The American Cancer Society recognises the link between alcohol and breast cancer, and so does a surgeon general’s report on addiction.
The alcohol industry doesn’t dispute it, either. “Many lifestyle choices carry potential risks and the consumption of alcohol is no exception,” a spokesperson for the Distilled Spirits Council wrote in an email response to Wired.
“Cancer is a complex disease,” the response continued. “Studies have found that excessive drinking is associated with an increased risk of certain types of cancer and some have also reported an association between moderate alcohol consumption and an increased risk of breast cancer. Women who have questions regarding alcohol consumption should speak with their physician who can determine what is best for them based on individual risk factors, such as family history, genetics and lifestyle.”
The Drink Less campaign is funded by the California Breast Cancer Research Programme, a state programme funded by a tobacco tax and donations. In 2019, its policy research advisory group decided to target awareness of alcohol as a risk factor for breast cancer in young women.
They requested a bid for a project from Peggy Reynolds, a cancer epidemiologist at UC San Francisco, and she reached out to the Alcohol Research Group to plan and run the project.
ARG is part of the Public Health Institute, a non-profit with a broad mission to advance global public health.
Martinez had never organised a social media campaign and doesn’t consider herself social media savvy. But after ARG won the $100,000 grant, she was running focus groups, coordinating an advisory group of cancer organisations, building a team of co-investigators and partnering with the ARG communications specialist.
“The young women made it very clear they did not want to be told what to do,” Martinez says of the focus groups. “’Drink less for your breasts’ felt more like a helpful suggestion.”
Planning for the social media campaign began just as the pandemic forced a national shutdown. As the pandemic dragged on, alcohol consumption rose, especially among women. Days of heavy drinking among women, defined as four or more drinks within a couple of hours, rose by 41 per cent, according to a survey by the RAND Corporation.
The study compared a baseline survey of 1,540 adults conducted in the spring of 2019 with their responses during a follow-up in the spring of 2020.
But pushing back against alcohol consumption isn’t simple. As the US found during a disastrous prohibition period from 1920 to 1933, opposing alcohol is not popular. When Sharima Rasanayagam, chief scientist for Breast Cancer Prevention Partners in San Francisco, gives talks about environmental causes of breast cancer, her audience is rapt – until she mentions alcohol.
“People like to drink and they don’t like to hear that,” she says. She tells them that quantity matters: “At the very least, drink less.”
It’s a message she delivers with care, to avoid giving women a reason for self-blame if they develop breast cancer and wonder “Why me?” Cases of breast cancer can’t be tied to alcohol alone, because many factors, including genetics and environmental exposures, contribute to the disease, she explains in a YouTube video linked to the Breast Cancer Prevention Partners website. But Rasanayagam notes that risks add up—and alcohol is one that women can reduce.
Fewer drinks, whether over time or in one day, mean less exposure to acetaldehyde and potentially less effect on oestrogen. “It’s been shown that the less you drink, the lower your risk,” she says. (Breast Cancer Prevention Partners is an advisor to the Drink Less for Your Breasts campaign.)
It’s a nuanced message but, in its own way, a bold one, as framed in a social media campaign, says David Jernigan, an alcohol policy expert at Boston University, who has been working in the field for 35 years. “What Priscilla is doing in California is ground-breaking,” he says.
Jernigan asserts that the harm from alcohol, which also includes drink-driving and an association with violence, warrants a large-scale response similar to anti-tobacco efforts. He notes that in Estonia, a campaign urging “Let’s drink less by half!” actually lowered per capita consumption by 28 per cent.
Estonia’s alcohol policy also included restrictions on advertising, more enforcement of driving-under-the-influence laws, higher taxes and a focus on treatment.
The World Health Organization is also developing a global action plan; the current draft sets a goal of reducing per capita consumption by 20 percent by 2030 (with 2010 consumption levels as the baseline). It urges nations to develop and enforce “high-impact policy options,” such as higher alcohol taxes, restrictions on advertising, and emphasizes awareness of health risks.
Jernigan calls that effort a good step that doesn’t go far enough. He favours the development of an international treaty on alcohol, similar to the “Framework Convention on Tobacco Control,” the first such negotiated through the World Health Organization. It has been signed by 168 countries that committed to taking steps to restrict tobacco advertising, raise cigarette taxes, and prevent youth smoking.
“The evidence is so strong that they cannot ignore alcohol as a health problem,” says Jernigan. “But the global politics around alcohol are nothing like the global politics around tobacco.”
Consumer advocates also want stronger action. Cigarettes carry strong health warnings and a Food and Drug Administration rule taking effect next year seeks to ramp up their impact with graphic images of people with tobacco-linked diseases.
Alcoholic beverage labels currently warn pregnant women of the risk of birth defects and carry the statement: “Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery, and may cause health problems.”
The Consumer Federation of America and seven other advocacy organizations (including Breast Cancer Prevention Partners and the American Society of Clinical Oncology) petitioned the US Department of Treasury’s Alcohol and Tobacco Tax and Trade Bureau in 2020 and again in 2021 for another warning: “According to the Surgeon General, consumption of alcoholic beverages can cause cancer, including breast and colon cancers.” The change would need to be approved by Congress.
So far, there’s been no response to the petition, but Thomas Gremillion, director of food policy for the Consumer Federation, remains hopeful. “We’re not restricting anyone’s rights,” he says. “We’re just giving consumers the right to know.”
That is Martinez’s mission, as well. She will work to spread that health message during October, when breast cancer is in the spotlight. Then she hopes other organizations, perhaps advocates for women’s health, will take up the cause.
The Drink Less for Your Breasts website will remain up and the social media content can still be shared, she says. She hopes the pink ribbons that remind women of breast cancer risk will also make them think twice before they lift a glass of pink beer.
- A Wired report