Alcohol and Breast Cancer: Risk Denial and Risk Relativization among U.S. Women

Abstract

Introduction: Research indicates a general lack of awareness regarding the link between alcohol consumption and cancer risk, particularly among women in the United States (US). This study aims to explore women's knowledge of alcohol's role in breast cancer risk and its sociodemographic correlates, including risk denial (RD) and risk relativization (RR) scores. Methods: The study surveyed 5027 adult U.S. women via an online Qualtrics survey in September–October 2021 (ABLE survey). Participants answered questions on alcohol's impact on breast cancer risk, and RD and RR scores were generated using principal component analysis. Multivariable regression models examined associations between these scores, sociodemographic factors, and awareness of the alcohol-breast cancer link. Results: A significant proportion of surveyed women expressed uncertainty (40.5%) or denial (34.9%) regarding alcohol's role in breast cancer risk. RD scores were associated with demographic factors such as race, ethnicity, age, and income. Hispanic/Latina women had the highest RD scores (10.51), followed by Non-Hispanic Black women (10.72), and older age groups. Unadjusted regression models revealed lower odds of "don't know" responses regarding awareness of alcohol as a risk factor for breast cancer (OR=0.98, p=0.003), with only RR remaining significant in adjusted analysis. RD was significant in adjusted models for "yes" responses, while for "no" responses, RD remained significant in both unadjusted and adjusted analyses. Conclusions: The study highlights a lack of awareness or denial of alcohol's link to breast cancer risk among U.S. women, especially among minoritized groups, women under age 25, and those with lower education levels. Despite higher RD and RR scores among minoritized women, awareness of the link was not significantly lower than in White women. Health education campaigns should address these disparities in risk perception to improve understanding and uptake of important health information.