To estimate the proportion of female patients from Mayo Clinic Family Medicine and Community Internal Medicine clinics who are aware of alcohol use as a breast cancer (BC) risk factor.
Patients and Methods
One thousand women aged 21 to 70 completed a survey collecting information on demographics, medical/family history, frequency and quantity of alcohol consumption, and other health behaviors. Participants were also asked to grade how likely certain factors were to increase lifetime BC risk.
Results
Most participants (844/990 [85.3%]) identified a family history of BC as a BC risk factor. In contrast, 48.4% (475/982) identified alcohol use as a BC risk factor. The remaining 51.6% (507/982) reported either they were not sure about alcohol consumption as a risk factor (341/982 [34.7%]), believed that there was no association (143/982 [14.6%]), or believed that alcohol consumption decreases the risk of BC (23/982 [2.3%]). In multivariable analyses, factors associated with awareness of alcohol consumption and BC risk included having never been pregnant (P = 0.048), more education (P < 0.001), and higher frequency of alcohol consumption in the past 12 months (P = 0.005).
Conclusion
Further education of patients and the public is needed to promote awareness of alcohol as a risk factor for BC.
GiaquintoANSungHMillerKD, et al.Breast Cancer Statistics, 2022. CA Cancer J Clin. 2022;72(6):524-541. doi:10.3322/caac.21754
2.
IslamiFGoding SauerAMillerKD, et al.Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018;68(1):31-54. doi:10.3322/caac.21440
3.
GapsturSMBanderaEVJerniganDH, et al.Alcohol and cancer: existing knowledge and evidence gaps across the cancer continuum. Cancer Epidemiol Biomarkers Prev. 2022;31(1):5-10. doi:10.1158/1055-9965.Epi-21-0934
Fokom DomgueJYuRHawkESheteS. Public awareness of the association between alcohol and cancer in the US. JAMA Oncol. 2025;11(7):789-791. doi:10.1001/jamaoncol.2025.1146
DorganJFBaerDJAlbertPS, et al.Serum hormones and the alcohol-breast cancer association in postmenopausal women. J Natl Cancer Inst. 2001;93(9):710-715. doi:10.1093/jnci/93.9.710
8.
RumgayHMurphyNFerrariPSoerjomataramI. Alcohol and cancer: epidemiology and biological mechanisms. Nutrients. 2021;13(9):3173. doi:10.3390/nu13093173
9.
SungHJiangCBandiP, et al.Differences in cancer rates among adults born between 1920 and 1990 in the USA: an analysis of population-based cancer registry data. Lancet Public Health. 2024;9(8):e583-e593. doi:10.1016/s2468-2667(24)00156-7
10.
SeitzHKMaurerB. The relationship between alcohol metabolism, estrogen levels, and breast cancer risk. Alcohol Res Health. 2007;30(1):42-43.
11.
Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10152):1015-1035. doi:10.1016/s0140-6736(18)31310-2
12.
SingletaryKWGapsturSM. Alcohol and breast cancer: review of epidemiologic and experimental evidence and potential mechanisms. JAMA. 2001;286(17):2143-2151. doi:10.1001/jama.286.17.2143
13.
Smith-WarnerSASpiegelmanDYaunSS, et al.Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA. 1998;279(7):535-540. doi:10.1001/jama.279.7.535
14.
LongneckerMP. Alcoholic beverage consumption in relation to risk of breast cancer: meta-analysis and review. Cancer Causes Control. 1994;5(1):73-82. doi:10.1007/bf01830729
15.
EllisonRCZhangYMcLennanCERothmanKJ. Exploring the relation of alcohol consumption to risk of breast cancer. Am J Epidemiol. 2001;154(8):740-747. doi:10.1093/aje/154.8.740
16.
AllenNEBeralVCasabonneD, et al.Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst. 2009;101(5):296-305. doi:10.1093/jnci/djn514
17.
VieiraRTobarJSSDardesRClaudioLThulerS. Alcohol consumption as a risk factor for breast cancer development: a case-control study in Brazil. Asian Pac J Cancer Prev. 2018;19(3):703-707. doi:10.22034/apjcp.2018.19.3.703
18.
TjønnelandAThomsenBLStrippC, et al.Alcohol intake, drinking patterns and risk of postmenopausal breast cancer in Denmark: a prospective cohort study. Canc Cau Cont. 2003;14(3):277-284. doi:10.1023/a:1023640720385
19.
TjønnelandAChristensenJOlsenA, et al.Alcohol intake and breast cancer risk: the European Prospective Investigation into Cancer and Nutrition (EPIC). Canc Cau Cont. 2007;18(4):361-373. doi:10.1007/s10552-006-0112-9
20.
ChenWYRosnerBHankinsonSEColditzGAWillettWC. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA. 2011;306(17):1884-1890. doi:10.1001/jama.2011.1590
21.
HamajimaNHiroseKTajimaK, et al.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):1234-1245. doi:10.1038/sj.bjc.6600596
KushiLHDoyleCMcCulloughM, et al.American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62(1):30-67. doi:10.3322/caac.20140
24.
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020–2025; 2020. Accessed December 21, 2024.DietaryGuidelines.gov.
SinclairJMcCannMSheldonEGordonIBrierley-JonesLCopsonE. 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. doi:10.1136/bmjopen-2018-027371
28.
CalvertCMToomeyTJones-WebbR. Are people aware of the link between alcohol and different types of Cancer?BMC Public Health. 2021;21(1):734. doi:10.1186/s12889-021-10780-2
29.
AlalwanMALongLHirkoKA, et al.Awareness of alcohol as a breast cancer risk factor and intentions to reduce alcohol consumption among U.S. young adult women. Transl Behav Med. 2023;13(10):784-793. doi:10.1093/tbm/ibad045
30.
KhushalaniJSQinJEkwuemeDUWhiteA. 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;17:101029. doi:10.1016/j.pmedr.2019.101029
31.
SwahnMHMartinezPBalengerA, et al.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. BMC Public Health. 2024;24(1):1076. doi:10.1186/s12889-024-18565-z
32.
WangCMillerSMEglestonBLHayJLWeinbergDS. Beliefs about the causes of breast and colorectal cancer among women in the general population. Cancer Causes Control. 2010;21(1):99-107. doi:10.1007/s10552-009-9439-3
SladeTChapmanCSwiftWKeyesKTonksZTeessonM. Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression. BMJ Open. 2016;6(10):e011827. doi:10.1136/bmjopen-2016-011827
35.
ProchaskaJODiClementeCC. The transtheoretical approach: crossing traditional boundaries of therapy. In: Handbook of Psychotherapy Integration. 2nd ed.Oxford University Press; 2005:548. Oxford Series in Clinical Psychology.
36.
HarrisPATaylorRThielkeRPayneJGonzalezNCondeJG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42(2):377-381. doi:10.1016/j.jbi.2008.08.010
37.
HarrisPATaylorRMinorBL, et al.The REDCap consortium: building an international community of software platform partners. J Biomed Inf. 2019;95:103208. doi:10.1016/j.jbi.2019.103208
38.
PeaceyVSteptoeADavídsdóttirSBabanAWardleJ. Low levels of breast cancer risk awareness in young women: an international survey. Eur J Cancer. 2006;42(15):2585-2589. doi:10.1016/j.ejca.2006.03.017
39.
AgabioRMadedduCContuP, et al.Alcohol consumption is a modifiable risk factor for breast cancer: are women aware of this relationship?Alcohol Alcohol. 2022;57(5):533-539. doi:10.1093/alcalc/agab042
40.
El MaouchiPFakhreddineOShmouryAH, et al.Breast cancer knowledge in Lebanese females with positive family history. Medicine (Baltim). 2023;102(7):e32973. doi:10.1097/md.0000000000032973
41.
ThomsenKLChristensenASPMeyerMKH. 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. doi:10.1016/j.pmedr.2020.101156
42.
NeufeldMKokoleDCorreiaD, et al.How much do Europeans know about the link between alcohol use and cancer? Results from an online survey in 14 countries. BMC Res Notes. 2024;17(1):56. doi:10.1186/s13104-024-06707-w
43.
PeltzerKPengpidS. Awareness of breast cancer risk among female university students from 24 low, middle income and emerging economy countries. Asian Pac J Cancer Prev. 2014;15(18):7875-7878. doi:10.7314/apjcp.2014.15.18.7875
44.
DoyleAO’DwyerCMonganDMillarSRGalvinB. Factors associated with public awareness of the relationship between alcohol use and breast cancer risk. BMC Public Health. 2023;23(1):577. doi:10.1186/s12889-023-15455-8
45.
HahnRATrumanBI. Education improves public health and promotes health equity. Int J Health Serv. 2015;45(4):657-678. doi:10.1177/0020731415585986
YoungBLewisSKatikireddiSV, et al.Effectiveness of mass media campaigns to reduce alcohol consumption and harm: a systematic review. Alcohol Alcohol. 2018;53(3):302-316. doi:10.1093/alcalc/agx094
48.
PettigrewSBoothLJongenelisMI, et al.A randomized controlled trial of the effectiveness of combinations of ‘why to reduce’ and ‘how to reduce’ alcohol harm-reduction communications. Addict Behav. 2021;121:107004. doi:10.1016/j.addbeh.2021.107004
49.
ChattertonBAgnoliASchwarzEBFentonJJ. Alcohol screening during US primary care visits, 2014-2016. J Gen Intern Med. 2022;37(15):3848-3852. doi:10.1007/s11606-021-07369-1
50.
ParthasarathySChiFWMetzV, et al.Disparities in the receipt of alcohol brief intervention: the intersectionality of sex, age, and race/ethnicity. Addiction. 2023;118(7):1258-1269. doi:10.1111/add.16195
51.
McCormickKACochranNEBackALMerrillJOWilliamsECBradleyKA. How primary care providers talk to patients about alcohol: a qualitative study. J Gen Intern Med. 2006;21(9):966-972. doi:10.1111/j.1525-1497.2006.00490.x
52.
MartSGiesbrechtN. Red flags on pinkwashed drinks: contradictions and dangers in marketing alcohol to prevent cancer. Addiction. 2015;110(10):1541-1548. doi:10.1111/add.13035
53.
PetticrewMMaani HessariNKnaiCWeiderpassE. How alcohol industry organisations mislead the public about alcohol and cancer. Drug Alcohol Rev. 2018;37(3):293-303. doi:10.1111/dar.12596
54.
GriggJManningVLockieD, et al.A brief intervention for improving alcohol literacy and reducing harmful alcohol use by women attending a breast screening service: a randomised controlled trial. Med J Aust. 2023;218(11):511-519. doi:10.5694/mja2.51991
55.
SethGGanesanVKaurN, et al.Awareness of the alcohol-breast cancer link among breast cancer survivors in the United States: a national cross-sectional survey. BMC Womens Health. 2025;25(1):355. doi:10.1186/s12905-025-03887-w. Published 2025 Jul 18.
56.
HundalJPeshinSGhazanfarR, et al.. Implementing lifestyle medicine in cancer survivorship: a narrative review of global models. Am J Lifestyle Med. 2025;15598276251359525. doi:10.1177/15598276251359525
57.
DixonHGPrattISScullyML, et al.Using a mass media campaign to raise women's awareness of the link between alcohol and cancer: cross-sectional pre-intervention and post-intervention evaluation surveys. BMJ Open. 2015;5(3):e006511. doi:10.1136/bmjopen-2014-006511
58.
ChristensenASPMeyerMKHDalumPKrarupAF. Can a mass media campaign raise awareness of alcohol as a risk factor for cancer and public support for alcohol related policies?Prev Med. 2019;126:105722. doi:10.1016/j.ypmed.2019.05.010
59.
MartinNBuykxPShevillsCSullivanCClarkLNewbury-BirchD. Population level effects of a mass media alcohol and breast cancer campaign: a cross-sectional pre-intervention and post-intervention evaluation. Alcohol Alcohol. 2018;53(1):31-38. doi:10.1093/alcalc/agx071
60.
HobinEWeerasingheAVallanceK, et al.Testing alcohol labels as a tool to communicate cancer risk to drinkers: a real-world quasi-experimental Study. J Stud Alcohol Drugs. 2020;81(2):249-261. doi:10.15288/jsad.2020.81.249
WeerasingheASchoueri-MychasiwNVallanceK, et al.Improving knowledge that alcohol can cause cancer is associated with consumer support for alcohol policies: findings from a real-world alcohol labelling Study. Int J Environ Res Publ Health. 2020;17(2):398. doi:10.3390/ijerph17020398
63.
BuykxPGilliganCWardBKippenRChapmanK. Public support for alcohol policies associated with knowledge of cancer risk. Int J Drug Pol. 2015;26(4):371-379. doi:10.1016/j.drugpo.2014.08.006
64.
SeidenbergABWisemanKPEckRHBlakeKDPlatterHNKleinWMP. Awareness of alcohol as a carcinogen and support for alcohol control policies. Am J Prev Med. 2022;62(2):174-182. doi:10.1016/j.amepre.2021.07.005
65.
BatesSHolmesJGavensL, et al.Awareness of alcohol as a risk factor for cancer is associated with public support for alcohol policies. BMC Public Health. 2018;18(1):688. doi:10.1186/s12889-018-5581-8
