Aim:We hypothesized that cross-generational effects of alcohol exposure could alter DNA methylation and expression of the HRAS oncogene and TP53 tumor suppressor gene that drive cancer development. Methods: DNA methylation of the HRAS and TP53 genes was tested in samples from young participants (Mean age of 13.4 years). Results: Controlling for both personal use and maternal use of substances during pregnancy, familial alcohol dependence was associated with hypomethylation of CpG sites in the HRAS promoter region and hypermethylation of the TP53 gene. Conclusion: The results suggest that ancestral exposure to alcohol can have enduring effects that impact epigenetic processes such as DNA methylation that controls expression of genes that drive cancer development such as HRAS and TP53. Alcohol use is responsible for about 4% of all deaths worldwide [1]. A portion of this increased incidence of all-cause mortality is due to head and neck cancers, particularly of the pharynx, larynx, oral cavity and esophagus as well as the liver [2]. Alcohol abuse and dependence are frequently seen in individuals diagnosed with Head and Neck Squamous Cell Carcinoma [3]. Moreover, prospective epidemiological data show that alcohol use has a significant dose-response relationship with increased hazard ratios for developing cancer starting at three drinks per day [4]. Consumption of alcohol appears to have a direct effect on gastrointestinal tissue promoting the development of malignancy. The incidence of the head and neck cancers is in direct proportion to the dilution of alcohol in the gut so that mouth cancers are most common followed by esophageal cancers with the least incidence occurring in stomach and intestinal cancers [5].Integrated approaches to understanding cancer risk appear to require analysis of genetic and epigenetic factors along with gene expression profiles to address the complexity of cancer etiology [6]. In addition to the direct effect of alcohol on tissues exposed to alcohol, the potential exists for alcohol to change the methylation of oncogenes and tumor suppressor genes involved in tumor development. Defining the factors that contribute to this increased risk for these cancers is critical to the ultimate goal of reducing cancer development.A diverse set of environmental conditions affect DNA methylation [7][8][9] with the potential for altering gene expression [10]. Alcohol use and smoking can produce altered methylation in humans [11,12]. Cross generational effects have been reported with famine experienced by parents affecting medical conditions and longevity in offspring [13,14]. Although not previously reported in humans, animal studies have shown that ethanol administration can influence DNA methylation through the germline in offspring exposed either through fetal exposure [15] or as a result of paternal exposure [16,17]; changes with the potential to alter every somatic cell in the body across generations. Determining if alcohol consumption in the preconception period in parents influences genes involv...