Annual US cancer deaths attributed to alcohol rose from 11,361 in 1990 to 23,126 in 2023, roughly a doubling, according to a study published this week in The Lancet Regional Health - Americas by researchers at the University of Miami’s Sylvester Comprehensive Cancer Center. The rise spanned most of the ten cancer types examined, not just liver, and in adults aged 20 to 54, colorectal cancer had the highest alcohol-attributable death rate in men, followed by esophageal cancer.
Key takeaways
- Alcohol-attributable US cancer deaths rose from 11,361 to 23,126 a year between 1990 and 2023.
- In adults aged 20 to 54, colorectal cancer had the highest alcohol-attributable death rate in men, followed by esophageal cancer, and ranked second in women behind breast cancer.
- These are modeled estimates, not causes written on death certificates, so read the rates rather than the raw counts.
What the study found
The team analyzed more than three decades of US data from the Global Burden of Disease Study.
Men and adults 55 and older carried the greatest burden. Among older men, liver cancer had the highest alcohol-attributable death rates, then esophageal and colorectal. Among women 55 and older, breast cancer led, then liver and colorectal.
Rates moved, not just totals. “While it’s true that overall cancer mortality has declined, we found the percentage of cancer deaths proportionally attributable to alcohol rose over 58% in people 20 and older over the last 33 years,” first author Dr. Chinmay Jani told CNN. The alcohol-related cancer death rate in older men climbed nearly 24% across the same period.
The younger picture changed most. “Notably, among adults aged 20 to 54, colorectal cancer was the leading cause of alcohol-attributable cancer mortality in men and the second leading cause in women, surpassing liver cancer in both groups,” Jani said in the university’s announcement. Of the ten cancers studied, the smallest increases were in prostate, pancreatic, and stomach cancers, and even those rose. In 2023, Washington, DC recorded the highest alcohol-attributable cancer death rate and Utah the lowest.
Dr. Kumar’s take
“Attributable” is doing a lot of work in this headline. No death certificate says alcohol. These deaths are assigned by a population attributable fraction, meaning researchers estimate how much a population drank, apply known risk relationships, and calculate what share of observed cancer deaths that exposure accounts for. It is a reasonable accounting method. It is not a count of bodies.
The number to watch is the rate, and to the study’s credit the rate moved too: the share of cancer deaths attributed to alcohol rose more than 58% in adults 20 and older, and the death rate in older men rose about 24%. That is a real signal, and a smaller one than “doubled” implies. Both figures deserve equal billing.
The age shift is the finding that deserves attention. Alcohol has been filed in the public mind as a liver problem for heavy drinkers in their sixties. In adults aged 20 to 54, it now tracks first with colorectal cancer in men and with breast cancer, then colorectal, in women. That fits the early-onset colorectal surge showing up in registries worldwide, and it reframes alcohol as a gut and breast issue for people in their thirties and forties. See also my write-ups on coffee and liver disease, cancer, and death risk and what 20 years of Women’s Health Initiative data shows about breast cancer.
Modeling also cannot cleanly separate alcohol from what travels with it, including smoking, weight, and diet. The Distilled Spirits Council told CNN the claim that there is “no safe level” of alcohol “misrepresents the body of scientific evidence.” They are right that this study sets no threshold. Alcohol’s status as a Group 1 carcinogen at the International Agency for Research on Cancer rests on strong causal associations with cancers of the oral cavity, pharynx, larynx, esophagus, liver, and colorectum.
What it means for you
Jani told CNN it did not take much to register in the data, about one standard drink a day.
Federal guidance shifted this year. In January, the Trump administration removed the long-standing limits of two drinks a day for men and one for women, replacing them with advice to “consume less alcohol for better overall health.”
No number here tells you a safe amount, and the researchers say so. “The message we want to deliver is that lowering your alcohol use to the lowest possible level will be best for your health,” Jani said.
If you drink regularly and you are in your thirties or forties, the risk this study points at is colorectal and breast, not cirrhosis. Do not defer colorectal cancer screening once you are eligible, and stop treating alcohol as a liver-only question.