In January 2025 the US Surgeon General issued an advisory identifying alcohol as the third leading preventable cause of cancer in the country, after tobacco and obesity. It named seven cancers with an established causal link and recommended adding cancer warning labels to alcoholic beverages. For breast cancer, risk begins rising at levels as low as one drink per day.
What the advisory said
The advisory established a causal link between alcohol consumption and at least seven cancers: breast cancer in women, colorectal cancer, esophageal cancer, cancer of the larynx, liver cancer, cancer of the mouth and cancer of the throat.
On scale, it reported that alcohol contributes to roughly 100,000 cancer cases and about 20,000 cancer deaths annually in the United States. Seventeen percent of breast cancer cases were attributed to alcohol.
The detail that surprised most readers was the threshold. Breast cancer risk rises at levels as low as one drink per day, which is within what many people consider moderate and unremarkable drinking.
The two death figures, and why they differ
This is where reporting on alcohol mortality routinely goes wrong, so it is worth setting out clearly. Two very different national numbers circulate and both are correct, because they measure different things.
The first is roughly 178,000 deaths per year during 2020 and 2021, up about 29 percent from 137,927 per year during 2016 and 2017, with those deaths shortening lives by an average of 24 years. That figure comes from CDC modeling that assigns a share of deaths across 58 alcohol related causes. It is an attributable fraction estimate, not a count of death certificates.
The second is 47,938 Americans who died in 2023 from alcohol induced causes, at an age adjusted rate of 12.6 per 100,000, down 7 percent from 13.5 in 2022. That is a death certificate count, where alcohol was recorded as the underlying cause.
The larger figure includes cancers, injuries and cardiovascular deaths partly attributable to drinking. The smaller one counts deaths directly caused by it. Presenting either as the alcohol death toll without that distinction misleads, and we see it done constantly.
The liver numbers
Of 96,610 liver disease deaths among people aged 12 and over in 2023, 44.5 percent, or 43,004, involved alcohol, comprising 27,684 men and 15,319 women. The alcohol related cirrhosis death rate was 8.5 per 100,000, down 7.8 percent from 9.3 in 2022, and 50.3 percent of all cirrhosis deaths, 28,632, were alcohol related.
Alcohol also contributed to more than 4.2 million emergency department visits in 2022, representing 3.5 percent of all visits.
What alcohol does to the brain
The National Institute on Alcohol Abuse and Alcoholism describes alcohol interfering with brain communication pathways, affecting balance, memory, speech and judgment.
Blackouts are worth understanding precisely, because they are commonly misdescribed. A blackout is not forgetting. It is a failure to record. Alcohol temporarily blocks the transfer of memories from short term to long term storage in the hippocampus, which means the memory was never consolidated in the first place. There is nothing to recover later, which is why trying to remember does not work.
At the severe end, Wernicke-Korsakoff syndrome results from chronic alcohol misuse combined with thiamine deficiency and can cause permanent brain damage and memory loss. Imaging in chronic heavy drinkers shows reduced brain volume and enlarged ventricles.
How many people this applies to
Federal survey data for 2024 found 134.3 million people aged 12 and over, 46.6 percent of that population, drank in the past month. Some 57.9 million, or 20.1 percent, binge drank in the past month, and 14.5 million, 5.0 percent, reported past month heavy use.
Those numbers are the reason a risk that begins at one drink per day matters at population scale even though it is modest for any individual. A small increase in risk applied to 134 million people produces a large number of cases.
See our alcohol reference page and drug information library.
Takeaways
- A January 2025 Surgeon General advisory named alcohol the third leading preventable cause of cancer in the US.
- Seven cancers have an established causal link: breast, colorectal, esophageal, larynx, liver, mouth and throat.
- Alcohol contributes to about 100,000 cancer cases and 20,000 cancer deaths a year, including 17 percent of breast cancer cases.
- Breast cancer risk begins rising at as little as one drink per day.
- The 178,000 and 47,938 death figures measure different things. One is attributable modeling, the other a death certificate count.
- Blackouts are a failure to record memory rather than a failure to recall it, which is why the memory cannot be retrieved.
Sources
Office of the Surgeon General, Alcohol and Cancer Risk 2025: The US Surgeon General’s Advisory, January 2025. Esser MB and colleagues, Deaths from Excessive Alcohol Use, United States, 2016 to 2021, Morbidity and Mortality Weekly Report, 2024, using the CDC Alcohol-Related Disease Impact application. National Institute on Alcohol Abuse and Alcoholism, alcohol related emergencies and deaths in the United States, health topics on alcohol and the brain, and alcohol use in the United States, updated 2025. StatPearls, Alcohol-Associated Liver Disease.
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Addiction Now publishes health journalism and reference material. This page is not medical advice, a diagnosis, or a treatment plan. Do not stop a prescribed medication without talking to a clinician. Withdrawal from alcohol, benzodiazepines and barbiturates can cause seizures and can be fatal without medical supervision.
