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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
  1. Julia Sinclair1,
  2. Mark McCann2,
  3. Ellena Sheldon3,
  4. Isabel Gordon4,
  5. Lyn Brierley-Jones5,
  6. Ellen Copson6
  1. 1 Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
  2. 2 MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
  3. 3 Core Trainee in Psychiatry, Peninsula Postgraduate Medical Education, Plymouth, UK
  4. 4 Department of Pharmacy Health and Well-being, University of Sunderland, Sunderland, UK
  5. 5 Department of Sociology, University of York, Wentworth College, York, UK
  6. 6 Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
  1. Correspondence to Professor Julia Sinclair; julia.sinclair{at}


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.

  • alcohol
  • mixed methods
  • survey
  • breast cancer
  • risk factor

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  • Contributors Based on taxonomy: Conceptualisation: JS, EC; Funding acquisition (CRUK innovation workshop): JS, MMcC, LB-J, EC; Methodology: JS, MMcC, LB-J, EC; Supervision: JS, EC; Investigation & Data curation: IG, LB-J, ES; Analysis, Validation & visualisation: MMcC, ES, IG, JS, EC; Writing and editing: All.

  • Funding The CRUK / BUPA Foundation Fund (Innovation Grant – 2014) grant number 19626 supported this work. MMcC holds a Medical Research Council/University fellowship supported by an MRC partnership grant (MC/PC/13 027) and is part of the MRC/CSO SPHSU Complexity programme (MC_UU_12017/14 / SPHSU14).

  • Competing interests ES, IG and LB-J have nothing to disclose. MMC reports grants from Medical Research Council, grants from Medical Research Council/Chief Scientist Office, during the conduct of the study. JS reports grants from the Medical Research Council, NIHR during the conduct of this study. EC reports personal fees from World Cancer Research Fund for acting as grant panel member, outside the submitted work.

  • Ethics approval The study received approval from the NRES Committee South Central - Hampshire A Research Ethics Committee (reference no.14/SC/1399), and all participants gave informed consent

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement An anonymised data extract is available at Open Science Framework

  • Patient consent for publication Obtained.

  • Patient and public involvement Thedesign for this study was developed at an innovation workshop funded jointly byCancer Research UK (CRUK)and BUPA Foundation (a private healthcare charitable trust) which includedpatient and public involvement (PPI) representation. Following up the initial surveyresults with participants in a series of focus groups and telephone interviewsensured participants were actively involved in the conduct of the study. The data and preliminary findings were presented at a CRUK showcase event includinga wide range of PPI stakeholders.

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