Breast cancer is the third most common cancer in Ireland, and the most common among women. Alcohol use is estimated to be attributable to approximately 7% of these breast cancer cases. Almost half of women in Ireland drink alcohol on a weekly basis (48%) and approximately 1 in every 5 women report binge drinking on a typical drinking occasion (19%). However, despite alcohol being classified as a Group 1 carcinogen (cancer causing) since 1988, many appear unaware of this fact.
What this study sought to examine
The annual Healthy Ireland Survey, representative of the adult population of Ireland, examines various health behaviours including smoking, alcohol use, weight, dental health, menstrual health, mental health, as well as information about use of health services. The survey has included baseline questions about alcohol use every year since it first began in 2015 and occasionally includes additional questions about alcohol. In Wave 2 of the Healthy Ireland Survey, respondents were asked to identify which of the five alcohol-related health conditions (liver disease, pancreatitis, high blood pressure, breast cancer, bowel cancer) they thought people were at an increased risk of developing if they regularly drank more than the low-risk limits recommended in Ireland (currently no more than 11 standard drinks per week for women or 17 standard drinks for men).
Of the health conditions, awareness of the link between alcohol use and breast cancer was the lowest and so this study sought to examine their characteristics so that recommendations could be made to target specific groups.
What we found
Just one in five respondents correctly identified that alcohol use was associated with increased risk of breast cancer (21%). Women (27%) showed greater awareness than men (15%), as did those aged 45—54 years (27%) especially when compared to those aged 15—24 years (13%). When considering educational attainment, those educated to degree level or higher were almost twice as likely than those with no qualifications to know of the risk (29% versus 16%). Also with greater awareness were:
- those engaged in home duties (26%)
- those in employment (24%)
- those married or in a civil partnership (24%)
- those in the least deprived deprivation category (23%)
Drinking patterns, such as how often and how much alcohol respondents drink, did not influence level of knowledge with hazardous drinkers (20%), low-risk drinkers (23%) and non–drinkers (21%) showing an almost equally low level of awareness. Similarly, area of residence did not impact knowledge.
Why do so few people know about the cancer risk associated with alcohol use?
The low level of awareness of the carcinogenic effect of alcohol is a cause for concern especially given the drinking patterns of many women in Ireland.
But is this finding unsurprising? There is very little information highlighting this risk. Labelling on alcohol products is limited and does not have the same strict criteria as other food and beverage products.
In Ireland, the Public Health (Alcohol) Act 2018 aims to reduce population-level alcohol use and related harm. The legislation includes components such as structural separation (alcohol products in mixed retail outlets must be kept separate from other products), minimum unit pricing, restrictions on alcohol advertising and sports sponsorship, and restrictions on the sale and supply of alcohol. The Act has also legislated for health warning labels on alcohol products, although to date, they have not yet commenced due to an ongoing EU consultation process.
These labels are intended to advise the public of the link between alcohol use and cancer, provide information about the number of standard drinks in the product, the calorie content of the product, the danger of alcohol use during pregnancy, and a website that provides impartial information about alcohol use and its harm. Such labelling on alcohol products have been found to be effective in providing information and in changing health behaviours in other jurisdictions where they have been introduced. They are also recommended by the World Health Organization (WHO).
What can be done?
Given that so few of the general population in Ireland know of the breast cancer risk associated with alcohol use, it is important that efforts be increased to raise awareness. This can be done through social media campaigns, health practitioner advice, and education programmes in communities and schools, with strategic targeting of those identified as having particularly low levels of knowledge. As the risk is specific to female breast cancer, it is crucial that women are made aware but also men, so that they can provide support to female family members, friends and colleagues. To inform effective public health messaging to reinforce this message, we need to understand drinking motivations, particularly among women who drink and yet know of the risks involved. In highlighting this risk, it may contribute to a decrease in hazardous drinking as well as reducing breast cancer incidence.
Consideration should be given to revising the low-risk drinking guidelines in Ireland in view of WHO recommendations that there is no safe level of alcohol use. Finally, the findings from this study support the need for health warning labels on alcohol products as set out in the Public Health (Alcohol) Act 2018.
Open access to the published paper can be found here: https://www.drugsandalcohol.ie/37780/
Written by Anne Doyle, Research Officer, Health Research Board Ireland.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.