Growing Alcohol-Attributable Cancer Burden in US Reveals Prevention Gap

Alcohol-attributable cancer mortality in the United States doubled between 1990 and 2023, with the burden disproportionately affecting men and older adults, according to a population-level analysis published in The Lancet Regional Health – Americas.¹

The study, a national assessment of alcohol-attributable mortality across 10 cancer types, highlights mortality trends and differences according to age, sex, and geographic location. Investigators analyzed data from the Global Burden of Disease (GBD) from 1990 through 2023, evaluating alcohol-attributable cancer deaths and mortality rates at the national and state levels. Analyses were stratified by sex and by age groups of 20 to 54 years and 55 years and older.

A Growing, Disproportionately Distributed Burden

Alcohol-attributed cancer deaths in the US rose from 11,361 deaths to 23,126 deaths within the 33-year time period. The age-standardized mortality rate (ASMR) attributable to alcohol increased from 3.8 per 100,000 population in 1990 to 4.1 per 100,000 in 2023, a 7.6% rise.

Notably, the burden was not evenly distributed: ASMR increased 14.3% among males (5.6 to 6.4 per 100,000) but declined 16% among females (2.5 to 2.1 per 100,000) over the study period. Despite the decline in mortality among women, the proportion of cancer mortality attributable to alcohol increased in both sexes, rising 16.7% among women and 92% among men over the study period.

Mortality rates were also higher among adults aged 55 years or older relative to younger aged 20 to 54 years, with ASMRs of 19.2 per 100,000 vs 2.4 per 100,000, respectively.

Liver Cancer Accounts for Largest Mortality Burden

Liver cancer accounted for the largest number of alcohol-attributable cancer deaths in 2023, with 7686 deaths and an ASMR of 1.3 per 100,000. Alcohol-attributable liver cancer mortality increased substantially over the study period, with the ASMR rising 113.9%, from 0.6 to 1.3 per 100,000. Among adults aged 55 years or older, liver cancer was the leading alcohol-attributable cause of death among men and the second leading cause among women.

Following liver cancer, esophageal cancer followed with 4902 deaths and an ASMR of 0.9 per 100,000, while colorectal cancer accounted for 3818 deaths and an ASMR of 0.7 per 100,000.

Geographic Variation Across the US

Alcohol-attributable cancer mortality also varied substantially by state. In 2023, Washington, DC, had the highest ASMR among both males and females, at 9.8 and 3.5 per 100,000, respectively. Utah had the lowest rates, at 3.9 per 100,000 among males and 1.4 per 100,000 among females.

Alcohol and Cancer: An Opportunity for Prevention

The findings underscore the potential role of alcohol reduction as a cancer prevention strategy, particularly through implementation of policies such as increased alcohol taxation and regulation of alcohol outlets. A 2024 analysis estimated that approximately 20,216 cancer deaths annually were attributable to alcohol use in the US between 2020 and 2021.² Approximately 16,800 of these deaths could potentially have been prevented if adults who drank reduced their consumption to no more than 2 drinks per day for men or 1 drink per day for women.

Together, these findings highlight an opportunity for both population-level interventions and clinical conversations around alcohol use. Given the increasing burden of alcohol-attributable cancer mortality observed in several populations and cancer types, greater awareness of alcohol as a modifiable cancer risk factor may support prevention efforts across the cancer care continuum.

“Our findings highlight the critical need for targeted prevention efforts and increased awareness to address the rising impact of alcohol consumption on cancer-related mortality,” study authors Jani et al concluded in the publication.

REFERENCES

1. Jani CT, Edwards K, Sharma R, et al. Alcohol-attributable cancer mortality in the United States, 1990–2023: a secondary analysis of Global Burden of Disease data. Lancet Reg. Health - Am. Published online September 2026:101599. doi:10.1016/j.lana.2026.101599

2. Esser MB, Sherk A, Liu Y, Henley SJ, Naimi TS. Reducing Alcohol Use to Prevent Cancer Deaths: Estimated Effects Among U.S. Adults. Am J Preventive Med. 2024;66(4):725-729. doi:10.1016/j.amepre.2023.12.003