Sophistication and glamour, celebration and commiseration, sharing and caring… A few years ago these all sounded like good reasons to open a bottle, and enjoy a glass or two on a Saturday, or a Friday evening, or Sunday lunch, or gloomy Thursday, and maybe a Tuesday if the day had been long. In in my annual GP check, I always confess to no more than 14 units a week and feel smug. My practice nurse nods approvingly.
The relationship between alcohol and breast cancer has been well described and has resulted in consistent findings by cancer researchers across the globe. In 2005, the third edition of the European Code against cancer recommended that “If you drink alcohol, whether beer, wine or spirits, moderate your consumption to two drinks per day if you are a man and one drink per day if you are a woman” and in 2014, the code was even clearer “If you drink alcohol of any type, limit your intake. Not drinking alcohol is better for cancer prevention”. 1 [European Code Against Cancer]
Why doesn’t this message get communicated to women within our NHS? Is it because the emphasis on alcohol has been on the highest consumers, and somewhere along the lines, alcohol and breast cancer is just too complex an issue to deal with – or are there other reasons? Every time I see a drinks advert that highlights (or is targeted) at women, I think, this is a serious action against breast cancer prevention efforts, and I question why the public health community is so loathe to support efforts to reduce breast cancer risk.
In the ActWell study 2 [ActWell Study – PubMed] (a lifestyle intervention amongst women attending routine breast screening clinics), we talked with women about the evidence on alcohol and cancer, and got some very interesting answers… Ranging from scepticism, show us the evidence, tell us how alcohol can possibly affect breasts, only relevant for younger women, binge drinkers and don’t tell us not to drink, a glass or two at the end of the day is our treat for coping with what life throws at us, we keep to the 14 units a week and alcohol free days…In other words, we follow the government’s advice and what’s more red wine and the heart – a prescription for good health? In the intervention design, we tackled alcohol through talking about it’s calorific value, and finding ways to decrease intakes through calorie control – much more acceptable than actually saying intakes of known carcinogens are risky – but we do have a challenge to address.
There are however some signs that alcohol consumption habits in women could be starting to change. Women on the wagon, Soberistas, Club Soda are examples of initiatives by women who want to change drinking habits. Two weeks ago, we saw the publication of work from Western Australia, 3 [BMJ Open] showing that a social marketing campaign could raise awareness about drinking and cancer, and improve intentions to change alcohol behaviour. That very visual campaign is hard to ignore, and although less glamorous than many of the sophisticated drink industry adverts, it is a campaign that brings a very memorable message.
In 2011 and 2013, the world cancer conference had no alcoholic drinks available at its opening receptions, and most people recognised that if they wished, they could seek a drink later and could easily survive a couple of hours without alcohol. I wish the same could be said of our national cancer agencies in the UK who aren’t quite there…yet.
There are big actions ahead in Scotland to support alcohol reduction, including pricing policy, and stricter blood alcohol limits for driving have already been introduced. But how far are we really supporting women and breast cancer risk? There is no doubt that alcohol messages from government need to be evidence based, and that includes evidence on breast cancer risk reduction. A change is long overdue.
Professor Annie S Anderson BSc PhD RD FRCP (Edin)
1 European Code Against Cancer If you drink alcohol of any type, limit your intake. Not drinking alcohol is better for cancer prevention
2 Anderson AS, Maureen M et al Breast cancer risk reduction – is it feasible to initiate a randomised controlled trial of a lifestyle intervention programme (ActWell) within a national breast screening programme? Available at http://www.ncbi.nlm.nih.gov/pubmed/25516158 22/03/2015
3 Dixon HG et al Using a mass media campaign to raise women’s awareness of the link between alcohol and cancer: cross-sectional pre-intervention and post-intervention evaluation surveys BMJ Open 2015;5:e006511 doi:10.1136/bmjopen-2014-006511 Available at http://bmjopen.bmj.com/content/5/3/e006511.full 22/03/2015