Drinking alcohol has been proven to increase the risk of developing breast cancer in over 100 studies, but both the general public and health professionals continue to ignore the issue.According to UK researchers, alcohol use is now estimated to be a major causative factor in between 5% to 11% of all breast cancer cases, but in their study, published in BMJ Open, less than one in five women attending a mammogram knew of the risk of alcohol, and – perhaps more worrying – less than half of the staff at the breast centre identified alcohol as a breast cancer risk factor.The mixed methodology study included over 200 woman attending a breast clinic for breast imaging – about half were symptomatic and the other half presented just for routine screening. These woman were surveyed along with over 30 staff. Following the survey a series of focus groups were conducted with both the women and the staff.Looking at different risk factors, almost one third of all participants identified obesity as a risk, and almost half recognised smoking as problematic. But alcohol? Only 16% in the screening group and 23% in the symptomatic group knew of any association between alcohol and breast cancer.“The study confirms that knowledge of alcohol as a modifiable risk factor for breast cancer is low,” the study authors said.The survey and focus groups also showed that many women did not know how much alcohol was in a standard drink such as a pint of beer or a glass of wine.So, as the authors point out, the dilemma is how will we ever modify this modifiable risk factor if people don’t even know about it and are unaware how to even assess their own alcohol consumption.The researchers suggest that the routine mammogram represents an ideal opportunity to intervene. Here is the time and the place where breast cancer will be front of mind – here is the time and place to increase awareness of alcohol as a breast cancer risk factors, assess a woman’s current alcohol consumption and suggest ways and means of reducing this if appropriate.Concerns that incorporating such a preventative strategy into a routine breast screening appointment might deter women from attending, appeared unfounded, the study noted.“Many women participating in this study reacted positively to the suggestion of adding information on cancer prevention, in general, to . . . breast screening or clinic attendances, although there was ambivalence by staff delivering it,” the researchers said.This ambivalence appeared to stem from a degree of uncertainty in relation to cancer risk factors, a lack of time available to discuss these issues with patients and a sense that it wasn’t their role to be providing this intervention.The other major barrier to conducting these assessments and implementing these preventative measures is motivation. In this study, two thirds of all participants drank alcohol. This is fairly representative of the population as a whole, with previous UK research showing that almost 80% of women had drunk alcohol in the past year, and more than one fifth of women aged 45 to 64 drank more than two standard drinks a day on average.“Home drinking is an embedded social practice, which may be resistant to change, and this normalisation of alcohol use by health professionals may account for some of the ambivalence they have to discuss alcohol consumption as a risk factor for breast cancer with patients,” they said.But this needs to change. There is plenty of evidence that alcohol brief interventions can be effective in reducing alcohol consumption. In fact the authors say, simply answering questions on alcohol consumption can result in behaviour change.“It is interesting to note that while it has become routine practice to assess patients in breast clinics for a possible inherited susceptibility to breast cancer and refer on for family history or genetics investigation, there is currently no equivalent pathway for patients who have potentially modifiable lifestyle risk factors, including alcohol use,” the researchers said. ReferenceSinclair J, McCann M, Sheldon E, Gordon I, Brierley-Jones L, Copson E. The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics. BMJ open 2019 Jun 17; 9(6): e027371. DOI: 10.1136/bmjopen-2018-027371

The spectre of breast cancer looms large for the majority of Australian women.But now researchers say if we tackle obesity and overweight as well as cutting out regular alcohol consumption we can prevent thousands of cases of this disease which is our most common cancer in women and second leading cause of cancer death.A new study has quantified how much these modifiable risk factors contribute to the incidence of breast cancer and predicts how many future cases they will cause. And it’s a bit frightening.According to this large Australian collaborative study, published in the international Journal of Cancer, if all Australian women maintained a healthy weight we could prevent 17,500 breast cancers in the next 10 years. And if women stopped drinking alcohol regularly (even one drink a day) it was estimated 11,600 future breast cancers could be avoided over the next decade.The researchers from University of NSW’s Centre for Big Data Research in Health were able to quantify the burden of these two risk factors after pooling six Australian cohort studies that included over 200,000 women. They were also able to differentiate the contribution of the various factors in premenopausal as opposed to postmenopausal breast cancers.“Regular alcohol consumption is the potentially modifiable risk factor responsible for the largest burden of breast cancer for premenopausal women in Australia, accounting for 12.6% of the burden and 2,600 cases of breast cancer over the next 10 years,” the study authors said. Body weight, or more accurately ‘body fatness’ was not a major factor for developing breast cancer before menopause.Apparently, this is the first time that regular alcohol consumption has been shown to be the leading modifiable contributing factor to breast cancer risk in this age group.And even though the finding would suggest that reducing the number of drinks per day would lessen the risk, the researchers found that the increased risk held true even with an average of one drink a day. Certainly bad news for more than half of Australian women who currently report drinking alcohol regularly, even if they are keeping to the current Australian recommendation not to drink more than two drinks a day on average.Among postmenopausal women, body fatness represents the biggest danger, accounting for 12.8% of the burden (17,500 breast cancer cases) over a decade. Given that three in five postmenopausal women in Australia are currently estimated to be overweight or obese this represents a key target for intervention. And alcohol consumption too, still made a substantial contribution to the risk in this cohort (6.6% or 9,000 breast cancer cases).Other modifiable risk factors included taking the oral contraceptive pill premenopause, and, among postmenopausal women taking menopausal hormone therapy (MHT).As the researchers point out, the issue of oral contraceptives as a breast cancer risk is a little complicated as it has to be weighed up against the protective effect these medications have against endometrial, ovarian and colorectal cancers as well as their reproductive health benefits.And as for MHT, the major breast cancer risk was for women taking MHT for five years or more.“Our findings thus support the current Australian and international recommendations of using MHT for the shortest duration possible, and only to alleviate menopausal symptoms, not for the prevention of chronic disease,” they said.Interestingly, for postmenopausal women at least, being physically active or having a history of breast feeding didn’t seem to alter the risk of developing breast cancer in the future.However, what the study has highlighted is the importance of targeting weight and alcohol as the most effective means to reduce the incidence of breast cancer.“The findings provide evidence to support targeted and population-level cancer control activities in Australia and beyond,” the study authors said. 

Reference