Alcohol-attributable cancer deaths in the United States doubled from 11,361 in 1990 to 23,126 in 2023, according to a secondary analysis of Global Burden of Disease data published in The Lancet Regional Health – Americas.
The research was led by investigators at the Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine. The findings were initially presented as an oral presentation at the 2025 American Society of Clinical Oncology Annual Meeting, where study corresponding author Chinmay Jani received the Conquer Cancer Merit Award.
Alcohol-Attributable Cancer Deaths Double Over Three Decades
Age-standardized mortality rates (ASMRs) shifted from 3.8 per 100,000 population in 1990 to 4.1 per 100,000 in 2023. While ASMRs increased among men by 14.3%—climbing from 5.6 to 6.4 per 100,000—they declined among women by 16%, dropping from 2.5 to 2.1 per 100,000. Despite the mortality rate decline in women, the proportion of cancer mortality attributable to alcohol increased for both sexes, rising 16.7% among women and 92% among men across the study period. By 2023, the majority of alcohol-attributable cancer deaths occurred in men, totaling 17,477 fatalities, and in individuals aged 55 and older, accounting for 19,460 deaths with an ASMR of 19.2 per 100,000.
Shifting Burden Across Cancer Types and Demographics
Liver cancer accounted for the highest number of alcohol-attributable cancer deaths in 2023 at 7,686, with an ASMR of 1.3 per 100,000. Esophageal cancer followed with 4,902 deaths and an ASMR of 0.9, while colorectal cancer recorded 3,818 deaths and an ASMR of 0.7. Liver cancer also demonstrated the greatest overall rise in ASMR from 1990 to 2023, increasing by 113.9% from 0.6 per 100,000. However, the percentage of ASMR attributable to alcohol decreased slightly by 0.6% for liver cancer, while increasing across nearly all other cancer types. The largest relative increases in alcohol-attributable ASMR were observed in stomach cancer at 57.2%, pancreatic cancer at 40.5%, and colorectal cancer at 39.7%.
Demographic breakdowns revealed distinct patterns across age groups. Among adults aged 20 to 54, colorectal cancer emerged as the leading alcohol-attributable cause of cancer death in men, while breast cancer ranked first for women, followed by colorectal cancer. Among adults aged 55 and older, liver cancer carried the highest alcohol-attributable mortality in men, whereas breast cancer ranked highest among women. According to a population-level analysis, older adults experienced significantly higher ASMRs compared to younger populations, registering 19.2 per 100,000 versus 2.4 per 100,000.
The most surprising finding was the breadth of alcohol’s potential impact across cancer types,
Chinmay Jani, corresponding author and chief fellow in hematology and oncology at Sylvester Comprehensive Cancer Center, stated in a university press release. Jani noted that while the relationship with liver cancer is widely recognized, its contribution to colorectal, esophageal, breast, pancreatic, and prostate cancers is less understood by the public.
Geographic Variation and Prevention Opportunities
The study highlights alcohol as a potentially modifiable cancer risk factor. The International Agency for Research on Cancer classifies alcohol as a Group 1 carcinogen, placing it in the same category as tobacco smoke and asbestos, with scientific evidence linking consumption to cancers of the breast, liver, esophagus, colorectum, and several head and neck sites.
Substantial geographic variation was identified nationwide. In 2023, the District of Columbia recorded the highest alcohol-attributable ASMR, with rates of 9.8 for men and 3.5 for women. Conversely, Utah recorded the lowest rates, at 3.9 per 100,000 for males and 1.4 per 100,000 for females.
Study authors emphasized that public awareness of the alcohol-cancer connection remains relatively low compared to awareness of tobacco use.
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