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.