A new advisory from the U.S. Surgeon General issues serious warnings of a significant link between alcohol and fatal cancers.¹ Studies now show alcohol is one of the three leading causes of preventable cancer, falling just below tobacco and obesity.

Per the report, in 2019 there were 96,730 alcohol-related cancer cases, with nearly 1 million preventable alcohol-related cancer cases in the last 10 years. Considering that 72% of U.S. adults consume one or more alcoholic drinks per week, this report indicates that a very large number of adults in the U.S. are at some level of risk for alcohol-related cancers.

Commonsensically, the more alcohol you drink, the higher your risk of cancer. But to me, the most shocking information is that only one drink per day increases cancer risk by 19% for women and 11.4% for men. This flies in the face of the old adage “one drink a day is a healthy habit.”

In fact, Dietary Guidelines for Americans now has a disclaimer: “Emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease.”

The seven types of cancers involved are breast, colorectum, esophagus, liver, mouth, throat and voice box. Women are particularly at risk for breast cancer. Research is also currently underway about the potential link between alcohol and other cancers such as skin, prostate, pancreas and stomach.

Framing it yet another way, annually in the U.S. there are about 20,000 alcohol-related cancer deaths compared to 13,500 alcohol-related traffic deaths. Alcohol-driven cancer kills 48% more people each year than drunk drivers do.   

Any type of alcohol (beer, wine, spirits, etc.) increases cancer risks. The International Agency for Research on Cancer (IARC) now classifies alcohol as a Group 1 Carcinogen alongside tobacco, asbestos and formaldehyde.

How exactly does alcohol cause cancer? In your body, ethanol (the type of pure alcohol found in all alcohol-containing beverages) breaks down into the metabolite acetaldehyde which damages DNA, increases inflammation, alters hormone levels and facilitates the body’s absorption of other carcinogens like those in tobacco smoke.

Of course, many individual factors (genetics) and environmental factors (exposure to carcinogens) impact any given person’s risk of cancer. Also, multiple factors drive an individual’s level of alcohol consumption. The surgeon general’s report states that social and economic factors, social norms, peer pressure, advertising and other commercial activities play a role.

The surgeon general recommends these steps:

1. Update the surgeon general’s warning label on alcoholic beverages as to cancer. (e.g., Ireland’s new label: “There is a direct link between alcohol and fatal cancers.”)
2. Reassess recommended limits for alcohol consumption to reduce cancer risks.
3. Strengthen and expand educational efforts to increase general awareness that alcohol consumption causes cancer.
4. Inform patients in clinical settings about the link between alcohol use and cancer.
5. Highlight alcohol consumption as a leading modifiable cancer risk factor and promote alcohol reduction strategies into population-level cancer prevention initiatives.
6. Raise awareness that the amount of alcohol used has a direct link to increased cancer risks.

The current alcohol warning label (which remains unchanged since its inception in 1988) states:

“GOVERNMENT WARNING: (1) according to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects. (2) Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery and may cause health problems.”

It would literally take an act of Congress to update the 1988 alcohol warning label.

In the meantime, for those who are concerned about cancer and want to reduce or stop their alcohol use, here are some tips:

1. Analyze Your Alcohol Dependence: Stopping alcohol use “cold turkey” can be very dangerous. If you have been a heavy drinker, detoxification may require hospitalization and even addiction treatment. Regardless, whether you drink a little or a lot, it is best to be safe and get advice and support from your doctor before making changes.
2. Set Clear Goals and Track Patterns: If you have decided to cut back or stop your alcohol use, then set clear and specific goals and stick to them, such as limiting alcohol use to only one drink for the occasion, and setting other boundaries such as one drink a day, but only on the weekends, etc.
3. Avoid Triggers and Find Alternatives: If you are not able to stick to your plan, you may be able to identify situations, emotions and behaviors that trigger you to use alcohol more than intended. In social settings it can be beneficial to order a non-alcoholic “mocktail” or sparkling water, or just avoid that first drink that can then lead to another. If you have been using alcohol to reduce anxiety and stress, try alternatives like exercising, reading, journaling or spending time with friends without drinking. Mindfulness and meditation can also be effective.
4. Change Your Environment: As the old saying goes, “If you always hang out in a barber shop, you’re likely to get a haircut sooner or later.” Reducing time spent in social situations centered around alcohol use can help you reduce alcohol consumption. You can also minimize the amount of alcohol kept in your home. Teaming up with family and friends who are also reducing or stopping alcohol use can make a big difference in your ability to stick to your plan.
5. Just Say No: No matter what the social situation or perceived pressure, do not be embarrassed in the least to decline alcohol. Instead, order a non-alcoholic drink, or decline that second drink. A simple “no thanks” will suffice. If you feel self-conscious not having a drink in your hand, order something like a Club Soda with a twist of lime, etc. Declining alcohol can seem like a big deal at first, but the truth is nobody really cares these days.
6. Easy Does It: Reducing or ending alcohol use will be a process, not an event. There will be ups and downs, so don’t beat yourself up if you are not perfect in executing your goals. It’s all about progress and staying on course with your goals, as opposed to perfection. If you can’t make progress and need support, consider completing a clinical assessment to examine your alcohol use and determine your needs.

Against the backdrop of all the above, it will be very interesting to see what impact this confirmed link between alcohol and deadly cancers has upon cultures and drinking norms worldwide. With cancer now in the mix with alcohol, how will it impact the story arc of alcohol? We know what happened with tobacco. In the 1930s and 40s doctors smoked cigarettes in television ads and actively promoted tobacco use. Then, in the 50s and 60s, science identified a link between tobacco and cancer. In 1971, the Public Health Cigarette Smoking Act banned all cigarette advertising on television and radio, and the surgeon general’s strong warning labels were required. Ultimately, in 1988, tobacco companies agreed to pay $206 billion to settle damages due to their products.

Of course, people still smoke tobacco and/or use e-cigarettes (vaping, which can contain chemicals like formaldehyde, acrolein and propylene glycol that can damage the lungs and airways). People will surely continue to use alcohol as well, despite its link to cancer. But perhaps alcohol users can be better informed before assuming the risk.

TLAP’s response to the 2025 Surgeon General’s Advisory on Alcohol and Cancer Risk is to remind the profession that TLAP is a comprehensive professional clinical program that can help with any mental health goal. The legal profession is well known for its “work hard, play hard” culture. Our profession also suffers, however, from increased rates of alcoholism. TLAP’s specialized programming facilitates exceptional alcoholism no-relapse recovery rates of 85% on average.

TLAP also helps ordinary drinkers who want to reduce cancer risks. TLAP’s professional clinical staff can support you in setting goals, moderating your behaviors, learning skills to navigate social situations and accessing appropriate clinical support if needed to reduce or discontinue alcohol use.

If you are concerned about your alcohol use and cancer, TLAP can help. Give us confidential call at (615) 741 3238, email us at tlap@tncourts.gov or visit us on the web at www.tlap.org. |||

BUDDY STOCKWELL was appointed by the Tennessee Supreme Court in July 2020 as executive director of the Tennessee Lawyers Assistance Program (TLAP). He comes from south Louisiana where he has been a volunteer and program monitor for the state’s Committee on Alcohol and Drug Abuse and the executive director of Louisiana’s comprehensive Judges and Lawyers Assistance Program (JLAP) peer professionals’ program. He is a certified clinical interventionist through “Love First” training at the Betty Ford Center and has personally been in recovery from alcoholism for over 38 years. Stockwell earned his law degree from LSU Law School in 1993. He practiced in both large and small firm settings, including a solo practice in Baton Rouge where he focused heavily on domestic litigation. Read more about him at tba.org/Stockwell.

NOTE
1. U.S. Department of Health and Human Services, “Alcohol and Cancer Risk: The U.S. Surgeon General’s Advisory,” www.hhs.gov/surgeongeneral/priorities/alcohol-cancer/index.html.