I’m fairly certain all of us know somebody – a relative, a friend – whose life has been derailed by excessive drinking. Alcohol is a drug, an addictive one, and the well-known consequences of alcohol abuse are, on a social level, ruined families and careers, and on a physiological one, liver damage, worst case, cirrhosis, the severe scarring of the organ that is often fatal. 

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But what is only now getting the attention it deserves is how alcohol contributes to cancer. The statistics are sobering. Globally, an estimated 4% of all cancers are linked with alcohol consumption. Best estimates suggest that alcohol contributes to, every year, 100,000 cancer cases and 20,000 cancer deaths in the U.S. Think that’s way, way too many? So do I. Here’s the topline of what you need to know about the carcinogenic substance that most Americans are imbibing on a regular basis, usually with no clue of how they’re putting their health at risk. 

Bad news doesn’t always travel fast 

According to a 2021 study, nearly 70% of Americans had no idea that alcohol carried a cancer risk. But that’s finally changing. This year, the U.S. Surgeon General put out an “advisory” on the alcohol-cancer link and recommended that a warning be added to booze labels. That might ring a few bells. Throughout most of the 20^th century, smoking was wildly popular, reaching a peak in 1964 when over 40% of Americans smoked. That year the Surgeon General released the report that brought to light the lung cancer risks. A year later, the government mandated warnings on cigarette packs. Today, the smoking rate is about 12%. I’d like to see history repeat itself with alcohol. I’ll admit, it’ll be an uphill challenge -- alcohol is deeply embedded in how our culture thinks about relaxing and having a good time. In fact, according to the Memorial Sloan-Kettering Cancer Center, two-thirds of Americans have had a drink in the past month. 

What kind of cancer are we talking about? 

Take your pick. The research has implicated alcohol as driving the rate of disease for seven types of cancer: including oral (mouth); voice box (laryngeal/pharynx); esophagus; liver and breast. The organs at risk are in the digestive tract where alcohol makes contact with the cells on the way down, plus the liver which has to metabolize the booze, and the breast which has a hormonal sensitivity to alcohol. More on that last one in a moment. 

But I thought red wine was good for you?

You would be wrong. There is a wide-spread misperception that the health risk posed by alcohol depends on the type of booze you’re drinking. Hard liquor was thought to be the most potentially toxic whereas wine and beer were mostly benign, especially red wine which for decades has enjoyed an unearned “health halo.” Sorry to bust your booze bubble. Alcohol is alcohol, no matter what the delivery system: a shot of bourbon, a glass of wine, a beer, all pack about 0.6 of an ounce of pure ethanol alcohol. The supposed heart health benefits of red wine so loudly proclaimed in the ‘70s and ‘80s were the result of poorly done studies that failed to account for the fact that red wine drinkers tended to be healthier in general – not because they were quaffing Pinot Noir. (Yes, red wine, especially Pinot, does contain the compound resveratrol which some have promoted for its health benefits, but hardly enough to offset alcohol’s metabolic damage.)  

The question of dose.

Alcohol, like most toxins, follows a “dose-response” model: the more you ingest, the worse for you. If, for years, you’ve had a steady one or two drink a night habit, you’re probably not going to spiral into alcoholism or damage your liver to the point of cirrhosis. But the cancer connection is tricky. Yes, the more your drink, the higher your risk. But even the 1-2 drink “moderate” daily dose can be enough to meaningfully increase risk. That’s especially true for individuals who are genetically more likely to develop cancer or who have already survived cancer. And for women -- in other words, half the population! The alcohol increases the level of estrogen in the blood, which, scientists believe, can fuel breast cancer by latching on to receptors on the tumor and boosting its growth and spread. 

What else does alcohol do to your system? 

Nothing good. The type of alcohol in booze, ethanol, mucks up your epigenetics, that is, the chemical switches that determine whether a particular gene is turned on or off. The ethanol helps turn off a gene that is responsible for defending the body against tumor growth. Just as bad, the ethanol breaks down in your body to become acetaldehyde which also does a number on your epigenetics and directly damages your DNA, for instance, hindering its ability to repair damaged DNA. And that can set in motion the uncontrolled growth of cells that we call cancer. (Cells in the mouth and the liver are particularly vulnerable to this kind of damage.) 

Wait, there’s more? 

Alcohol can increase levels of oxidative stress, another alcohol-empowered villain. More “free radicals” can spell trouble in the esophagus, increasing the risk of mutations and subsequently tumors, and in the liver where it promotes scarring which can develop into cirrhosis and, finally, liver cancer. The alcohol-colon cancer is less clear but the research suggests that alcohol reduces the body’s supply of folate which protects against cancer. (If you can’t stop or cut back significantly your alcohol consumption -- and I believe most of us can -- at least get plenty of folate by loading up on leafy green veggies and taking a daily multi.) Alcohol also disturbs the balance of bacteria in the gut, the microbiome, which may play also play a carcinogenic role. 

The deadly duos

According to the experts at Sloan Kettering, alcohol is the third most important preventable cause of cancer, behind smoking and carrying around excess weight. Well, guess what? Alcohol often makes the first two worse. It acts as a solvent inside the body, dissolving the toxic chemicals in cigarette smoke and allowing them to penetrate the tissues in the mouth and the throat. Smoking and drinking? In my opinion, you’ve got to have a death wish. And for many, alcohol is a daily form of “empty calories” that contributes to the weight problems that by itself drive up cancer risk. 

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Ultimately, the best medicine of all here is to ditch the stuff altogether. You’ll help minimize cancer risk and overall, your body will be so much better happier and healthier without it. Non-alcoholic cheers to that!