Lifetime Alcohol Intake Linked to Colorectal Cancer Risk

Higher lifetime alcohol consumption and sustained heavy drinking are associated with an increased risk of colorectal cancer (CRC), while alcohol cessation may reduce adenoma risk, according to a large analysis from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. The findings provide long-term perspective on alcohol exposure patterns relevant to CRC prevention counseling.

Study Findings

Investigators assessed lifetime alcohol intake among US adults by collecting self-reported drinking data across 4 age periods, calculating average drinks per week from age 18 to study baseline. Among 12,327 participants with a negative baseline screen, 812 developed colorectal adenomas at a second screen. Over 20 years of follow-up, 1679 incident CRC cases occurred among 88,092 participants.

Current drinkers with an average lifetime intake of 14 or more drinks per week had a higher risk of CRC compared with those consuming one drink or less per week (hazard ratio [HR], 1.25). Risk was particularly elevated for rectal cancer (HR, 1.95). Similarly, individuals with consistent heavy drinking patterns had nearly double the risk of CRC compared with light drinkers (HR, 1.91).

In contrast, alcohol cessation appeared protective for precursor lesions. Former drinkers had lower odds of nonadvanced adenoma compared with current light drinkers (odds ratio, 0.58). Notably, current drinkers averaging 7 to fewer than 14 drinks per week showed a lower CRC risk compared with those consuming less than one drink per week (HR, 0.79), with the strongest association seen for distal colon cancer.

Clinical Implications

The authors concluded that “consistent heavy alcohol intake and higher average lifetime alcohol drinking may increase CRC risk, whereas cessation may lower adenoma risk.” They also emphasized that “associations may differ by tumor site,” highlighting heterogeneity across colorectal subsites.

These findings support nuanced counseling that considers lifetime intake, not just current consumption, and reinforce the potential benefits of alcohol reduction or cessation, particularly for patients undergoing CRC screening or surveillance.

Reference
O'Connell CP, Berndt SI, Chudy-Onwugaje K, et al. Association of alcohol intake over the lifetime with colorectal adenoma and colorectal cancer risk in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Cancer. 2026;132(3):e70201. doi:10.1002/cncr.70201