Just one alcoholic drink a day can increase your risk of cancer. But most Americans don’t know the dangers, new survey says

Most Americans are unaware that drinking alcohol increases their risk of cancer, per a new survey conducted by the Annenberg Public Policy Center at the University of Pennsylvania.

’Tis the season of twinkling lights, travel, traditions—and increased alcohol consumption. Whatever your faith, or lack thereof, your winter holiday season likely involves office parties, family gatherings, and friendly celebrations. This “most wonderful time of the year” is when some people are more likely to drink beyond their limits, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

While the immediate dangers of alcohol, such as blackouts and impaired driving, are well-known, the substance’s ties to cancer apparently aren’t. Most Americans (60%) are unaware that drinking alcohol increases their risk of cancer, per a new survey conducted by the Annenberg Public Policy Center (APPC) at the University of Pennsylvania.

More than 1,700 U.S. adults 18 and older were polled in September as part of the APCC Annenberg Survey of Attitudes on Public Health, and the results were published Nov. 22. Participants were asked, “As far as you know, does regularly consuming alcohol (increase), (decrease), or have no effect on your chances of later developing cancer or are you not sure?” They answered (total exceeds 100% due to rounding):

  • Increase: 40%

  • Decrease: 1%

  • No effect: 20%

  • Not sure: 40%

“Public health messages about the risks associated with drinking alcohol have to overcome the effects of decades of sophisticated marketing and positive media portrayals,” Patrick Jamieson, PhD, director of APPC’s Annenberg Health and Risk Communication Institute, said in a news release about the survey.

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Beer, wine, liquor all tied to cancer

If you consume alcohol at all, you’re at risk. Whether your go-to beverage is beer, wine, or liquor, all alcoholic drinks are associated with cancer, according to the Centers for Disease Control and Prevention (CDC).

Your body metabolizes the ethanol in your drink into a possible carcinogen called acetaldehyde. This toxic chemical can damage your DNA, creating ruined cells capable of turning into cancer. And that’s just one way alcohol can heighten your risk of the disease. Alcohol can increase your blood levels of estrogen, a sex hormone linked to breast cancer risk, as well as hamper your ability to absorb and break down nutrients thought to be associated with cancer risk, according to the National Cancer Institute (NCI).

Alcohol ups your odds of developing these types of cancer, per the American Cancer Society:

  • Breast (in women)

  • Colon and rectum

  • Esophagus

  • Liver

  • Mouth

  • Throat (pharynx)

  • Voice box (larynx)

In addition, the CDC notes that alcohol may increase the risk of prostate cancer in men, and research has shown that drinking three or more alcoholic beverages a day increases your risk of stomach and pancreatic cancers. Annually, alcohol-related cancers kill about 20,000 adults nationwide.

The more you drink, regularly and over time, the higher your chances of developing cancer, the NCI says—even if you consume only one drink a day. And once the damage has been done, it can take years to reverse, if at all. One study, for example, showed that it would take more than 35 years for former drinkers to lower their risks of laryngeal and pharyngeal cancers to those of people who don’t drink.

What’s considered drinking in moderation?

The Dietary Guidelines for Americans recommend adults 21 and older consume no more than one (women) or two (men) drinks a day. The NIAAA considers a “standard” drink to contain 14 grams, or 0.6 fluid ounces, of pure alcohol:

  • 12 ounces of regular beer (5% alcohol)

  • 5 ounces of wine (12% alcohol)

  • 1.5 ounces of distilled spirits (40% alcohol)

More than half of U.S. adults consume alcohol, according to the CDC. About 6% drink heavily (eight or more drinks a week for women and 15 or more for men), and 17% binge drink (four or more drinks in one sitting for women and five or more for men).

How to maintain sobriety throughout the holidays

Whether you’re sober, have alcohol use disorder, or are looking to rein in your drinking habits, avoiding alcohol—particularly during the winter holiday season—can be difficult. The American Psychiatric Association offers these tips for yuletide sobriety:

  1. Plan ahead: Create a strategy for holiday events, including “escape routes” if you feel overwhelmed.

  2. Seek support: Reach out to support groups such as Alcoholics Anonymous (AA), friends, or family members who can provide assistance and encouragement.

  3. Avoid triggers: Identify and avoid situations or people that may trigger your desire to drink.

  4. Focus on nonalcoholic options: Enjoy nonalcoholic beverages to participate in the festivities without alcohol.

  5. Practice self-care: Prioritize self-care by getting enough rest, eating well, and managing stress.

  6. Develop coping strategies: Learn healthy adaptive coping mechanisms for dealing with stress, anxiety, and cravings.

If you or a loved one are struggling with alcohol use, the NIAAA Alcohol Treatment Navigator can connect you to self-guided programs, telehealth treatment, mutual support groups, and health care professionals who are trained to help. If you need immediate support, contact the 988 Suicide & Crisis Lifeline.

For more on how alcohol impacts your health:

This story was originally featured on Fortune.com