Dr. Klein noted, „In less than half a century, we’ve seen major changes in the way people think about tobacco.“ Noelle LoConte, M.D., an oncologist at the University of Wisconsin-Madison who studies alcohol and cancer risk, said that these findings confirm what doctors have long observed. Broad reaching public health media campaigns, particularly those that increase information seeking, are needed to increase awareness. There have been decades of public education campaigns about the health risks of tobacco, warning labels on tobacco products, and smokefree laws.
Awareness of alcohol as a breast cancer risk factor
The focus on “problem” drinkers has led to a reduced perceived severity of harms caused by alcohol to the “moderate” drinker (40), which could account for some of the low level of awareness in the population. Low awareness of alcohol as a risk factor for cancer compared to tobacco could be a result of several factors. Policies used for tobacco control have contributed directly to the decline in smoking, have changed social norms around tobacco use, and have increased awareness about the harms of these products.
- We found low awareness (30%) of the alcohol-breast cancer link among breast cancer survivors.
- A 2024 WHO report found that only 21% of European women were aware of the alcohol–breast cancer connection 15.
- Despite the low overall awareness, our findings suggest that information from medical professionals may increase awareness, as observed in the higher prevalence of awareness in this sample compared to the general ABLE survey population (24%) 46.
- Public health campaigns about the cancer risk posed by alcohol in England and Australia have been effective at raising awareness with their target audiences.
- “We need to really make sure that we reinforce the message that all alcohol increases cancer risk,” she said.
Participants and procedures
In this multivariable analysis, we controlled for age, race, ethnicity, self-reported health, rural/urban status, AUDIT category and the U.S. region of residence. The study confirmed that most American adults aren’t aware of the link between alcohol consumption and cancer. It also found that, even among those who are aware, there’s a belief that it varies by the type of alcohol. For example, more participants were aware of the cancer risks from hard liquor and beer than about the risk from wine, with some participants believing awareness of alcohols link to cancer lagging nci wine lowers your cancer risk.
Links to NCBI Databases
Additionally, reductions in post-diagnosis drinking were minimal, with only 10% of survivors quitting drinking, with a sizeable proportion reporting increases in intake, and no association between post-diagnosis drinking changes and awareness. This suggests the need for providers to make a clearer connection between alcohol use and breast cancer outcomes to improve awareness of alcohol’s effects on breast cancer and the adoption of healthy lifestyle behaviors after a cancer diagnosis. Overall, our findings highlight the need for tailored education and intervention strategies to enhance awareness and promote healthier lifestyle choices among breast cancer survivors.
National Cancer Institute (NCI)’s Post
“We need to really make sure that we reinforce the message that all alcohol increases cancer risk,” she said. Alcoholic drinks contain ethanol, which is a known carcinogen, and there are several ways in which it may cause cancer. For example, ethanol can increase estrogen in the body, which increases the risk of breast cancer. The breakdown of ethanol in the body can also create high levels of acetaldehyde, which can damage DNA and cause liver, head and neck, and esophageal cancers. However, our focus in this secondary analysis is on the breast cancer survivor group within the study sample.
Data availability
These concerns often focus on medication interactions during treatment and the potential impact of alcohol on cancer recurrence post-treatment 59. Evidence suggests survivors may not consistently receive information about alcohol-related risk from their providers. A National Cancer Institute (NCI) blog post highlighted that many survivors continue drinking, including at harmful levels, with few reporting they had been counseled on alcohol’s impact on recurrence or secondary cancers 62. Similarly, a study in the Journal of Clinical Oncology (JCO) reported that only 7% of breast cancer patients recalled receiving alcohol advice at diagnosis, and those who did were more likely to reduce intake 63. The dependent measure, awareness that alcohol consumption increases breast cancer risk, was assessed by asking participants, “Do you think your risk of developing the following types of cancer is increased by drinking alcohol?
Links to NCBI Databases
The study also found that people who believed drinking alcohol increased the risk of heart disease were more aware of the alcohol–cancer risk than those who were unsure or believed drinking lowered the effect on heart risk. Participants in the survey are a nationally representative sample of adults aged 18 and older. The nearly 4,000 people who took part in the survey were asked how much does drinking several types of alcohol (wine, beer, and liquor) affect the risk of getting cancer. Breast cancer mortality in the U.S. has decreased from 33.1 per 100,000 patients in 1990 to 19.1 in 2021 1, primarily due to advancements in early detection and treatment 2,3,4. However, the incidence of breast cancer increased from 126.7 per 100,000 women in 2003 to 137.4 in 2019 1, contributing to a growing population of breast cancer survivors. Thirty-eight percent of the US population indicated that there was an association between drinking too much alcohol and cancer, 36.17% were uncertain, and 25.47% believed there was no association (Table 1).
Further, the prevalence of alcohol use, including high-risk drinking, has increased significantly in the US since 2002, with particularly sharp increases among women, racial/ethnic minorities, and people with lower income or educational attainment (2). Because cancer risk increases with the amount of ethanol consumed, all alcoholic beverages pose a risk. Researchers and health professionals can do more to help break down these misconceptions, Dr. LoConte added.
These data combined with existing US estimates have shown little improvement in awareness as estimates of awareness have consistently fluctuated between surveys over time. This pattern is particularly concerning given that awareness of other risk factors for cancer such as obesity have shown a steady increase over the same time period (20). The low level of awareness for alcohol as a risk factor for cancer compared to other important risk factors may not be surprising given that issues related to alcohol have been more focused on heavy drinkers or people with alcohol abuse disorders (40).
- Oral and esophageal cancers have the strongest association with alcohol use, and some associations vary by sex (6).
- All relevant ethical safeguards have been met in relation to patient or subject protection.
- Intriguingly, only 10% of survivors quit drinking post- diagnosis, and the remaining reported no changes (45%) or an increase in drinking (34%).
- In the United States alone, about 75,000 cancer cases and 19,000 cancer deaths are estimated to be linked to alcohol each year.
- The Health Information National Trends Survey (HINTS) that collected the data discussed in this paper was supported via a National Cancer Institute contract to Westat.
Awareness was higher among those with more education and higher health self-efficacy. People with a personal history of cancer and those ≥ 60 years of age had a higher prevalence of reporting “Don’t know”. Educating the public about the cancer risk from drinking alcohol, regardless of the beverage type, is especially urgent given the increase in drinking during the COVID-19 pandemic, Dr. Klein said.
Multivariate analyses confirmed that medical professionals significantly influenced patients’ awareness of the link between alcohol and breast cancer. This underscores the need for comprehensive training programs to enhance survivors’ knowledge about alcohol’s role in breast cancer. Several studies highlight oncologists’ concerns about patients’ limited awareness of this link 59,60,61.