Women and alcohol

Posted 20.08.2018

By Professor Annie Anderson, Scottish Cancer Prevention Network

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 has been long.

The relationship between alcohol and breast cancer

The relationship between alcohol and breast cancer has been well documented 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”.

However, a recent review of 32 studies on awareness about alcohol and cancer showed much room for improvement and noted that attempts to increase awareness have been limited and constitute a significant public health need. The authors suggest potential strategies to increase awareness, such as alcohol bottle labelling and fostering patient/physician discussions regarding the link. I would really like to know why the alcohol message does not get communicated to women within our NHS. It is one thing being asked how much you drink at regular GP checks, but it seems as long as you report around 14 units a week no one wants to talk about risks.

The risks

We know from extensive studies that risk for breast cancer starts to increase at more than 10g alcohol per day (a unit in the UK is 8g) but this is clearly being kept as a secret! As for drinking to decrease heart disease – a recent Lancet paper presents compelling data to support an upper intake of 100g alcohol per week clearly demonstrating no benefits for most cardio vascular conditions (apart from Myocardial infarction).

It is clear that historically, 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 assault on breast cancer prevention efforts and I question why the public health community are so loathe to support efforts to reduce breast cancer risk.

In the ActWell study (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 skepticism, 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?

Different approach

More recently, when we talked about messages to decrease alcohol in the intervention design we tackled alcohol through talking about the calorific value and finding ways to decrease intakes through calorie control…  but then here is an example of a response to this approach

I only drink vodka and I don’t think of the calories in it but what I do think of is the calories in is my mixer.  So I wouldn’t have normal coke.  I have Diet 7 Up or soda water with a wee dash of lime. I wouldn’t take my vodka with full fat coke.  Think of all the calories in that (the vodka is fine it’s the coke that’s the problem).

Are things starting to change?

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. Recently, we saw the publication of work from Western Australia 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.

Recent World Cancer conference’s organised by the UICC http://www.uicc.org/  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. The next UK National Cancer Research Institute conference in Glasgow in November this year will we see alcohol flowing in receptions and from trade stands.

Major steps are already being taken in Scotland to support alcohol reduction including the introduction of Minimum Unit Pricing and stricter alcohol blood limits for driving. But how far are we really tipping the balance of cultural norms and how far are we supporting women to reduce 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.