Breast cancer is the most common type of cancer globally, with 2.3 million cases reported in 2022 and 670,000 deaths worldwide. 99% of breast cancer cases occur in women and breast cancer is present in every country around the world. Given this percentage, breast cancer is both a women’s health issue and a feminist concern.
There are a variety of causal factors that contribute to an increased risk of breast cancer including:
Aging; risk for breast cancer increases with age
Genetic factors such as inherited gene mutations like BRCA1and BRCA2
Dense breast tissue
Personal history with breast cancer
Family history with breast and/or ovarian cancer
Exposure to radiation therapy
Being physically inactive
Being overweight after menopause
Alcohol use/consumption
Reproductive history
Tobacco use
This article is specifically interested in exploring the relationship between alcohol use and breast cancer risk. As it stands, there are relatively low levels of understanding and awareness of this relationship despite the fact that alcohol is a toxic, addictive, psychoactive and readily available substance that was classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC) in 1988. We have had data that communicates the cancer risk that alcohol poses for 35+ years yet our awareness levels continue to remain low; this is a problem.
According to the World Health Organization, alcohol is one of the leading risk factors for breast cancer in women (after genetic and hereditary factors). Alcohol is causally linked to at least 7 different types of cancer including: mouth, voice box, throat, esophagus, breast, liver, colon & rectum. When looking at this list, the areas of the body most impacted make sense from an intuitive perspective as they are many of the areas that alcohol touches as it moves through the body. The breasts are the exception to this though, which might contribute to why we don’t intuitively connect the causal relationship between alcohol and breast cancer.
Based on a variety of studies conducted on the awareness levels of the relationship between alcohol and breast cancer, what’s clear is that public health messaging needs to be doing a more thorough job at communicating the risks and harms of alcohol as it relates to breast cancer as the vast majority of women around the world are unaware of this relationship.
According to a recent study involving 14 European countries, only 21% of women involved in this study were aware of the connection between drinking alcohol and developing breast cancer. In a US-based study using 2020 data, American adults in this study also demonstrated very low levels of awareness when it came to alcohol and cancer. In addition to low levels of awareness (ranging approximately between 20 and 30%) of this causal relationship, some Americans falsely believed that cancer risk was dependent on the type of alcohol being consumed. What’s even more concerning is that some Americans (10.3% of this study) believed that wine in particular decreased cancer risk. This is especially alarming in the context of breast cancer as women are typically the majority consumers when it comes to wine. This false belief could likely be attributed to the archaic idea that a daily glass of red wine is beneficial for heart health though this idea has largely been debunked by the World Heart Federation. In Canada, awareness levels between the relationship between alcohol and breast cancer are around 28%. While there will be variances in awareness levels around the globe, what is evident from the examples above is the vast majority of those who drink alcohol are not aware of the cancer risk and this needs to change.
Why are awareness levels so low?
There are likely many reasons to account for the low levels of awareness when it comes to alcohol intake and breast cancer development.
One reason could be the normalization of alcohol consumption or more broadly what I call Normative Alcohol Culture, which largely dictates not only how we engage with alcohol but also how we think and talk about it. When anything becomes normalized, we are far less likely to question it which is very much the case when it comes to alcohol consumption. Within the realm of Normative Alcohol Culture, the messaging, which is largely shaped and influenced by Big Alcohol and alcohol marketing messages, is that alcohol is harmless and in some cases, even healthy. Alcohol companies go to great lengths to sell their products including engaging the services of women’s wellness influencers to sell their products which contributes to muddled and confusing messaging. When the people we turn to for health and wellness advice are now urging us to consume certain types of alcoholic beverages, it’s bound to create some cognitive dissonance or at the very least, confusion when it comes to alcohol. The alcohol industry has done an incredible job at churning out steady messages around the potential health benefits of alcohol while actively concealing information about the inherent risks and harms that accompany alcohol consumption. When the bulk of our exposure to alcohol messaging comes from skewed marketing campaigns, it’s no wonder we are confused and lack awareness about the truth about alcohol.
When thinking about alcohol knowledge and awareness more broadly, there also seems to be a lack of understanding around more straightforward ideas like what a standard drink is. It's important to note that standard drinks can also vary from country to country or region to region but generally speaking, it’s a good idea to familiarize yourself with what a standard drink is. When there isn’t clarity on the part of the individual when it comes to what a standard drink is, it then becomes hard to know or accurately track how much alcohol one is consuming. Without having an accurate estimate on how much alcohol is being consumed, it then becomes challenging to fully understand the risk at hand.
Age and levels of education also seem to impact awareness levels i.e. older adults with higher education levels generally exhibit more awareness in this area. Knowing this, it becomes all the more important for public health departments to provide accurate, accessible information wherever alcohol is sold and to ensure this messaging is digestible for anyone reading it, regardless of age or level of education.
For women who consume alcohol, what is the actual risk?
As we know, breast cancer is a health issue that predominantly affects females; as such, being a woman carries with it a baseline risk of developing breast cancer of 12% which is taken from the statistic that 1 in 8 women will develop breast cancer in her lifetime. The Drink Less For Your Breasts Campaign has provided some key information on how breast cancer risk increases when we add alcohol to the mix. For example, if we use the example of someone drinking 1 standard drink per day over the course of a week (7 standard drinks/week), the risk of developing breast cancer increases by 14% (meaning 14% of the baseline 12% = 1.68 → 12 + 1.68 = 13.68% is the new risk level for developing breast cancer). When it comes to understanding alcohol and breast cancer, two things are essential to consider: patterns of drinking over time are important and every drink matters. The more alcohol that’s consumed, the greater the risk. Conversely, by reducing the amount of alcohol consumed, the risk for developing breast cancer is decreased.
How does alcohol increase breast cancer risk?
The biological processes and mechanisms through which alcohol causes cancer are complex and varied. When it comes to breast cancer, the main points of concern are how ethanol is metabolized in the body and the impact that alcohol has on estrogen. Ethanol metabolizes into acetaldehyde, which causes DNA damage and mutations that can potentially cause cancer. Alcohol also impacts estrogen levels and estrogen is known to significantly affect the development and progression of some breast cancers. Alcohol’s impact on hormone levels may explain the heightened risk for breast cancer [source].
Why is alcohol a feminist issue?
When we consider the widespread number of global cases of breast cancer, the ubiquitous nature of alcohol in many parts of the world, and the fact that breast cancer is a disease that impacts mostly women, it becomes important to understand this issue through a feminist lens. This is an issue of consent, an issue of health equity and a women’s health issue.
Given the context outlined above, it becomes especially concerning and problematic to know that the alcohol industry actively targets women with feminized marketing messages and tactics. Whether it’s “Mommy wine culture” messaging which suggests alcohol is an appropriate solve for the unrealistic and untenable standards and expectations of motherhood, the pinkwashing of alcoholic products or the false notions of female empowerment that alcohol marketers attempt to manipulate women with, the marketing messages are targeted and predatory. While alcohol ads attempt to create strong positive associations between alcohol consumption and female friendships, equality and empowerment, alcohol is also very strongly sold to women and mothers in particular as a way to unwind, manage stress and self-medicate, all in a socially acceptable way.
Big Alcohol or the alcohol industry knowingly engages in aggressive marketing towards women with the full knowledge and understanding of the harms their products cause, including the breast cancer risk that alcohol contributes to; they continue to churn out misleading and manipulative messages all in the name of increased profits and entirely to the detriment of women and women’s health.
What can we do?
Public health departments should be taking a more active role in consistently communicating clear and accessible information on the risks inherent in alcohol consumption and their influence on breast cancer.
At the individual level, we can invite more conversations on this topic. Share this article with people in your life who consume alcohol. This is not meant to be a scare tactic; my objective is always to provide clear, evidence-based information on alcohol so that people can make informed decisions when it comes to how they engage with it.
Read up on the topic. Check out the Drink Less for Your Breasts Campaign and the World Health Organization website on alcohol use and breast cancer risk. You can also check out this conversation that I had with Dr. Priscilla Martinez (the Principle Investigator for the Drink Less for Your Breasts Campaign) on this topic.
Familiarize yourself with what a standard drink is and tune into how much you are consuming on a weekly basis. Your country likely has recommendations around what is considered lower risk when it comes to alcohol consumption. Based on the most recent data and evidence, Canada recently released updated low-risk drinking guidelines which suggests a maximum of 2 standard drinks per week in order to stay in the low-risk category.
This is a topic that impacts us all. Spread the word. Have the conversations. Share accurate information. Let’s shift the tide of awareness levels and reduce the harms caused by alcohol. Women deserve better.