Background: There is convincing evidence of a link between alcohol consumption and primary breast cancer. Less clear is the association between alcohol intake and breast cancer recurrence or development of second primary breast cancer in the survivor population. There is some evidence that clinicians are challenged by delivering clear and consistent advice to breast cancer survivors regarding alcohol intake.
Aim: To undertake a mixed methods study exploring the extent to which alcohol consumption is associated with breast cancer recurrence and the ways in which this is discussed between clinicians and patients.
Methods: A systematic literature review was undertaken of studies investigating the relationship between alcohol consumption and breast cancer recurrence using the following search phrase: (breast cancer OR breast adenocarcinoma OR breast neoplasm OR breast tumor) AND (alcohol* OR alcohol intake OR alcohol consumption OR ethanol) AND (recurrence OR second primary). A qualitative interview study was conducted with oncology clinicians to explore the provision of alcohol advice by healthcare professionals to breast cancer patients.
Results: Approximately half of the 16 included studies observed a modest positive association between alcohol consumption and increased risk of breast cancer recurrence or development of a second primary breast cancer, with some studies observing associations from as little as six grams of alcohol intake per day. Clinician interviews were undertaken with n=8 dietitians, n=9 breast care nurses and n=10 oncologists. The extent and nature of advice provided about alcohol was influenced by several patient and clinician factors.
Conclusion: There is some evidence that alcohol consumption increases the risk of breast cancer recurrence, particularly in postmenopausal women. The association between alcohol and development of a second primary breast cancer is less clear. Further work is required to support clinicians to deliver lifestyle advice to cancer patients in an accessible and practical way.