The United States has seen a 33% reduction in the overall cancer death rate from 1991 to 2021, according to the latest Cancer Progress Report.

The report, released Wednesday by the American Association for Cancer Research, estimates the decrease equates to about 4.1 million lives saved. 

The cancer death rate for children and adolescents has also declined 24% in the past two decades, the report found.

While the decline in cancer deaths are attributable to lower smoking rates, treatment improvements and earlier detection, there’s still a risk factor that the authors warn isn’t as well known: alcohol.

Excessive levels of alcohol consumption increase the risk for six different types of cancer, according to the report, including: 

“In the U.S., 5.4% of cancers were attributed to alcohol consumption in 2019, the most recent year for which data are available,” a news release for the report states. “Research has shown an association between the degree of alcohol consumed during pregnancy and the likelihood of the child developing leukemia after birth, with both moderate and high levels of drinking during pregnancy increasing the risk.”

The report also notes alcohol intake at an earlier age can increase cancer risk later in life.

“Unfortunately, awareness about the link between alcohol and cancer is still low, highlighting the need for public messaging campaigns, such as cancer-specific warning labels displayed on alcoholic beverages, along with effective clinical strategies to reduce the burden of alcohol-related cancers,” the release continued.

Previously, researchers found more than 40% of all cancer fatalities among adults age 30 and over in the United States could be linked to lifestyle risks that can be changed. In addition to alcohol, the other most impactful modifiable risk factors include smoking, excess body weight, physical inactivity and diet.