Raising a Glass or Raising the Risk? Rethinking Social Norms Around Alcohol: Sami Mansfield

“April marks Alcohol Awareness Month, a valuable opportunity to examine one of the most normalized yet under-recognized health risks in our culture.

While alcohol is often associated with professional events, social bonding, and relaxation, it carries serious consequences. Even modest consumption can increase the risk of several chronic illnesses—particularly cancer.

Alcohol has been causally linked to at least seven types of cancer: breast, colorectal, liver, esophageal, and cancers of the head and neck, including the oral cavity, pharynx, and larynx (IARC, 1988). Growing research also suggests associations with pancreatic, prostate, skin, and lung cancers (Bagnardi et al., 2015).

Many people are unaware that alcohol is classified as a Group 1 carcinogen by the International Agency for Research on Cancer—placing it in the same high-risk category as tobacco, asbestos, and ultraviolet radiation (IARC, 1988). This designation means there is strong scientific evidence that alcohol causes cancer in humans.

Globally, alcohol use is responsible for nearly 750,000 cancer cases annually. In the United States, it contributes to about 100,000 cancer cases and 20,000 cancer deaths each year, making it the third leading preventable cause of cancer after tobacco use and obesity (Islami et al., 2024).

Consider these statistics:

• Women who drink one alcoholic beverage per day face a 2.5% increase in lifetime cancer risk.
• Those who drink two per day have an even higher risk, especially for breast cancer, with four additional women out of 100 developing cancer due to alcohol (Allen et al., 2009).

To put it in context, drinking one bottle of wine per week has the same cancer risk as smoking 10 cigarettes per week for women and five cigarettes per week for men (Hydes et al., 2019). That comparison makes the risk more tangible—and harder to overlook.

Alarmingly, more than 3,400 alcohol-related cancer deaths in the U.S. occur among people who drink within current dietary guidelines. These guidelines suggest up to one drink per day for women and two for men—but evidence now shows that even this “moderate” drinking level carries measurable risk.

Alcohol’s link to cancer follows a dose-response relationship: the more you drink, the higher your risk. But no level of alcohol consumption has been found to be completely safe.

For years, moderate alcohol use—particularly red wine—was thought to be good for heart health. But newer, higher-quality research challenges that claim. Many of the earlier studies were methodologically flawed, including former drinkers (who may have quit due to health issues) in the non-drinker groups or failing to control for key lifestyle and genetic differences. Recent Mendelian randomization studies now show that even modest alcohol use increases the risk for ischemic heart disease, atrial fibrillation, and stroke.

And it’s not about the type of beverage—beer, wine, or spirits all contain ethanol, which is the cancer-causing agent.

Many individuals wonder if reducing or quitting alcohol after a cancer diagnosis can still make a difference. The answer is yes.

Significant benefits are seen in oral and esophageal cancers, especially after 10 or more years of alcohol abstinence (Gapstur et al., 2023). There is also promising evidence for reduced risk of colorectal and laryngeal cancers. For individuals with hormone receptor-positive breast cancer, alcohol reduction may provide meaningful risk reduction, though the consensus remains: when it comes to breast cancer, no alcohol is best.

This information isn’t meant to instill fear. It’s about understanding the facts so we can make better-informed decisions for our long-term health and well-being.

For healthcare professionals, caregivers, and coaches, conversations about alcohol can be sensitive—but they’re important.

Here are some strategies for supportive, non-judgmental communication, thank you to my colleague Elizabeth Farkouh for these exceptional talking points.

• Avoid assumptions. Don’t rely on labels like “social drinker.” Ask open-ended questions.
• Use neutral language. Terms like “alcohol use” are preferable to “abuse” or “misuse.”
• Emphasize the positive. Phrases like “less is best” are empowering and open the door to behavior change.

Changing habits isn’t easy. But with time, intention, and small actions, it’s absolutely possible. If you’re looking to cut back, here are five supportive strategies:

1. Identify your patterns. Use an app or journal to reflect on when, where, and why you drink. Awareness is the foundation of change.
2. Set personal goals.
3. Substitute alcohol-free alternatives. Stocking your fridge with some fancy carbonated beverages such as prebiotic drinks or healthy soda alternatives, invest in a carbonated water maker, or create some fun mocktail ideas.
4. Recognize your triggers. Stress, loneliness, or social pressure are often reasons that we use alcohol. Starting by identifying these is the best way to start.
5. Use empowering language. Swap vague terms like ‘responsible drinking’ for clearer language like ‘risk-aware drinking’ or ‘alcohol use with intention.

The reality is that even many professional oncology conferences and health-related events continue to serve alcohol, offer ultra-processed foods, and involve hours of sitting—while simultaneously promoting cancer prevention and wellness. These behaviors are rooted in longstanding culture and convenience, not necessarily evidence. But overlooking this contradiction risks undermining our prevention efforts.

As the saying goes, “It’s not your fault—but it is your responsibility.” We now have the science and the tools to model healthier behaviors, and that includes rethinking alcohol’s role in our daily lives and professional environments.

Alcohol is a modifiable risk factor. That means you can take action—starting today—to protect your long-term health. Whether you’re a survivor, a clinician, or someone focused on well-being, consider using this April to reflect, reset, and reduce.

Instead of asking, “How much is okay?” consider asking, “Is this really worth it—for my health, my goals, and my future?”

This blog content was inspired by an event held with the American College of Lifestyle Medicine’s Cancer Member Interest Group called Uncorking the Truth: Latest Evidence on Alcohol and Cancer led by Elizabeth Farkouh.”

written by Sami Mansfield

Sami Mansfield is an exercise oncology and lifestyle medicine consultant with endless curiosity and persistence. As the founder of Cancer Wellness for Life, Sami has dedicated her career to empowering cancer survivors and clinicians through innovative, evidence-based programs that improve health outcomes while optimizing cost-efficiency.

Sami is a contributing author to groundbreaking guidelines, including the ASCO Guidelines on Exercise, Nutrition, and Weight Management, and has helped shape numerous state cancer control plans.

She is the current chair of the Cancer Member Interest Group for the American College of Lifestyle Medicine, where she drives forward initiatives emphasizing the connection between science and implementation. Her patient-facing programs like BUILD and My Lifestyle Shift have reached global audiences, transforming lives through the pillars of lifestyle medicine.

Read more posts featuring Sami Mansfield at OncoDaily.com.