<p>by Vasilis Vasiliou, Arthur Stem, David C. Thompson</p> Alcohol consumption is a preventable driver of many cancers, yet a central biological question remains unresolved: by what mechanisms does ethanol promote malignancy? We propose that alcohol in the context of the exposome (i.e., the network of chemical, biological, and social determinants that interact with ethanol across the life span) provides a unifying framework for understanding alcohol-related carcinogenesis. Viewed through the lens of the exposome, alcohol is not only as a direct carcinogen but also as a systemic amplifier of environmental risk acting across multiple levels of biological organization, from molecular damage to whole-body physiology. This reframing has important implications for mechanistic research, precision prevention, and public-health policy.