BMJ Open study: Alcohol consumption as a modifiable risk factor for breast cancer

Sinclair J, McCann M, Sheldon E, et al | 2019| 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 |e027371|doi:10.1136/bmjopen-2018-027371

New research now published in the BMJ Open, recruited women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in these settings, the study used a mixed-methods approach- interviews and surveys- to ask women about their knowledge and attitudes towards alcohol as a risk factor for breast cancer.

The findings highlight that only 20 per cent of women in the sample recognised alcohol as a breast cancer risk factor, almost half of NHS staff identified it as a risk factor. 

Abstract

Objectives Potentially modifiable risk factors account for approximately 23% of breast cancers, with obesity and alcohol being the two greatest. Breast screening and symptomatic clinical attendances provide opportunities (‘teachable moments’) to link health promotion and breast cancer-prevention advice within established clinical pathways. This study explored knowledge and attitudes towards alcohol as a risk factor for breast cancer, and potential challenges inherent in incorporating advice about alcohol health risks into breast clinics and screening appointments.

Design A mixed-method study including a survey on risk factors for breast cancer and understanding of alcohol content. Survey results were explored in a series of five focus groups with women and eight semi-structured interviews with health professionals.

Setting Women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in those settings.

Participants 205 women were recruited (102 NHSBSP attenders and 103 symptomatic breast clinic attenders) and 33 NHS Staff.

Results Alcohol was identified as a breast cancer risk factor by 40/205 (19.5%) of attenders and 16/33 (48.5%) of staff. Overall 66.5% of attenders drank alcohol, and 56.6% could not estimate correctly the alcohol content of any of four commonly consumed alcoholic drinks. All women agreed that including a prevention-focussed intervention would not reduce the likelihood of their attendance at screening mammograms or breast clinics. Qualitative data highlighted concerns in both women and staff of how to talk about alcohol and risk factors for breast cancer in a non-stigmatising way, as well as ambivalence from specialist staff as to their role in health promotion.

Conclusions Levels of alcohol health literacy and numeracy were low. Adding prevention interventions to screening and/or symptomatic clinics appears acceptable to attendees, highlighting the potential for using these opportunities as ‘teachable moments’. However, there are substantial cultural and systemic challenges to overcome if this is to be implemented successfully.

Read the article in full from the BMJ Open

In the news:

BBC News Women not aware enough of breast cancer link to alcohol

[NICE Consultation] Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence

NICE | April 2019 | Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Clinical guideline [CG115]

The NICE consultation on Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Clinical guideline [CG115] is open until 8 May 2019

Full details are available from NICE 

See also: [NICE Surveillance Consultation] Alcohol-use disorders: prevention

[NICE Surveillance Consultation] Alcohol-use disorders: prevention

 NICE |  April 2019 | Alcohol-use disorders: prevention Public health guideline [PH24]

The public health guideline for Alcohol-use disorders: prevention (PH24) has been checked by NICE for the need to update.  The NICE consultation is open until 5pm on 8 May 2019 

Full details are available from NICE 

How many cigarettes are there in a bottle of wine? A comparison of gender-linked population cancer risks between alcohol and tobacco

ydes, T.J., Burton, R., Inskip, H., Bellis, M.A., & Sheron, N. | 2019 |A comparison of gender-linked population cancer risks between alcohol and tobacco: how many cigarettes are there in a bottle of wine? | BMC Public Health | 19| 316 | https://doi.org/10.1186/s12889-019-6576-9

A study published in the BMC Public Health  calculated ‘cigarette-equivalent of population cancer harm’ for alcohol intake as the cancer risk associated with cigarettes is much better understood, than the cancer risk associated with alcohol consumption. 

The researchers found that consumption of one bottle of wine per week is associated with an increased absolute lifetime risk of alcohol-related cancers in women, driven by breast cancer, equivalent to the increased absolute cancer risk associated with ten cigarettes per week. For men this increased absolute cancer risk was equal to smoking five cigarettes a week.

Image source: @phe_uk

Abstract

Background

In contrast to our knowledge about the number of cancers attributed to smoking, the number of cancers attributed to alcohol is poorly understood by the public. We estimate the increase in absolute risk of cancer (number of cases per 1000) attributed to moderate levels of alcohol, and compare these to the absolute risk of cancer attributed to low levels of smoking, creating a ‘cigarette-equivalent of population cancer harm’.

 

Methods

Alcohol and tobacco attributable fractions were subtracted from lifetime general population risks of developing alcohol- and smoking-related cancers, to estimate the lifetime cancer risk in alcohol-abstaining non-smokers. This was multiplied by the relative risk of drinking ten units of alcohol or smoking ten cigarettes per week, and increasing levels of consumption.

 

Results

One bottle of wine per week is associated with an increased absolute lifetime cancer risk for non-smokers of 1.0% (men) and 1.4% (women). The overall absolute increase in cancer risk for one bottle of wine per week equals that of five (men) or ten cigarettes per week (women). Gender differences result from levels of moderate drinking leading to a 0.8% absolute risk of breast cancer in female non-smokers.

 

Conclusions

One bottle of wine per week is associated with an increased absolute lifetime risk of alcohol-related cancers in women, driven by breast cancer, equivalent to the increased absolute cancer risk associated with ten cigarettes per week. These findings can help communicate that moderate levels of drinking are an important public health risk for women. The risks for men, equivalent to five cigarettes per week, are also of note (Source:  BMC).

 

The full paper is available at Public Health BMC

Related: PHE Health Matters: tobacco and alcohol CQUIN

In the news: BBC News How many cigarettes in a bottle of wine?

BBC News Is it time to raise the smoking age to 21

Identifying and offering brief advice to tobacco and alcohol users

The latest edition of Health Matters focuses on preventing ill health caused by tobacco and alcohol use | Public Health England

This professional resource focuses on preventing ill health caused by tobacco and alcohol use and makes the case for why NHS providers should implement the Screening and brief advice for tobacco and alcohol use in inpatient settings CQUIN, published in March 2019.

Image source: http://www.gov.uk

Smoking is the single largest cause of preventable ill health and premature death, and there are over 6 million people in England who smoke. It costs the NHS in England approximately £2.6 billion a year for treating diseases caused by smoking, but every £1 spent on smoking cessation saves £10 in future health care costs and health gains.

An estimated 1 in 4 patients in acute hospital beds in England are smokers and the prevalence of smoking in secure mental health units is even higher at 64% of patients. Therefore, a large number of smokers can be reached through health services and in particular hospitals.

Alcohol misuse contributes wholly or partially to 200 health conditions, including cancers, cardiovascular conditions, depression and liver disease. The toxic effect of alcohol misuse over time and acute alcohol intoxication lead to hospital admission.

In England, 10.4 million people consume alcohol at levels above the UK CMOs’ low-risk guideline, increasing their risk of alcohol-related ill health. Alcohol identification and brief advice (IBA) can identify and influence patients who are drinking above low risk.

The national CQUIN scheme offers the chance to identify and support:

• inpatients who smoke
• inpatients who are drinking above low risk

It is intended to complement and reinforce existing activity to deliver interventions to smokers and those who use alcohol at increasing risk and higher risk levels.

Full resource at Public Health England

NICE updates guideline on alcohol education in schools

NICE |  February 2019 | NICE updates guideline on alcohol education in schools

NICE is updating its guideline on Alcohol interventions in secondary and further education.

New draft recommendations will support the Department for Education’s (DfE) plan to make alcohol education a compulsory component of personal, social and health education (PSHE) in all state-funded schools in England from September 2020.

The guideline, developed with Public Health England, advises a positive approach to alcohol education; inviting classroom discussion and wider school policies to embed a ‘whole-school approach’ to PSHE.

Full details from NICE 

New year, new you – why Dry January is taking off

University of Leeds | January 2019 |  New year, new you – why Dry January is taking off

New research from the University of Leeds sought to investigate the popularity of Dry January, it is the first study to use qualitative research to explore the alcohol abstinence challenge. 

The research team examined 30-plus promotional emails issued by charity Alcohol Concern (now part of Alcohol Challenge UK)  during Dry January in 2017.

They analysed participants’ experiences of taking part by assessing 62 posts and 2,500 comments made between 1 January 2017 and 4 February 2017 in an open Facebook group.

Following analysis of the comments, the researchers determined that fundraising for charity was not a motivating factor to participate, as the participants were more likely to discuss personal benefits.

These included sleep quality, appearance, energy levels, weight loss, levels of self-esteem, and surprise at discovering their own strength and willpower (Source: University of Leeds).

The study has been published in the journal Drugs: Education, Prevention and Policy,

Full reference:

Yeomans, H. |2018| New Year, New You: a qualitative study of Dry January, self-formation and positive regulation| Drugs: Education, Prevention and Policy| DOI: 10.1080/09687637.2018.1534944

Abstract

In the last 5 years, giving up alcohol for January has become a common social practice in UK. Inspired by Alcohol Concern’s Dry January initiative and other related campaigns, an estimated 5 million UK adults attempted to abstain from alcohol in January 2017. Moreover, evaluative research has suggested that a 1-month spell of abstinence is an effective way of reducing average, longer-term drinking. However, the popularity and apparent effectiveness of Dry January are not well-understood. This article presents the first qualitative analysis of the meaning and significance of this important new cultural phenomenon. Based on analysis of media and social media content, it examines both how Dry January is managed by Alcohol Concern and how it is experienced by participants. The burgeoning popularity of Dry January is found to result from how this process of temporary abstinence is underpinned by positive regulatory techniques and the salience of embodiment. Consequently, rather than being a simple regime of bodily abstinence and self-control, Dry January should instead be understood as an embodied experience of ethical self-formation. The article also reflects on the implications of this finding for alcohol regulation more widely.

The full article is available to read and download online from Drugs: Education, Prevention and Policy