BMC Public Health · 5 authors, 2 centres
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This study of 7,498 Irish adults found that only 21% of respondents were aware that drinking more than the recommended low-risk alcohol limit increases breast cancer risk. Factors most strongly associated with awareness were female sex, middle age (45–54 years), and higher educational attainment. The findings highlight an urgent need for public health campaigns, including cancer warning labels on alcohol products, to target lower-education groups and younger drinkers.
**Background:** Alcohol use is a well-established risk factor for seven cancer types, including female breast cancer, yet public awareness of this link remains poor globally. In Ireland, breast cancer is the third most common cancer overall and the most common among women, with approximately 3,700 new cases diagnosed annually. Per capita alcohol consumption in Ireland was the eleventh highest among OECD countries at 10.8 L in 2019, and 72% of women aged 15+ reported drinking in the past year. This study aimed to quantify public awareness of the alcohol–breast cancer association in Ireland and identify sociodemographic and drinking-related factors associated with awareness.
**Methods:** Data were drawn from Wave 2 of the Healthy Ireland Survey, a nationally representative cross-sectional survey of adults aged 15 years or older in Ireland. A total of 7,498 respondents completed face-to-face computer-assisted interviews between September 2015 and May 2016 (response rate 59.9%). Respondents were shown a showcard listing health conditions and asked to indicate which conditions they perceived were associated with drinking more than the recommended low-risk number of standard drinks per week. Drinker status was classified using the AUDIT-C: scores <5 indicated low-risk drinkers, scores ≥5 indicated hazardous drinkers. Sociodemographic variables included sex, age, education (ISCED levels collapsed into three categories), employment status, deprivation category (Pobal HP deprivation index), marital status, and region. Bivariate associations were assessed using Pearson χ² tests, and variables significant at p<0.05 were entered into a multivariable logistic regression model to estimate odds ratios (OR) and 95% confidence intervals (CI).
**Key Results:** Among the weighted sample (n=7,434 with valid alcohol data), 51.2% were female, 23.9% had a degree-level qualification or above, 53.3% were employed, and 55.7% were married or in a civil partnership. Overall, 25.2% were non-drinkers, 35.7% were low-risk drinkers (AUDIT-C <5), and 39.2% were hazardous drinkers (AUDIT-C ≥5). Males were more likely than females to be hazardous drinkers (54.6% vs. 24.5%). Only 21.2% of all respondents correctly identified the association between exceeding low-risk drinking limits and breast cancer risk. Awareness was significantly higher among females (26.7%) than males (15.4%), among those aged 45–54 years (26.5%) compared with 15–24 years (12.5%), and among those with degree-level education (29.4%) compared with no qualifications (15.8%). In the multivariable logistic regression model, females were nearly twice as likely as males to be aware (OR=1.99, 95% CI: 1.71–2.32, p<0.001). Those aged 45–54 years were significantly more likely to be aware than those aged 15–24 years (OR=1.71, 95% CI: 1.10–2.66, p=0.017). Degree-level education was associated with twice the odds of awareness compared with no qualifications (OR=1.99, 95% CI: 1.60–2.47, p<0.001), and below-degree qualifications also showed higher odds (OR=1.28, 95% CI: 1.06–1.54, p=0.01). Low-risk drinkers (AUDIT-C <5) were less likely to be aware than non-drinkers (OR=0.84, 95% CI: 0.71–1.00, p=0.045). Among hazardous drinkers, only 19.7% were aware of the link.
**Clinical Implications:** The very low level of public awareness—particularly among hazardous drinkers, younger adults, and those with lower educational attainment—represents a major missed opportunity for cancer prevention. Since alcohol is a modifiable risk factor, increasing knowledge could contribute to reduced hazardous drinking and lower breast cancer incidence. The findings strongly support the implementation of Section 12 of Ireland's Public Health (Alcohol) Act, which mandates cancer warning labels on alcoholic products—a measure already enacted but not yet commenced. Public health campaigns should specifically target women (especially younger drinkers), men (to enable them to support female family and friends), and individuals with lower educational levels. The study's strengths include its large random probability sample ensuring generalisability; limitations include potential under-reporting of alcohol use, exclusion of non-English speakers and institutionalised/homeless populations, and the use of AUDIT-C rather than the full AUDIT.