Skip to main content
Top
Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Breast Cancer | Research

Demographic disparities in the limited awareness of alcohol use as a breast cancer risk factor: empirical findings from a cross-sectional study of U.S. women

Authors: Monica H. Swahn, Priscilla Martinez, Adelaide Balenger, Justin Luningham, Gaurav Seth, Sofia Awan, Ritu Aneja

Published in: BMC Public Health | Issue 1/2024

Login to get access

Abstract

Background

Alcohol use is an established yet modifiable risk factor for breast cancer. However, recent research indicates that the vast majority of U.S. women are unaware that alcohol use is a risk factor for breast cancer. There is limited information about the sociodemographic characteristics and alcohol use correlates of awareness of the alcohol use and breast cancer link, and this is critically important for health promotion and intervention efforts. In this study, we assessed prevalence of the awareness of alcohol use as a risk factor for breast cancer among U.S. women and examined sociodemographic and alcohol use correlates of awareness of this link.

Methods

We conducted a 20-minute online cross-sectional survey, called the ABLE (Alcohol and Breast Cancer Link Awareness) survey, among U.S. women aged 18 years and older (N = 5,027) in the fall of 2021. Survey questions assessed awareness that alcohol use increases breast cancer risk (yes, no, don’t know/unsure); past-year alcohol use and harmful drinking via the Alcohol Use Disorders Identification Test (AUDIT); and family, health, and sociodemographic characteristics. We conducted multivariate multinomial regression analysis to identify correlates of awareness that alcohol use increases breast cancer risk.

Results

Overall, 24.4% reported that alcohol use increased breast cancer risk, 40.2% reported they were unsure, and 35.4% reported that there was no link between alcohol use and breast cancer. In adjusted analysis, awareness of alcohol use as a breast cancer risk factor, compared to not being aware or unsure, was associated with being younger (18–25 years old), having a college degree, and having alcohol use disorder symptoms. Black women were less likely than white women to report awareness of the alcohol use and breast cancer link.

Conclusions

Overall, only a quarter of U.S. women were aware that alcohol use increases breast cancer risk, although 40% expressed uncertainty. Differences in awareness by age, level of education, race and ethnicity and level of alcohol use offer opportunities for tailored prevention interventions, while the overall low level of awareness calls for widespread efforts to increase awareness of the breast cancer risk from alcohol use among U.S. women.
Literature
2.
go back to reference Collaborative Group on Hormonal Factors in Breast Cancer. Alcohol, tobacco and breast cancer– collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. Br J Cancer. 2002;87(11):1234.CrossRefPubMedCentral Collaborative Group on Hormonal Factors in Breast Cancer. Alcohol, tobacco and breast cancer– collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. Br J Cancer. 2002;87(11):1234.CrossRefPubMedCentral
3.
go back to reference Allen NE, Beral V, Casabonne D, Kan SW, Reeves GK, Brown A, Green J, on behalf of the Million Women Study C. Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst. 2009;101(5):296–305.CrossRefPubMed Allen NE, Beral V, Casabonne D, Kan SW, Reeves GK, Brown A, Green J, on behalf of the Million Women Study C. Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst. 2009;101(5):296–305.CrossRefPubMed
4.
go back to reference Rumgay H, Shield K, Charvat H, Ferrari P, Sornpaisarn B, Obot I, Islami F, Lemmens VEPP, Rehm J, Soerjomataram I. Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study. Lancet Oncol. 2021;22(8):1071–80.CrossRefPubMedPubMedCentral Rumgay H, Shield K, Charvat H, Ferrari P, Sornpaisarn B, Obot I, Islami F, Lemmens VEPP, Rehm J, Soerjomataram I. Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study. Lancet Oncol. 2021;22(8):1071–80.CrossRefPubMedPubMedCentral
5.
go back to reference Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, Scotti L, Jenab M, Turati F, Pasquali E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer. 2015;112(3):580–93.CrossRefPubMed Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, Scotti L, Jenab M, Turati F, Pasquali E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis. Br J Cancer. 2015;112(3):580–93.CrossRefPubMed
6.
go back to reference Scoccianti C, Lauby-Secretan B, Bello P-Y, Chajes V, Romieu I. Female breast cancer and alcohol consumption: a review of the literature. Am J Prev Med. 2014;46(3):S16–25.CrossRefPubMed Scoccianti C, Lauby-Secretan B, Bello P-Y, Chajes V, Romieu I. Female breast cancer and alcohol consumption: a review of the literature. Am J Prev Med. 2014;46(3):S16–25.CrossRefPubMed
7.
go back to reference Cifu G, Arem H. Adherence to lifestyle-related cancer prevention guidelines and breast cancer incidence and mortality. Ann Epidemiol. 2018;28(11):767–73. e761.CrossRefPubMed Cifu G, Arem H. Adherence to lifestyle-related cancer prevention guidelines and breast cancer incidence and mortality. Ann Epidemiol. 2018;28(11):767–73. e761.CrossRefPubMed
8.
go back to reference Liu Y, Nguyen N, Colditz GA. Links between alcohol consumption and breast cancer: a look at the evidence. Women’s Health. 2015;11(1):65–77.PubMed Liu Y, Nguyen N, Colditz GA. Links between alcohol consumption and breast cancer: a look at the evidence. Women’s Health. 2015;11(1):65–77.PubMed
10.
go back to reference Esser MB, Sacks JJ, Sherk A, Karriker-Jaffe KJ, Greenfield TK, Pierannunzi C, Brewer RD. Distribution of drinks consumed by US adults by average daily alcohol consumption: a comparison of 2 nationwide surveys. Am J Prev Med. 2020;59(5):669–77.CrossRefPubMedPubMedCentral Esser MB, Sacks JJ, Sherk A, Karriker-Jaffe KJ, Greenfield TK, Pierannunzi C, Brewer RD. Distribution of drinks consumed by US adults by average daily alcohol consumption: a comparison of 2 nationwide surveys. Am J Prev Med. 2020;59(5):669–77.CrossRefPubMedPubMedCentral
11.
go back to reference Keyes KM. Age, period, and cohort effects in alcohol use in the United States in the 20th and 21st centuries: implications for the coming decades. Alcohol Research: Curr Reviews. 2022;42(1):02–02.CrossRef Keyes KM. Age, period, and cohort effects in alcohol use in the United States in the 20th and 21st centuries: implications for the coming decades. Alcohol Research: Curr Reviews. 2022;42(1):02–02.CrossRef
12.
go back to reference Grucza RA, Sher KJ, Kerr WC, Krauss MJ, Lui CK, McDowell YE, Hartz S, Virdi G, Bierut LJ. Trends in adult alcohol use and binge drinking in the early 21st-Century United States: a Meta-analysis of 6 National Survey Series. Alcohol Clin Exp Res. 2018;42(10):1939–50.CrossRefPubMedPubMedCentral Grucza RA, Sher KJ, Kerr WC, Krauss MJ, Lui CK, McDowell YE, Hartz S, Virdi G, Bierut LJ. Trends in adult alcohol use and binge drinking in the early 21st-Century United States: a Meta-analysis of 6 National Survey Series. Alcohol Clin Exp Res. 2018;42(10):1939–50.CrossRefPubMedPubMedCentral
13.
go back to reference Roberts A, Rogers J, Mason R, Siriwardena AN, Hogue T, Whitley GA, Law GR. Alcohol and other substance use during the COVID-19 pandemic: a systematic review. Drug Alcohol Depend. 2021;229(Pt A):109150–109150.CrossRefPubMedPubMedCentral Roberts A, Rogers J, Mason R, Siriwardena AN, Hogue T, Whitley GA, Law GR. Alcohol and other substance use during the COVID-19 pandemic: a systematic review. Drug Alcohol Depend. 2021;229(Pt A):109150–109150.CrossRefPubMedPubMedCentral
14.
go back to reference Martinez P, Karriker-Jaffe KJ, Ye Y, Patterson D, Greenfield TK, Mulia N, Kerr WC. Mental health and drinking to cope in the early COVID period: data from the 2019–2020 US National Alcohol Survey. Addict Behav. 2022;128:107247.CrossRefPubMedPubMedCentral Martinez P, Karriker-Jaffe KJ, Ye Y, Patterson D, Greenfield TK, Mulia N, Kerr WC. Mental health and drinking to cope in the early COVID period: data from the 2019–2020 US National Alcohol Survey. Addict Behav. 2022;128:107247.CrossRefPubMedPubMedCentral
15.
go back to reference Yeo YH, He X, Ting P-S, Zu J, Almario CV, Spiegel BMR, Ji F. Evaluation of trends in Alcohol Use disorder–related mortality in the US before and during the COVID-19 pandemic. JAMA Netw Open. 2022;5(5):e2210259.CrossRefPubMedPubMedCentral Yeo YH, He X, Ting P-S, Zu J, Almario CV, Spiegel BMR, Ji F. Evaluation of trends in Alcohol Use disorder–related mortality in the US before and during the COVID-19 pandemic. JAMA Netw Open. 2022;5(5):e2210259.CrossRefPubMedPubMedCentral
16.
go back to reference Khushalani JS, Qin J, Ekwueme DU, White A. Awareness of breast cancer risk related to a positive family history and alcohol consumption among women aged 15–44 years in United States. Prev Med Rep 2020, 17. Khushalani JS, Qin J, Ekwueme DU, White A. Awareness of breast cancer risk related to a positive family history and alcohol consumption among women aged 15–44 years in United States. Prev Med Rep 2020, 17.
17.
go back to reference Merten JW, Parker A, Williams A, King JL, Largo-Wight E, Osmani M. Cancer risk factor knowledge among young adults. J Cancer Educ. 2017;32(4):865–70.CrossRefPubMed Merten JW, Parker A, Williams A, King JL, Largo-Wight E, Osmani M. Cancer risk factor knowledge among young adults. J Cancer Educ. 2017;32(4):865–70.CrossRefPubMed
18.
go back to reference Calvert CM, Toomey T, Jones-Webb R. Are people aware of the link between alcohol and different types of Cancer? BMC Public Health. 2021;21(1):734–734.CrossRefPubMedPubMedCentral Calvert CM, Toomey T, Jones-Webb R. Are people aware of the link between alcohol and different types of Cancer? BMC Public Health. 2021;21(1):734–734.CrossRefPubMedPubMedCentral
19.
go back to reference Olson KL, Whitley P, Velasco J, LaRue L, Dawson E, Huskey A. Seasonal and regional influences on alcohol consumption: an analysis of near-real-time urine drug test results in those seeking health care. Drug Alcohol Depend. 2021;227:108908.CrossRefPubMed Olson KL, Whitley P, Velasco J, LaRue L, Dawson E, Huskey A. Seasonal and regional influences on alcohol consumption: an analysis of near-real-time urine drug test results in those seeking health care. Drug Alcohol Depend. 2021;227:108908.CrossRefPubMed
20.
go back to reference Balenger A, Scott LC, Swahn MH, Aneja R. Acceptability of primary care counseling and brief Educational messages to increase awareness about alcohol and breast Cancer risks among bisexual and lesbian women. Int J Environ Res Public Health. 2023;20(5):4184.CrossRefPubMedPubMedCentral Balenger A, Scott LC, Swahn MH, Aneja R. Acceptability of primary care counseling and brief Educational messages to increase awareness about alcohol and breast Cancer risks among bisexual and lesbian women. Int J Environ Res Public Health. 2023;20(5):4184.CrossRefPubMedPubMedCentral
21.
go back to reference Hawkins NA, Berkowitz Z, Peipins LA. What does the public know about preventing cancer? Results from the Health Information National trends Survey (HINTS). Health Educ Behav. 2010;37(4):490–503.CrossRefPubMed Hawkins NA, Berkowitz Z, Peipins LA. What does the public know about preventing cancer? Results from the Health Information National trends Survey (HINTS). Health Educ Behav. 2010;37(4):490–503.CrossRefPubMed
22.
go back to reference Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT: The Alcohol Use Diosorders Identification Test - Guidelines for use in primary care. In., 2nd edn; 2001. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT: The Alcohol Use Diosorders Identification Test - Guidelines for use in primary care. In., 2nd edn; 2001.
23.
go back to reference Killgore WDS, Cloonan SA, Taylor EC, Lucas DA, Dailey NS. Alcohol dependence during COVID-19 lockdowns. Psychiatry Res. 2021;296:113676.CrossRefPubMed Killgore WDS, Cloonan SA, Taylor EC, Lucas DA, Dailey NS. Alcohol dependence during COVID-19 lockdowns. Psychiatry Res. 2021;296:113676.CrossRefPubMed
24.
go back to reference Buykx P, Li J, Gavens L, Hooper L, Lovatt M, Matos EGd, Meier P, Holmes J. Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey. BMC Public Health. 2016;16(1):1–12.CrossRef Buykx P, Li J, Gavens L, Hooper L, Lovatt M, Matos EGd, Meier P, Holmes J. Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey. BMC Public Health. 2016;16(1):1–12.CrossRef
27.
go back to reference Venables WN. BDR: Modern Applied statistics with S. New York, NY: Springer; 2022. Venables WN. BDR: Modern Applied statistics with S. New York, NY: Springer; 2022.
28.
go back to reference Wang C, Miller SM, Egleston BL, Hay JL, Weinberg DS. Beliefs about the causes of breast and colorectal cancer among women in the general population. Cancer Causes Control. 2010;21(1):99–107.CrossRefPubMed Wang C, Miller SM, Egleston BL, Hay JL, Weinberg DS. Beliefs about the causes of breast and colorectal cancer among women in the general population. Cancer Causes Control. 2010;21(1):99–107.CrossRefPubMed
29.
go back to reference McKetta S, Keyes KM. Heavy and binge alcohol drinking and parenting status in the United States from 2006 to 2018: an analysis of nationally representative cross-sectional surveys. PLoS Med. 2019;16(11):e1002954.CrossRefPubMedPubMedCentral McKetta S, Keyes KM. Heavy and binge alcohol drinking and parenting status in the United States from 2006 to 2018: an analysis of nationally representative cross-sectional surveys. PLoS Med. 2019;16(11):e1002954.CrossRefPubMedPubMedCentral
30.
go back to reference Goings TC, Salas-Wright CP, Belgrave FZ, Nelson EJ, Harezlak J, Vaughn MG. Trends in binge drinking and alcohol abstention among adolescents in the US, 2002–2016. Drug Alcohol Depend. 2019;200:115–23.CrossRef Goings TC, Salas-Wright CP, Belgrave FZ, Nelson EJ, Harezlak J, Vaughn MG. Trends in binge drinking and alcohol abstention among adolescents in the US, 2002–2016. Drug Alcohol Depend. 2019;200:115–23.CrossRef
31.
go back to reference Thomsen KL, Christensen ASP, Meyer MKH. Awareness of alcohol as a risk factor for cancer: a population-based cross-sectional study among 3000 Danish men and women. Prev Med Rep. 2020;19:101156.CrossRefPubMedPubMedCentral Thomsen KL, Christensen ASP, Meyer MKH. Awareness of alcohol as a risk factor for cancer: a population-based cross-sectional study among 3000 Danish men and women. Prev Med Rep. 2020;19:101156.CrossRefPubMedPubMedCentral
32.
go back to reference Buykx P, Li J, Gavens L, Hooper L, Lovatt M, Gomes de Matos E, Meier P, Holmes J. Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey. BMC Public Health. 2016;16(1):1–12.CrossRef Buykx P, Li J, Gavens L, Hooper L, Lovatt M, Gomes de Matos E, Meier P, Holmes J. Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey. BMC Public Health. 2016;16(1):1–12.CrossRef
33.
go back to reference Kickbusch IS. Health literacy: addressing the health and education divide. Health Promot Int. 2001;16(3):289–97.CrossRefPubMed Kickbusch IS. Health literacy: addressing the health and education divide. Health Promot Int. 2001;16(3):289–97.CrossRefPubMed
34.
go back to reference Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–63.CrossRefPubMed Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–63.CrossRefPubMed
35.
go back to reference Sinclair 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;9(6):e027371.CrossRefPubMedPubMedCentral Sinclair 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;9(6):e027371.CrossRefPubMedPubMedCentral
36.
go back to reference Alalwan MA, Long L, Hirko KA, LoConte NK, Scherr CL, Keller-Hamilton B, Atkinson L, Suraapaneni S, Gatti-Mays ME, Manne S. Awareness of alcohol as a breast cancer risk factor and intentions to reduce alcohol consumption among US young adult women. Translational Behav Med 2023:ibad045. Alalwan MA, Long L, Hirko KA, LoConte NK, Scherr CL, Keller-Hamilton B, Atkinson L, Suraapaneni S, Gatti-Mays ME, Manne S. Awareness of alcohol as a breast cancer risk factor and intentions to reduce alcohol consumption among US young adult women. Translational Behav Med 2023:ibad045.
37.
go back to reference Meyer SB, Foley K, Olver I, Ward PR, McNaughton D, Mwanri L, Miller ER. Alcohol and breast cancer risk: Middle-aged women’s logic and recommendations for reducing consumption in Australia. PLoS ONE. 2019;14(2):e0211293.CrossRefPubMedPubMedCentral Meyer SB, Foley K, Olver I, Ward PR, McNaughton D, Mwanri L, Miller ER. Alcohol and breast cancer risk: Middle-aged women’s logic and recommendations for reducing consumption in Australia. PLoS ONE. 2019;14(2):e0211293.CrossRefPubMedPubMedCentral
38.
go back to reference Buykx P, Gilligan C, Ward B, Kippen R, Chapman K. Public support for alcohol policies associated with knowledge of cancer risk. Int J Drug Policy. 2015;26(4):371–9.CrossRefPubMed Buykx P, Gilligan C, Ward B, Kippen R, Chapman K. Public support for alcohol policies associated with knowledge of cancer risk. Int J Drug Policy. 2015;26(4):371–9.CrossRefPubMed
39.
go back to reference Bates S, Holmes J, Gavens L, de Matos EG, Li J, Ward B, Hooper L, Dixon S, Buykx P. Awareness of alcohol as a risk factor for cancer is associated with public support for alcohol policies. BMC Public Health. 2018;18(1):688–688.CrossRefPubMedPubMedCentral Bates S, Holmes J, Gavens L, de Matos EG, Li J, Ward B, Hooper L, Dixon S, Buykx P. Awareness of alcohol as a risk factor for cancer is associated with public support for alcohol policies. BMC Public Health. 2018;18(1):688–688.CrossRefPubMedPubMedCentral
40.
go back to reference Bates S, Holmes J, Gavens L, De Matos EG, Li J, Ward B, Hooper L, Dixon S, Buykx P. Awareness of alcohol as a risk factor for cancer is associated with public support for alcohol policies. BMC Public Health. 2018;18:1–11.CrossRef Bates S, Holmes J, Gavens L, De Matos EG, Li J, Ward B, Hooper L, Dixon S, Buykx P. Awareness of alcohol as a risk factor for cancer is associated with public support for alcohol policies. BMC Public Health. 2018;18:1–11.CrossRef
41.
go back to reference Seidenberg AB, Wiseman KP, Eck RH, Blake KD, Platter HN, Klein WM. Awareness of alcohol as a carcinogen and support for alcohol control policies. Am J Prev Med. 2022;62(2):174–82.CrossRefPubMed Seidenberg AB, Wiseman KP, Eck RH, Blake KD, Platter HN, Klein WM. Awareness of alcohol as a carcinogen and support for alcohol control policies. Am J Prev Med. 2022;62(2):174–82.CrossRefPubMed
42.
go back to reference Chisholm D, Moro D, Bertram M, Pretorius C, Gmel G, Shield K, Rehm J. Are the best buys for alcohol control still valid? An update on the comparative cost-effectiveness of alcohol control strategies at the global level. J Stud Alcohol Drug. 2018;79(4):514–22.CrossRef Chisholm D, Moro D, Bertram M, Pretorius C, Gmel G, Shield K, Rehm J. Are the best buys for alcohol control still valid? An update on the comparative cost-effectiveness of alcohol control strategies at the global level. J Stud Alcohol Drug. 2018;79(4):514–22.CrossRef
43.
go back to reference Miller CA, Guidry JPD, Dahman B, Thomson MD. A tale of two diverse qualtrics samples: information for online survey researchers. Cancer Epidemiol Biomarkers Prev. 2020;29(4):731–5.CrossRefPubMedPubMedCentral Miller CA, Guidry JPD, Dahman B, Thomson MD. A tale of two diverse qualtrics samples: information for online survey researchers. Cancer Epidemiol Biomarkers Prev. 2020;29(4):731–5.CrossRefPubMedPubMedCentral
44.
go back to reference Leach LS, Butterworth P, Poyser C, Batterham PJ, Farrer LM. Online recruitment: feasibility, cost, and representativeness in a study of postpartum women. J Med Internet Res. 2017;19(3):e61–61.CrossRefPubMedPubMedCentral Leach LS, Butterworth P, Poyser C, Batterham PJ, Farrer LM. Online recruitment: feasibility, cost, and representativeness in a study of postpartum women. J Med Internet Res. 2017;19(3):e61–61.CrossRefPubMedPubMedCentral
Metadata
Title
Demographic disparities in the limited awareness of alcohol use as a breast cancer risk factor: empirical findings from a cross-sectional study of U.S. women
Authors
Monica H. Swahn
Priscilla Martinez
Adelaide Balenger
Justin Luningham
Gaurav Seth
Sofia Awan
Ritu Aneja
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-18565-z

Other articles of this Issue 1/2024

BMC Public Health 1/2024 Go to the issue