Introduction

Alcohol is a leading modifiable risk factor for cancer in the United States (U.S.) and is classified as a Group 1 carcinogen by the International Agency for Research on Cancer [1]. It is causally linked to cancers of the oral cavity, pharynx, larynx, esophagus, colorectum, liver, and female breast, with risk increasing as alcohol consumption rises [1], [2]. Despite these facts, alcohol remains one of the most widely used substances among U.S. adults, with patterns of use ranging from occasional drinking to the development of alcohol use disorder (AUD), a clinical condition marked by impaired control, social impairment, and risky use [3]. The frequency and extent of alcohol consumption, even at moderate levels, influence both cancer incidence and outcomes [4], [5], underscoring the need to better understand these patterns in relation to cancer risk.

Despite these risks, gaps remain in understanding how drinking frequency and quantity influence cancer risk in U.S. adults [6], [7]. Existing policies such as alcohol taxes, outlet density limits, and advertising restrictions are inconsistently implemented [8], [9], and few incorporate cancer-specific messaging [7]. Misconceptions fueled by industry marketing and limited coverage in public health curricula further hinder prevention [7]. Additionally, alcohol use patterns differ by socioeconomic status (SES) and demographic characteristics. Individuals with higher SES may consume similar or greater amounts of alcohol than those with lower SES, but the latter experience disproportionate harm due to compounding factors such as comorbid health risks, reduced healthcare access, and social vulnerability [10], [11], [12]. Racial/ethnic minorities, people experiencing homelessness, and those with mental health conditions face greater alcohol-related consequences [10], [11], [12].

To address these gaps, this systematic review examines the relationship between varying levels of alcohol consumption (e.g. excessive, moderate, and mild) and the risk of developing cancer in U.S. adults. It also explores the comorbid conditions that may increase long-term cancer risk among alcohol users, such as obesity, smoking, and chronic liver disease, and identifies the social and demographic factors that place certain population groups at heightened risk. Finally, the review synthesizes evidence on strategies and interventions, spanning policy, clinical practice, and public health outreach, that could be implemented to reduce the burden of alcohol-related cancers and promote cancer prevention nationwide.

Section snippets

Methods

This review was conducted by a team of medical students, as well as preventive medicine, epidemiology, addiction medicine, and public health experts with experience in alcohol use research and its association with chronic diseases, including cancer. The review followed the Arksey & O’Malley Framework and the Joanna Briggs Institute (JBI) recommendations for the extraction, analysis, and presentation of results in systematic reviews [13], [14]. This framework consists of five steps: To (1)

Results

A total of 62 studies were retained for analysis after excluding another six studies as they were published abstracts (Fig. 1). The retained studies encompassed a variety of designs, including cohort studies (n = 45), case-control studies (n = 13), ecological studies (n = 2), a quasi-experimental study (n = 1), and a cross-sectional study (n = 1). The sample sizes across these studies ranged from n = 80 to n = 99,939,322 (Table 1).

Discussion

This systematic review synthesized evidence from sixty-two U.S.-based studies examining the relationship between alcohol consumption and cancer risk, along with associated comorbidities, SDoH, and recommendations for prevention. Across study designs, alcohol intake, particularly at higher frequency or greater quantity, was consistently associated with elevated risk for multiple cancers, most notably colorectal, breast, and liver. Dose-response relationships were a common finding, underscoring

Limitations

This study has several limitations. First, we focused on descriptive, observational, qualitative, and experimental studies, excluding case reports, letters to the editor, published conference abstracts, and grey literature. As a result, some relevant evidence may not have been captured. Reference list tracing was not performed; however, the PROSPERO-registered protocol was developed with an experienced librarian using a comprehensive MeSH and keyword strategy to minimize omissions. Second, the

Conclusion

Alcohol consumption is a significant, modifiable risk factor for multiple cancers in U.S. adults, with risk increasing as frequency and volume of intake rise. This review highlights the role of comorbidities and social determinants of health in shaping both exposure and vulnerability to alcohol-associated cancers. Findings underscore the need for integrated prevention strategies that combine lifestyle interventions, policy measures, and effective access to screening and early detection.

Author’s contribution

All authors reviewed and agreed on the final version of this manuscript.

CRediT authorship contribution statement

Lea Sacca: Writing – review & editing, Visualization, Validation, Supervision, Project administration, Conceptualization. Alana Starr: Writing – original draft, Software, Methodology, Investigation, Formal analysis, Data curation. Christine Kamm: Writing – original draft, Software, Methodology, Formal analysis, Data curation. George Kosseifi: Writing – original draft, Validation, Methodology, Formal analysis, Data curation. Morgan Decker: Writing – original draft, Software, Methodology,

Consent to participate

Not applicable

Consent for publication

Not applicable

Ethics approval

Not applicable

Funding

The authors did not receive any form of funding to complete this work.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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