I’m a radiation oncologist, and I can’t tell you how many times I’ve heard this question: “Doc, how much can I drink before it really starts to raise my risk of cancer?”

It’s a common concern, and honestly, it’s tough to answer.

People want a clear number, a magic threshold, but it’s not simple.

The truth is that even small amounts of alcohol can increase your risk.

That’s right, even that glass of wine with dinner or that beer after work isn’t completely harmless.

Dr. Vivek Murthy, The Surgeon General of the U.S. Public Health Service, has been emphasizing it, and I echo that warning.

Alcohol and Cancer

Researchers have associated alcohol with at least seven cancer types: mouth, throat, larynx, esophagus, breast, liver, colon, and rectum.

In fact, in 2020 alone, over 740,000 cancer cases worldwide were attributed to alcohol consumption.

That’s a staggering number.

Even more concerning is that many people are unaware of this link.

A 2019 survey found that only 45 percent of Americans believe alcohol significantly impacts cancer risk. More on that finding in a bit.

Here’s the bottom line: the more you drink, especially regularly over time, the higher your risk.

And this applies to all types of alcohol — beer, wine, and liquor.

I know this isn’t what people want to hear.

We all enjoy a drink occasionally, but it’s crucial to be aware of the risks and make informed choices.

Even Small Alcohol Amounts Increase Cancer Risk

Even small amounts of alcohol can increase your cancer risk.

• What’s a standard drink? A standard drink has 14 grams of alcohol, like a 5-ounce glass of wine, a 12-ounce beer, or a 1.5-ounce shot of liquor.
• Less than one drink a week still has risks. Research shows that even this small amount can increase your risk of certain cancers.
• Lifetime risk: For women who have less than one drink a week, about 17 out of 100 will develop an alcohol-related cancer in their lifetime. This number includes cancers like breast cancer (about 11 out of 100 women), which alcohol’s effect on estrogen levels can influence. Men who have less than one alcoholic drink per week have about a 1 in 10 chance of developing alcohol-related cancer during their lifetime.

Any Alcohol Amount or Type Increases Cancer Risk

Any amount of alcohol consumption increases cancer risk.

The idea that a drink a day is good for you is outdated.

Current research shows that even one alcoholic beverage weekly increases your health risks.

What About One Drink Per Day?

Many of my Seattle friends and patients consume at least one standard drink daily.

You heard the risk increase for less than one alcoholic beverage per week.

What about daily?

Again, from the U.S. Surgeon General’s report:

For women, this means a 19 percent lifetime risk of developing an alcohol-related cancer.

For men, it means an 11 percent lifetime risk of developing an alcohol-related cancer.

Which Cancers Are Associated with Alcohol?

Alcohol consumption increases the risk of at least seven cancer types:

• Mouth
• Throat
• Voicebox
• Esophagus
• Breast
• Liver
• Colorectal

I’d like to make this information more practical by giving the absolute (rather than relative) risk increases for two drinks daily:

Five more women out of 100 will develop cancer secondary to drinking two alcoholic beverages daily. Three additional men out of 100 will develop cancer.

If you consume more than four drinks daily, you can add four more cancers to the list: Liver, stomach, gallbladder, and pancreas.

Less Than Half of Americans Are Knowledgeable

This pronouncement from Dr. Murthy disturbs me:

Less than one-half of Americans are aware that alcohol consumption increases cancer risk.

Here are the specifics:

Problems With My Analysis

It’s time for me to criticize Dr. Murthy’s analysis of the alcohol data.

The Surgeon General put out advice saying that even moderate drinking is linked to a series of cancers.

He implicates at least seven cancers.

Meta-analyses form the basis for much of my thinking.

Think of a meta-analysis as making a juice blend.

The quality of the juice depends entirely on the fruits you add.

Because alcohol consumption is self-reported, there are limitations:

• Accuracy: People might not accurately remember or report how much they drink.
• Bias: Reporting habits could differ based on race, socioeconomic status, and education level.
• “Non-drinker” category: The reasons people don’t drink vary widely, including health issues, past alcohol problems, or medical advice.

How I Approach Habits

I tend to consider several endpoints when I think about habits that may impact my health, including the following:

• What is my projected life expectancy? If it is six months, I might do things I wouldn’t do if I had decades.
• How well will I live (morbidity/ disability)? My quality of life (my health span) is enormously important.
• How much joy does the activity spark?
• What is the impact on those around me? If I were mean to others after drinking, it would (I hope) greatly influence my consumption.

Do you approach habits differently? Perhaps your belief system (religious or otherwise) has an influence?

For me, less is better.

But I don’t like the taste of alcohol in general (I don’t mind the occasional sake or hanjan (the latter is a Korean brand of soju, traditionally a rice-based spirit.

If I did drink, one word: Moderation.

Finally, if you have concerns, talk to your healthcare provider.

They can help you understand your risk factors and make the best decisions for your health.

Vivek H. Murthy

News about Vivek H. Murthy. Commentary and archival information about Vivek H. Murthy from The New York Times.

www.nytimes.com