study characterizes the population-level risk burden but does not allow one to determine the cause of a specific cancer in a specific individual.

The main thing is in the numbers

Indicator	Result
Analysis period	1990-2023
Alcohol-attributable cancer deaths, 1990	11,361
2023	23 126
Change in absolute number	approximately +104%
The greatest burden	Men, aged ≥55 years
Men 20-54 years old	Colorectal cancer is number one
Women 20-54 years old	Breast cancer is number one
The highest rate among territories in 2023	Washington, DC
Minimum	Utah
Type of study	Secondary analysis of GBD
DOI	10.1016/j.lana.2026.101599

[1]

What exactly did the scientists study?

The study is a secondary analysis of Global Burden of Disease data, not a new cohort in which tens of thousands of people were surveyed about their alcohol consumption and then followed until death. The researchers used existing GBD mortality estimates and the proportion of mortality attributable to alcohol.

The authors analyzed age-standardized mortality rates and the proportion of these rates attributable to alcohol consumption in the United States from 1990 to 2023. The results were stratified by gender, age (20-54 years and 55 years and older), and geography, including all 50 states and the District of Columbia. Joinpoint regression with Monte Carlo permutation testing was used to analyze time trends.

A preliminary version of the analysis was presented at the 2025 annual meeting of the American Society of Clinical Oncology. Data through 2021 were used: researchers reported an increase in the absolute number of deaths from 11,896 to 23,207 and assessed eight major cancer types. The peer-reviewed 2026 version uses updated data from the 2023 GBD, so some figures differ from the conference abstract.

The update is crucial for another reason. The GBD 2023 reassessed the dose-response relationships between alcohol consumption and twenty diseases. These include ten types of cancer: breast, colorectal, esophageal, laryngeal, liver, lip and oral cavity, pharynx, pancreatic, prostate, and stomach. Thus, the current assessment is broader than previous models of alcohol-attributable cancer.

How the analysis was conducted

Component	Method
Source	Global Burden of Disease
Geography	USA, 50 states + Washington, DC
Period	1990-2023
Indicator	Mortality rate per 100,000 population
Standardization	By age
Age groups	20-54 and ≥55 years old
Separation	Gender, age, state, cancer type
Trend analysis	Joinpoint regression
Statistical trend selection	Monte Carlo permutation testing
Result type	Model attributable mortality

[2]

Why a doubling of deaths doesn't mean individual risk has also doubled

The number of deaths increased from 11,361 to 23,126, but absolute numbers and age-standardized risk are different indicators. Over the past three decades, the US population has grown and aged significantly, and cancer is a much more common cause of death in older age groups. Therefore, some of the increase in the absolute number of deaths is inevitably related to demographics.

This is clearly evident in the initial analysis for 1990–2021. Despite a near-doubling of the number of deaths, the overall age-standardized rate increased much more modestly—from approximately 3.9 to 4.1 deaths per 100,000 population. Therefore, the statement "alcohol-related cancer mortality has doubled" without further clarification may be misleading; it is more accurate to speak of a doubling of the absolute number of estimated deaths.

At the same time, certain tumors demonstrated much more unfavorable age-adjusted trends. For example, in a previous GBD analysis, mortality from alcohol-attributable liver cancer increased by approximately 2.21% per year, while for other cancer sites, rates remained stable or decreased.

Thus, the final 23,000 deaths are simultaneously influenced by at least three processes: population change, population aging, and changes in the actual risk of certain cancers and alcohol exposure. This is why the authors simultaneously consider absolute numbers, standardized rates, and the proportion of deaths attributable to alcohol.

What does the increase in mortality mean?

Indicator	What does it show?
Absolute number of deaths	The actual total burden on the population
Age-standardized indicator	Change in risk after adjusting for age
Proportion attributed to alcohol	What proportion of the burden does the model attribute to alcohol?
Doubling 11,361 → 23,126	Does not mean doubling individual risk
The aging population influences the outcome	Yes
The result is influenced by population growth	Yes
There are some cancers with real ASMR growth	Yes

The greatest burden fell on men

In all major analyses, men had a significantly higher burden of alcohol-related cancer mortality than women. The preliminary GBD 2021 analysis estimated approximately 16,555 deaths among men in 2021, accounting for approximately 71% of all alcohol-attributable cancer deaths.

The age-standardized rate in the same analysis was approximately 6.25 deaths per 100,000 men versus 2.21 per 100,000 women. Reasons for this difference likely include higher average alcohol consumption in men, more frequent heavy drinking, differences in smoking and tumor structure, and biological characteristics of individual cancers.

A new 2023 analysis maintained the fundamental pattern: the authors report that men remain the group with the highest burden. The difference was particularly pronounced at older ages, where the combination of long-term cumulative alcohol exposure and age-related increases in baseline cancer risk leads to a significantly higher number of deaths.

But lower absolute mortality among women does not mean a lesser impact from alcohol. The disease structure is simply different: in women, breast cancer plays a significant role, remaining one of the most common tumors and having a proven dose-dependent relationship with alcohol.

Gender differences

Indicator, 2021 data as context	Men	Women
Alcohol-attributable deaths	≈16,555	≈6,650
Age-standardized mortality	6.25/100,000	2.21/100,000
Leading localization	Liver	Breast
Common burden	Significantly higher	Below
Trend Analysis 2023	Remains high	Significant load remains

[3]

After 55 years, alcohol-attributable mortality increases especially sharply.

Age turned out to be one of the most powerful risk factors. The authors emphasize that people 55 and older bear the bulk of the overall burden. This is expected: most solid tumors become significantly more common with age, and the carcinogenic effects of alcohol are cumulative.

In a preliminary analysis in 2021, approximately 20,360 of the 23,207 alcohol-attributable cancer deaths occurred in people aged 55 and older. Age-specific rates in this group were significantly higher than among people aged 20-54.

For example, among men aged 55 and older, the rate was approximately 31.7 deaths per 100,000, while among those aged 20-54, it was approximately 2.4 per 100,000. Among women, the corresponding rates were approximately 10.4 and 1.4 per 100,000. This does not mean that alcohol becomes a carcinogen only after age 55; rather, the effects of long-term exposure become more noticeable against the backdrop of a sharply increasing baseline cancer rate.

This is why researchers consider reducing alcohol consumption as a long-term preventative strategy. Many years can pass between exposure to a carcinogen and the development of a tumor, so a change in behavior today may primarily influence future risk rather than have an immediate effect.

Age and load

Indicator, 2021	20-54 years old	≥55 years old
Men	≈2.4/100,000	≈31.7/100,000
Women	≈1.4/100,000	≈10.4/100,000
The bulk of deaths	No	Yes
Cumulative alcohol exposure	Less	More
Baseline cancer risk	Below	Significantly higher

[4]

In young men, colorectal cancer was the most common cancer.

One of the most surprising findings of the new analysis concerns men aged 20-54. In this group, the leading cause of alcohol-attributable cancer death was not liver cancer, but colorectal cancer.

This is particularly interesting in the context of the current rise in early colorectal cancer. The new study does not claim that alcohol is the primary cause of this rise: early colorectal cancer is associated with a multitude of factors—obesity, metabolic disorders, diet, the microbiome, heredity, and other factors. However, alcohol is emerging as one of the potentially modifiable components of this risk.

Among women aged 20-54, colorectal cancer was the second leading cause of alcohol-attributable death after breast cancer. The authors emphasize that in both young adult groups, colorectal cancer outperformed liver cancer by this metric.

However, it's impossible to conclude that the majority of colorectal tumors in young people are caused by alcohol. This is only the estimated proportion of mortality that the Global Burden of Disease model attributes to alcohol exposure. Most cases of colorectal cancer are multifactorial.

What's found between 20 and 54 years of age?

Floor	1st place	2nd place
Men	Colorectal cancer	Other localizations
Women	Breast cancer	Colorectal cancer
Liver cancer	Below colorectal in both groups	-

[5]

In women, the main burden is associated with breast cancer.

Among women, breast cancer was found to be the leading cause of alcohol-attributable cancer mortality. This finding is consistent with previous studies: because breast cancer is so common, even a relatively modest increase in individual risk translates into a significant number of additional cases and deaths at the population level.

The link is biologically plausible in several ways. Alcohol can increase estrogen levels, promote acetaldehyde formation, oxidative stress, and DNA repair impairment. These processes are not specific to the mammary gland, but the hormonal mechanism is particularly important for hormone-dependent tumors.

In earlier US estimates, breast cancer accounted for about 3,400 alcohol-attributable deaths in women annually, and in some models, more than half of the total alcohol-attributable cancer burden among women.

A new analysis confirms that this isn't just a problem for older adults: among women aged 20-54, breast cancer also remained the leading cause of alcohol-related cancer death. Therefore, informing women about the link between alcohol and breast cancer may be particularly important for prevention.

Alcohol and breast cancer

Indicator	Meaning
Leading alcohol-attributable cancer in women	Breast cancer
Leader among women aged 20-54	Yes
Mechanisms	Estrogens, acetaldehyde, oxidative stress
The relationship is dose-dependent.	Yes
Are even small amounts completely safe from cancer risk?	There is no such threshold.

Liver cancer remains the biggest problem among older men.

Despite the attention paid to other tumors, liver cancer remains one of the major components of the alcohol-related cancer burden. Among men 55 and older, it had the highest rate of alcohol-attributable mortality.

The 2021 GBD data estimated approximately 7,410 alcohol-attributable liver cancer deaths in the United States—approximately 32% of all related cancer deaths. The age-standardized rate was approximately 1.26 per 100,000 people.

Even more remarkable was the time trend: the mortality rate from alcohol-attributable liver cancer increased by approximately 2.21% annually in the 2000–2021 analysis. This contrasted with age-standardized rates for breast or colorectal cancer, where age-standardized rates declined slightly during this period despite a persistently high absolute number of deaths.

The reason for alcohol's significant role in liver cancer is particularly clear biologically. Long-term consumption can lead to alcohol-associated liver disease, fibrosis, and cirrhosis, which dramatically increase the risk of hepatocellular carcinoma. Alcohol can also act directly through acetaldehyde and oxidative stress.

Key indicators for liver cancer

Indicator	Contextual Analysis Data 2021
Deaths	≈7,410
Proportion of all alcohol-attributable cancer deaths	≈32%
Age-standardized mortality	≈1.26/100,000
Annual trend	+2.21%
A special burden	Men ≥55 years old

[6]

In addition to the liver, the esophagus, oral cavity and pharynx are important

Alcohol has a particularly strong relative association with tumors of the upper gastrointestinal and respiratory tracts. In international studies, some of the highest population-attributable fractions are observed for cancers of the esophagus, pharynx, and oral cavity.

The mechanism is largely linked to acetaldehyde, a carcinogenic metabolite of ethanol. The mucous membranes of the mouth and esophagus are directly exposed to alcohol, and local microorganisms are also capable of converting ethanol into acetaldehyde. This creates conditions for DNA damage and mutations.

In a preliminary US analysis of young adults aged 20-54, lip and oral cavity cancer had the highest proportion of alcohol-attributable deaths: approximately 41.8% in men and 26.9% in women. This differs from the absolute number of deaths: a tumor can have a high alcohol-attributable rate but be less common than colorectal cancer.

This distinction is important for understanding the news. "The largest alcohol-related share" and "the largest number of deaths" are different metrics. In young men, colorectal cancer results in a higher absolute number of alcohol-attributable deaths, even though the relative role of alcohol in individual oral cancers is greater.

Absolute and relative burden

Indicator	Example
The largest absolute number	Depends on age and gender
The largest alcohol-attributable share	Often tumors of the oral cavity/pharynx/esophagus
Men 20-54, lip/oral cavity	≈41.8%
Women 20-54	≈26.9%
The reason for the differences	The frequency of cancer itself + the strength of the connection with alcohol

[7]

Why did the pancreas and prostate gland appear in the new analysis?

The GBD methodology is periodically revised as new epidemiological studies accumulate. In the 2023 update, researchers reassessed the association between alcohol consumption and 20 diseases using the Burden of Proof framework, using cohort and case-control studies published before 2023.

This set included ten types of cancer, including pancreatic and prostate tumors. This is why the press release for the new Lancet analysis cites the growing burden not only for the long-recognized alcohol-associated cancers but also for pancreatic and prostate cancer.

This does not mean that the evidence base for each tumor type is equally strong. For cancers of the oral cavity, pharynx, esophagus, liver, breast, and colorectal cancers, causality has been studied for decades. For some additional sites, estimates have greater uncertainty and are more dependent on the chosen meta-analytic model.

Therefore, in popular science presentation, it is more accurate to say that the GBD estimates the burden associated with these tumors, rather than that the new American study itself has proven for the first time a causal link between alcohol and each of the ten types of cancer.

What tumors does the updated GBD model take into account?

No.	Localization
1	Breast
2	Colorectal cancer
3	Esophagus
4	Larynx
5	Liver
6	Lip and oral cavity
7	Pharynx
8	Pancreas
9	Prostate
10	Stomach

[8]

Large differences were found between states

Geographical analysis revealed significant heterogeneity within the United States. In 2023, Washington, DC, had the highest rate of alcohol-attributable cancer mortality, while Utah had the lowest.

This difference isn't necessarily due solely to the amount of alcohol consumed. Cancer rates are influenced by the population's age structure, smoking and obesity rates, socioeconomic factors, access to prevention, screening, and treatment, and historical differences in alcohol policy. Therefore, comparing states doesn't allow us to conclude that a single factor directly explains the differences.

However, previous US studies have shown an interesting pattern: states with stricter comprehensive alcohol policies had lower rates of alcohol-attributable cancer mortality. In one analysis, a 10% increase in the strictness of alcohol policies was associated with an approximately 8.5% reduction in mortality from a combined group of alcohol-related cancers.

These data remain observational, but they support the idea that the alcohol-attributable cancer burden is potentially modifiable not only by individual decisions but also by population policies such as pricing, taxation, accessibility, and public information.

Geographical result

Indicator	Territory
The highest figure is in 2023	Washington, DC
The lowest	Utah
Geographic variability	Expressed
Is it explained only by alcohol?	No
Possible factors	Consumption level, age, smoking, treatment, social factors, policy

How Alcohol May Contribute to Cancer Development

The main direct carcinogenic product is acetaldehyde, formed during ethanol metabolism. It can bind to DNA and proteins, forming adducts and increasing the likelihood of mutations. It is the ethanol in alcoholic beverages and the acetaldehyde formed in the body that are considered carcinogenic.

The second mechanism is the formation of reactive oxygen species and chronic oxidative stress. This can damage cell membranes, proteins, and genetic material, while simultaneously fueling inflammation. In the liver, this process is further amplified by chronic tissue damage and regeneration.

Alcohol also affects hormonal balance, specifically, it can increase estrogen levels. This is considered one of the mechanisms underlying the link to breast cancer. Disturbances in folate metabolism and one-carbon metabolism, which can affect DNA synthesis and methylation, are also discussed.

Finally, alcohol is often combined with smoking. For head, neck, and esophageal tumors, these two effects can potentiate each other. Therefore, even with statistical adjustment, completely separating out all lifestyle interactions is extremely difficult.

Main carcinogenic mechanisms

Mechanism	Possible consequence
Acetaldehyde	DNA damage
Oxidative stress	Mutations and inflammation
Increased estrogen levels	Breast cancer risk
Folate metabolism disorder	Alteration of DNA synthesis/methylation
Cirrhosis	Dramatically increases the risk of liver cancer
Alcohol + tobacco	Synergistic injury of the upper respiratory/gastrointestinal tract

Can this work be used to determine a “safe amount” of alcohol?

No. This study was not designed to determine an individual alcohol level below which cancer risk is guaranteed to be eliminated. It analyzes the already calculated GBD alcohol-attributable mortality at the population level.

The authors formulate their conclusion cautiously: the minimum safe dose, precisely from the point of view of all possible consequences, remains a subject of research, but reducing consumption to the lowest practically achievable level should reduce part of the oncological risk.

However, for cancer, the data differ from some cardiovascular outcomes, where older observational studies suggested a J-shaped relationship. For some tumors, the risk increases even with low consumption. For example, a 2020 global analysis estimated that even drinking up to 10 grams of ethanol per day contributed to tens of thousands of cancer cases worldwide each year.

This doesn't mean that one glass of alcohol immediately causes cancer. It's a small increase in risk, which may be small for one person, but when spread across millions of people, translates into a significant number of additional cases.

Why "alcohol-attributable death" is not the same as a determined cause of death

GBD uses comparative risk assessment. First, based on studies, it estimates how the risk of a particular disease changes with different levels of alcohol consumption. These risk functions are then combined with the distribution of alcohol consumption in the population and the number of deaths from the corresponding disease.

From this, the population attributable fraction is calculated—the proportion of cases that statistically would not have occurred at the chosen minimum exposure level. This fraction is then applied to the total number of deaths. This is how estimates like 23,126 alcohol-attributable deaths in 2023 are derived.

Therefore, it's impossible to take a specific person with colorectal cancer who consumed alcohol and, based on the model, claim that alcohol caused their tumor. Most common cancers don't have a single, individually identifiable cause: the disease develops as a result of the interaction of genetics, age, environment, and behavior.

However, this method is extremely useful for public health. It allows us to estimate the magnitude of the potentially preventable population burden and compare it with other modifiable risk factors.

How to read the indicator

Formulation	Is it correct?
23,126 people have been proven to have died due to alcohol.	No
The model estimates about 23,126 deaths as statistically attributable.	Yes
This is based on dose-related relative risks.	Yes
It is possible to determine the cause of a specific person's tumor	No
The population preventable burden can be estimated	Yes

Main limitations of the study

The first limitation is the dependence on the quality of the Global Burden of Disease. The GBD is a complex model that integrates multiple data sources. When direct data are missing or incomplete, statistical modeling and extrapolation are used, so each estimate is subject to uncertainty.

The second is the assessment of alcohol consumption itself. People systematically underestimate the amount they drink in surveys, and the pattern of consumption—daily small amounts versus episodes of heavy drinking—can have different meanings. GBD attempts to correct for these issues, but it's impossible to completely eliminate measurement error.

The third limitation is a change in methodology. The preliminary 2025 analysis reported 11,896 deaths in 1990 and 23,207 in 2021, while the final GBD 2023 analysis yields 11,361 in 1990 and 23,126 in 2023. This is not an error: updating models, input data, and risk functions can retrospectively change previous estimates.

Finally, the study is an ecological analysis of population mortality. It provides a good answer to the question of how the estimated alcohol burden has changed in the US, but is significantly less suitable for predicting a specific individual's risk.

What limits the accuracy of the results

Limitation	Consequence
GBD model	There is statistical uncertainty
Self-report of alcohol consumption	Possible underestimation
Methodology changes between GBD versions	Historical estimates are subject to revision.
Environmental analysis	Individual conclusions cannot be drawn
Multiple contributing factors	Possible residual mixing
Cancer latency period	Today's mortality reflects past impacts

What work means for cancer prevention

The article's key practical implication is that alcohol should be viewed as more than just a factor in liver disease. New data show that a significant portion of the population burden is distributed among several tumors, with colorectal and breast cancers occupying particularly significant positions.

This has implications for patient communication. The link between cigarettes and cancer is well known to almost everyone, while Americans' awareness of the link between alcohol and cancer remains significantly lower. The authors believe raising awareness is one of the most immediate prevention opportunities.

At the population level, warning labels on alcoholic beverages, advertising restrictions, tax increases, and other measures to reduce overall consumption are being discussed. Some modeling studies suggest that such measures could reduce future incidence and mortality from alcohol-related cancers.

However, the article does not advocate considering alcohol the sole or even the primary factor in the development of most tumors. Prevention remains important by quitting smoking, maintaining a healthy weight, being physically active, receiving HPV and hepatitis B vaccinations, protecting against ultraviolet radiation, and participating in recommended screening programs.

The main points in one table

Result	Meaning
Alcohol-attributable cancer deaths, 1990	11,361
2023	23 126
Change in absolute number	≈+104%
The main burden	Men and ≥55 years old
The leading cancer in older men	Liver
Leading women	Breast
Men 20-54	Colorectal cancer
Women 20-54	Mammary gland, then colorectal
Highest state-level burden 2023	Washington, DC
Lowest	Utah
Data source	GBD 1990-2023
Design	Secondary population analysis
Indicator	Modeled attributable mortality
DOI	10.1016/j.lana.2026.101599

[9]

News source

The main publication is titled “Alcohol-attributable cancer mortality in the United States, 1990–2023: a secondary analysis of Global Burden of Disease data” and was published in The Lancet Regional Health - Americas on September 2, 2026. Corresponding author is Chinmay Jani, MD, Sylvester Comprehensive Cancer Center, University of Miami; senior author is Gilberto Lopes, MD, chief of the Division of Medical Oncology at Sylvester. DOI: 10.1016/j.lana.2026.101599.

Preliminary results from this research program were presented at ASCO 2025 under the title “Escalating impact of alcohol-related cancer mortality in the US: A call for action,” DOI 10.1200/JCO.2025.43.16_suppl.10519. The 2026 peer-reviewed article updated the analysis to GBD 2023 data, so the final absolute figures differ slightly from the conference version.

The key finding: the number of estimated cancer deaths statistically linked to alcohol consumption in the United States roughly doubled between 1990 and 2023. This increased burden cannot be attributed solely to liver cancer or severe alcoholism: colorectal cancer, breast cancer, esophageal cancer, and head and neck cancers also play significant roles, and the impact is noticeable even among adults under 55. This is a population-based model, not proof that alcohol was the sole cause of each of the 23,000 individual deaths.