If Alcohol Consumption Were Eliminated, Which US Counties Would Still Experience High Rates of Breast Cancer Among Women?

Abstract

Background Breast cancer is the most prevalent cancer among women in the United States, accounting for roughly one-third of all newly diagnosed female cancers (American Cancer Society, 2024). The risk factors for breast cancer include both non-modifiable and modifiable factors. Non-modifiable factors include age at menarche, early menstrual cycles and late menopause. Modifiable factors include smoking, diabetes, obesity and environmental factors such as air pollution. The interplay between lifestyle factors and environmental exposures in cancer development has long been debated. While alcohol consumption is widely recognized as a major breast cancer risk factor, the role of environmental exposure such as air pollution remains less emphasized in cancer prevention strategies. Objectives This study seeks to investigate the impact of environmental pollution on county-level female breast cancer incidence rates after simulating the removal of the effects of alcohol consumption. By eliminating the impact of alcohol consumption, the study provides a more thorough understanding of how environmental pollution contributes to breast cancer risk among women. Methods This study utilized cancer incidence data for women aged 20—84 from the 22 registries of the Surveillance, Epidemiology, and End Results (SEER, 2022) program for the year 2019. Alcohol consumption data was obtained from the Institute of Health Metrics and Evaluation (IHME, 2024) which is modeled based on data from the Behavioral Risk Factor Surveillance System (BRFSS, 2024). The study included environmental exposure data for diesel, benzene from the Environmental Protection Agency (EPA, 2024) and data for Particulate Matter (PM_₂.₅) and Particulate Matter (PM_₁₀), from the Center for Air, Climate and Energy Solutions (CACES, 2024). Multilevel regression models were used to assess the contribution of alcohol to breast cancer incidence among women, and to generate rates of breast cancer incidence with any alcohol consumption removed. Logistic regression models were used to examine the association between various air pollutants and county-level high rates of breast cancer after simulating the removal of the contribution due to alcohol consumption (Myers, et al., 2020; Myers and Kriebel, 2022). Results This study examined the contribution of alcohol consumption to breast cancer incidence among women, revealing a significant association. Results showed a 4% increase in the incidence rate for each ten percent increase in the prevalence of any alcohol consumption (Incidence Rate Ratio [IRR] = 1.04, 95% Confidence Interval [CI] 1.04-1.05). Any alcohol consumption was defined as having at least one drink of any alcoholic beverage in the past 30 days. When the effect of any alcohol consumption was set to zero, the county-level rate of breast cancer was reduced by approximately 12%. Additionally, county-level analyses identified that air pollutants such as diesel, benzene, PM2.5 and PM10 were associated with increased odds of a county being in the top 20th percentile of breast cancer incidence rates) after eliminating the effect of any alcohol consumption. Conclusion The study demonstrates that while reducing alcohol consumption is an important strategy for lowering breast cancer risk, it does not fully account for breast cancer incidence among women. The observed association between air pollution and breast cancer risk highlights the need to consider environmental exposures in addition to established risk factors. The results underscore the need for continued investigation into environmental exposures to better inform breast cancer prevention efforts.