MIAMI — Cancer deaths attributed to alcohol in the United States roughly doubled between 1990 and 2023, and among adults ages 20 to 54 the leading killers were not liver tumors, researchers reported.
The analysis, published in The Lancet Regional Health — Americas and led by physicians at the University of Miami’s Sylvester Comprehensive Cancer Center, estimated 23,126 alcohol-attributable cancer deaths in 2023, up from 11,361 in 1990. Men accounted for 17,477 of the later total. The work drew on more than three decades of Global Burden of Disease data.
“The most surprising finding was the breadth of alcohol’s potential impact across cancer types,” said Chinmay Jani, corresponding author and chief fellow in hematology and oncology at Sylvester. “Although its relationship with liver cancer is widely recognized, its contribution to cancers such as colorectal, esophageal, breast, pancreatic and prostate cancer is less well understood by the public.”
That gap is sharpest under age 55. “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. For women in that age band, breast cancer ranked first and colorectal second. Esophageal cancer followed colorectal among younger men. Liver cancer sat below both in each sex.
The raw death rate in ages 20 to 54 was unchanged at 2.4 per 100,000 from 1990 to 2023. What changed was alcohol’s share. The percentage of cancer mortality attributed to drinking in that group rose from 4.5% to 6.6%. Among people 55 and older, the age-standardized rate climbed from 15.8 to 19.2 per 100,000, and alcohol’s share rose from 1.7% to 3.0%.
“Even though overall the cancer mortality was going down for some of these cancers … alcohol associated mortality was going up,” Jani told The Washington Post. “Which means that alcohol as a risk factor was impacting more cancer deaths in 2023 than it was in 1990.” He told MedPage Today the same pattern held “for both males and females, and for the younger and elderly population as well.” “For the younger population, cancer mortality from colorectal cancer has taken over from liver cancer, especially among males, which is concerning,” he said.
Among older men, liver cancer still produced the highest alcohol-linked death rates, then esophageal and colorectal cancers. Among women of all ages, breast cancer was the leading alcohol-attributable cancer death. The study found rising alcohol shares across most tumor types except liver cancer in some older groups. The largest proportional jumps included stomach, pancreatic and colorectal cancers.
The International Agency for Research on Cancer classifies alcoholic beverages as a Group 1 carcinogen. Ethanol and its metabolite acetaldehyde can damage DNA, raise estrogen and promote inflammation. Public surveys still show limited awareness of that list beyond the liver.
The estimates are modeled, not death-certificate counts that list “alcohol” as the cause. They apply population drinking patterns and established risk ratios to cancer mortality. That method can miss binge patterns, underreporting and other overlapping risks such as obesity and smoking. It cannot prove that any single patient’s tumor was caused by drinking. State rates varied: the District of Columbia was highest and Utah lowest in the paper’s maps.
An earlier version of the analysis, using data through 2021, was presented at the American Society of Clinical Oncology meeting. Gilberto Lopes, Sylvester’s chief of medical oncology, co-led the work.
The clinical implication is screening, not slogans. Early-onset colorectal cancer has been rising in the United States for years. Breast cancer remains the most common cancer in younger women. Neither is framed in most public-health ads as an alcohol disease. Jani’s tables say that, among drinkers who die of cancer before 55, those two sites now outrank the organ people picture when they cut back.
The study does not prescribe a safe number of drinks. It does say the death count tied to alcohol is larger than it was a generation ago, that men and older adults still carry most of it, and that the mix under 55 has shifted toward the colon, rectum and breast. Physicians who ask only about the liver are asking the wrong first question.
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