Researchers develop alcohol intervention for women attending breast screening appointments

Monash University, Turning Point and the Victorian Health Promotion Foundation (VicHealth) have developed a successful alcohol intervention for women attending breast screening appointments, as part of a world-first trial.

Published in the Medical Journal of Australia (MJA), the study improved participants' knowledge about alcohol and its link with breast cancer.

Alcohol is a major modifiable risk factor for female breast cancer; in Australia, alcohol consumption accounts for 6.6 percent of cases in post-menopausal women, and 18 percent of breast cancer deaths. Yet, awareness of this risk remains surprisingly low and is not systematically addressed in healthcare settings.

Research shows women drinking at even very low levels face an elevated risk of breast cancer.

Risky drinking has significantly increased among midlife and older aged women, a cohort that is at highest lifetime risk of developing breast cancer.

The joint project from Monash University, Turning Point and VicHealth saw researchers work with women to develop Health 4Her, a brief alcohol intervention tailored to the breast screening setting.

The Health4Her intervention included personalized feedback about drinking levels, information about alcohol harms, positive messaging about the health benefits of reducing consumption, and strategies to keep drinking in a low-risk range.

Health4Her also included information on exercise and keeping weight in a healthy range as other ways to reduce breast cancer risk, so that it was relevant to all women attending routine breast screening, and allowed high-risk alcohol consumption to be targeted in a discrete, non-stigmatizing way. The Health4Her intervention was tested in a randomized controlled trial.

The study, led by Dr. Jasmin Grigg, included 557 women with an average age of 60 years who attended routine breast screening at Maroondah BreastScreen (Eastern Health, Melbourne) between February and August 2021.

The majority of study participants (82%) had recently consumed alcohol products, and just one in five (20%) were aware that drinking alcohol was a risk factor for breast cancer.

After receiving the Health4Her intervention, a significantly greater proportion of participants (65%) were aware that drinking alcohol products increases the risk of breast cancer.

"Previous research has shown that women attending breast screening services have low awareness of the alcohol-breast cancer link, so these results are encouraging," Dr. Grigg said.

The intervention was also found to increase women's alcohol literacy more broadly, doubling the proportion of participants able to identify the amount of alcohol in an Australian standard drink (11% to 23%), near tripling the proportion of participants knowing the number of standard drinks in an average serve of wine (8% to 22%), and quadrupling the proportion of participants knowing the maximum weekly consumption recommended by Australian Alcohol Guidelines (4% to 16%).

"There is now strong evidence that even very light drinking increases breast cancer risk," Dr. Grigg said. "We know that population-based breast screening programs are uniquely positioned to provide women with health information and strategies to reduce risk of breast cancer, at a time when breast cancer is top of mind.

"With data showing nearly 1.9 million Australian women were screened by BreastScreen Australia in 2018-2019, health messaging about this specific risk offered in this supportive environment has potential for extensive reach."

Melbourne woman Kathryn Elliott was just 46 when she was diagnosed with locally advanced breast cancer six weeks after she stopped drinking alcohol in August 2019. Concerned about her long-term binge drinking patterns, it wasn't until Kathryn received the shock diagnosis that she questioned whether her drinking might have had an impact on her developing breast cancer.

Once Kathryn started researching the topic, she uncovered many scientific studies that proved the direct link between alcohol consumption and increased breast cancer risk, and she is now passionate about sharing her experience to increase awareness.

"Knowledge around this issue is low given 1,000-2,000 breast cancer cases each year in Australia can be directly attributable to alcohol consumption. We need to talk about it so that people understand the harms alcohol products cause. Given alcohol is a major modifiable risk factor I'm glad I've been able to make this significant change to my lifestyle," Kathryn said.

The findings of the study represent an important first step in a series of initiatives that are needed to increase alcohol literacy and address harmful consumption among midlife and older aged women, a high-risk population that has traditionally been overlooked as a target of alcohol health promotion.

"The findings from the Health4Her trial are incredibly promising," said Kris Cooney, Executive Manager, Policy, Strategy & Impact Group, at VicHealth. "We know there are proven links between alcohol and cancer, yet alcohol companies often downplay the harm their products cause.

"Health4Her shows that giving women targeted, practical and current information about the link between alcohol products and cancer in a supportive environment like a routine breast screen, has the potential to change behavior and ultimately reduce cancer risk."