Alcohol Consumption Trajectories from Early Adulthood to Adulthood and Cancer Risk in Adulthood: A Systematic Review and Meta-analysis

Long-term alcohol consumption patterns may influence cancer risk, yet evidence on life-course consumption trajectories remains inconsistent. This study summarized existing literature, identified common alcohol trajectories, and assessed their associations with overall and site-specific cancer risk. We searched PubMed, EMBASE, and Scopus (2000 March2025) for observational studies reporting alcohol intake at ≥2 time points and adult cancer outcomes. Six trajectories were identified: lifetime abstention, stable light, moderate increasing, moderate decreasing, decreasing-heavy, and stable high. Adjusted hazard ratios were pooled using random-effects models, with subgroup and sensitivity analyses conducted. Nine studies (n=3,860,679) met inclusion criteria. Compared with lifetime abstention, stable-light drinking was associated with a small increase in overall (aHR=1.03;95%CI:1.00-1.05) and alcohol-related cancer risk aHR=1.07;95%CI:1.02-1.12). Higher risks were observed for moderate increasing, decreasing heavy, and stable-high trajectories, with gastrointestinal cancers showing the strongest associations (aHR=1.58;95%CI:1.40-1.77). Breast cancer risk increased among women with moderate increasing or stable high intake. No consistent associations were found for genitourinary cancers. Sustained or increasing alcohol intake from early adulthood substantially elevated cancer risk, while even stable light drinking carried modest risk. Individuals reducing heavy drinking later in life remained at increased risk, suggesting early life alcohol-related damage may not be fully reversible.