In the sober (curious) world, it’s Sober October.

October is also Breast Cancer Awareness Month, so I couldn’t think of a better time to talk about a topic that is largely and intentionally obscured and lacks overall awareness: alcohol use and its impact on breast cancer risk.

Before we get into it, I want to acknowledge that this topic is heavy, may feel scary, and may even prompt a slew of emotions to bubble to the surface. Whatever we may feel in response to this article is fine. My invitation to you, if this feels like too much, is to save this article and circle back to it at a later point.

I also want to acknowledge that what’s discussed in this article might feel almost hard to believe. You might ask yourself if the risks are so significant, why wouldn’t we all know them and have more awareness about it? Why wouldn’t more people be having this conversation?

These are great questions and ones I ask myself regularly. Without sounding too cynical (though we all have every right to be), when it comes to alcohol and its harms, we have been lied to—repeatedly, by a variety of sources and in a multitude of ways, for years. As you are reading this, I’ll ask you to suspend what you believe to be true about alcohol and let the research shared within this piece inform new ideas and beliefs. What’s shared here when it comes to the actual risks and harms of alcohol is not my opinion or belief, but rather evidence-based research. It’s all linked here so you can look into it for yourself.

The fact of the matter is if you are interested in learning more about this topic, what’s largely required of you is that you do your own research, and this often requires reading academic journal articles, which many don’t have access to or the training to actually read and understand what’s discussed in the articles. As someone with a research-based master’s degree, I fortunately have the background and training to understand most of what I’m reading, but that’s not most people’s experience. A person shouldn’t have to have an advanced degree in order to understand their risk when it comes to a substance like alcohol, which is everywhere and consumed by the majority of adults. This information should be just as readily and easily available as alcohol is to buy and consume. And until that’s the case, I will continue to speak loudly and unapologetically on this topic.

My hope is that this piece is read by many and contributes to increased overall awareness on this topic. My intention in talking about this topic is always to provide evidence-based information on the risks associated with alcohol use as it relates to breast cancer risk so that you can make educated decisions when it comes to what you put in your body. This isn’t about me trying to encourage everyone to not drink; I’m here to provide information that enables you to make informed, empowered decisions that support the life you want to live. That’s it. I hope this article contributes to that for you.

In my drinking days (I’ve been sober now for more than six years), I had precisely zero idea that a relationship existed between alcohol and breast cancer, so if this is you, please know that you are not alone and the fact that you don’t have the knowledge isn’t a reflection on you but instead an indicator of how effective, misleading, and deceptive marketing messages are. It was really only within the last five years or so that I began to dig deeper (and I had to dig) into the inherent risks that are associated with drinking alcohol. Since beginning my career in the recovery space as a sober coach, a significant part of my work is to know as much as humanly possible about alcohol, how it functions in the body, and the harm it can cause.

Before we get into it, I think it’s really important to establish the context in which we exist when it comes to alcohol. First, in many parts of the world, alcohol has become incredibly normalized. Despite being a known carcinogen, alcohol has become so integrated into our world (what I have come to call normative alcohol culture) that it’s become more of a practice to explain why you aren’t consuming it rather than why you are.

Big Alcohol and many marketing dollars are largely responsible for what we believe to be true about alcohol and how we have come to integrate it into our lives. And before you say you are immune to marketing messages, let me offer this: it is projected that alcohol companies will spend $7.7 billion in advertising in 2023. The only reason that alcohol companies would ever spend this amount of money on advertising is if their advertising efforts were effective in generating revenue, which they are. Global alcohol sales are poised to hit $349.68 billion by 2023, which is incidentally higher than the GDP for many countries globally. We’re talking about a lot of money and the influence that this money has when it comes to messaging. I get it—no one wants to admit they’ve been influenced or duped by marketing, but in reality, marketing messaging is powerful, insidious, and ubiquitous and has bled into nearly every aspect of our lives. Even the most critical mind of marketing messaging and motivations is not impervious to it.

One of the main reasons I feel so invested in regularly having conversations about alcohol use and breast cancer is that we know that awareness levels of this relationship are dangerously low. We have a variety of studies that demonstrate that awareness levels on the relationship between alcohol and breast cancer hover around 25 percent, which is much lower compared to awareness levels of alcohol use and liver cancer, for example. If you happen to fall into the roughly 75 percent of folks who aren’t aware of the link between alcohol use and breast cancer, please know that you’re in the majority and this lack of awareness is the intentional result of hiding information and misleading consumers.

Back in July, I had the pleasure of talking with the brilliant Dr. Priscilla Martinez on my Instagram channel. Dr. Martinez is a scientist and researcher with the Alcohol Research Group. She is the Principal Investigator of the Drink Less for Your Breasts campaign to raise awareness that alcohol use is a risk factor for breast cancer. She is co-director of the National Alcohol Survey and a lecturer at the School of Public Health at UC Berkeley. All that to say that she’s an expert when it comes to alcohol use and breast cancer risk.

During this conversation, I asked her why she thought that awareness levels when it comes to alcohol use and breast cancer were significantly lower, and she offered a lot of helpful insights. In addition to breast cancer being (generally) a women’s health issue (which often aren’t prioritized) coupled with muddled messaging when it comes to alcohol and potential “health” benefits, she also offered that in most other cases of cancer related to alcohol use, they tend to associate it with points where alcohol makes contact with our bodies i.e. mouth and throat, esophagus, liver, colon, rectum, and so on, and because alcohol doesn’t make any direct contact with the breast, it doesn’t feel as intuitive as the other areas of the body, so it makes sense that we don’t immediately connect alcohol use and breast cancer risk. I found these insights to be really helpful in explaining why we are where we are. There are a multitude of factors that make the current situation what it is.

When we’re talking about breast cancer risk, it’s really important to be clear on exactly what we’re talking about. Dr. Martinez gets into this in more detail in our talk, but it’s important to outline it here as well.

First off, risk is a situation involving exposure to danger, and in the context of alcohol use and breast cancer risk, when we say risk, we are talking about the likelihood of breast cancer developing.

Before adding alcohol to the mix, the average risk of a woman in Canada or America developing breast cancer in her lifetime is 12-13 percent; this translates into one in eight women developing breast cancer (or seven in eight not developing breast cancer). This is the baseline for breast cancer risk for women, simply by virtue of being women.

Based on the data, when we add alcohol to this baseline risk, the increased risk is approximately 14 percent for each alcoholic drink consumed each day, meaning one standard alcoholic drink per day over a week. This risk is based on drinking on a regular basis and drinking patterns over time. What we also know is that as we increase our alcohol consumption, we also increase our breast cancer risk and the reverse of that is also true i.e. less alcohol consumption = reduced risk.

So what does 14 percent increased risk actually mean? This is where things can get tricky. Sometimes stats and percentages and ratios are helpful but only if they are clear and clearly explained. If the baseline risk for a woman to develop breast cancer is 12 percent in her lifetime, by adding alcohol to the mix (as outlined above), her risk increases to 13.68 percent (14 percent of 12 percent is 1.68, which is then added to 12 percent = 13.68 percent).

And while an increase of 1.68 percent (which is an increase with only 7 drinks/week) may not seem like a lot, what I found especially shocking was that the risk increased, even when small amounts of alcohol are consumed, which should flag to us how toxic and dangerous this substance is. Yes, what’s most important is patterns of drinking over time, but it’s also important to remember that every single drink counts and no amount of alcohol consumed is safe and without risk. Alcohol use is one of the leading risk factors for breast cancer and evidence consistently demonstrates that even small (0.35 ounces) increases in alcohol intake daily is associated with increased risk of developing breast cancer. In August of this year, Canada released its updated Low-Risk Alcohol Drinking Guidelines, which now recommends two standard drinks per week (or less) as low-risk for women.

When it comes to breast cancer, there are many risk factors including: aging, breast density, family history, BRCA gene mutation, alcohol use, smoking, reproductive status (late menopause), hormone exposures (estrogen), and physical inactivity. Many of these are not within our control, but when it comes to alcohol, that is an entirely modifiable risk factor that we have a say over. It’s also important to note that an increase in risk factors does not automatically result in a breast cancer diagnosis.

Here are some suggestions when it comes to staying engaged and active with your breast health:

1. Get to know what’s normal for your breasts and body so that you can detect abnormalities should they arise.

2. Learn your family history of breast and other cancers.

3. Reduce your alcohol consumption or eliminate alcohol completely.

4. Reduce smoking or eliminate it completely.

5. Regular mammogram screenings for women aged 40+.

6. Stay active.

When detected early, breast cancer is treatable, so having knowledge, reducing risk, and engaging proactively can positively impact outcomes. Having accurate, evidence-based information enables us to make better choices when it comes to risk management.

Because I believe so passionately in access to information and informed decisions, I would love to make a request: if you found this article useful, I would invite you to share it with someone else in your life who might benefit. If you happen to have breasts or know someone who does, please pass it along.

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