By Diane Buhler

“Health is much more than the absence of disease” – this is an apt piece of wisdom when it comes to the issue of breast cancer. Health promotion strategies enable people to increase control over, and improve their health. But how do these accepted tenets translate when we are focusing on girls and young women? A more appropriate reference might be the 90’s song, “Girls Just Want to Have Fun”. The answer is: it’s a challenge but one that is doable and necessary!

In 2005, Parent Action on Drugs (PAD) received funding from the Canadian Breast Cancer Foundation – Ontario Chapter to work in collaboration with youth and health promotion partners in English and French communities in Ontario on an assessment and planning project called Check it out/À voir. The project was to find out what young women, ages 16 to 20, think about alcohol, nutrition and physical activity and the risks for breast cancer.

Project Background

Our route to this project was somewhat circuitous. As an organization concerned with issues around youth and their use of alcohol and other drugs, we have spent more than two decades meeting and discussing with youth ways to decrease the harms and problems associated with their drinking and drug use, and giving them the information to make their own decisions about this issue. Our concern with young women and their use of alcohol, in particular, began around 2000, when surveys revealed young men were showing significant decline in both their drinking prevalence as well as their heavy drinking patterns. Young women were not. The 2005 Ontario Student Drug Use Survey reported that young women ages 16-20 were drinking at levels identified by the World Health Organization as hazardous, meaning already impacting their health, with nearly 30% of girls in Grades 11 and 12 in Ontario drinking at hazardous levels.

At the same time, our work with young women showed that they were concerned with gender specific information—both physiological and social-emotional. Women process alcohol somewhat differently than men. This impacts their levels of intoxication as well as their potential for chronic diseases.

By 2003, the link between alcohol and breast cancer had emerged, with studies by Babor et al and Aronson showing alcohol as a risk factor for breast cancer. When we put this information forward to young women, they were very surprised – but interested. In a note of disclosure, many of the associates at Parent Action on Drugs are female, mothers of young women, and (like so many others) have personal and family concerns with breast cancer. We felt a need to get this information out to our audience of concern – young women, and particularly, young women drinkers.

An original submission to the Canadian Breast Cancer Foundation – Ontario Chapter was rightly met with the response to do our homework! We needed to consolidate our partnership with young women, expand our concerns to other lifestyle issues which have a relationship to disease prevention and increased health, and connect with organizations with established credibility in the field of breast cancer support and prevention. The connection we were able to establish with the Canadian Breast Cancer Network has been most helpful as we have proceeded with this work. But most of all, we needed to find out: are young women interested in the link between breast cancer and lifestyle issues? And, if so, what are the best avenues to reach them and what formats will provide information to them in a way they will accept?

Assessment and Planning Project

With a small “Assessment and Planning” grant from the Foundation, PAD was able to work with a project team representing physical activity, nutrition and alcohol concerns, as well as the CBCN and young women themselves. Together we developed an assessment tool to ascertain young women’s interest in and knowledge of the impact of alcohol, nutrition and physical activity on the risks for breast cancer and on breast health. A key part of the project was to assess young women who were both in high school and post-secondary situations in Ontario, and to provide all assessment tools in both English and French. Following the participation of 40 young women in 4 focus groups, we developed an on-line survey and then proceeded to disseminate it through schools, health promoters, web links, networks, word of mouth – by any means we could! We asked questions about their perceptions of their current use of alcohol, levels of physical activity, and eating patterns, their expectations about these in five years for themselves and their peers, their knowledge of the three different lifestyle connections to risks for breast cancer, their interest in these links, and how they would like to see information presented to make it meaningful to them and others in their age range. The analysis of the information from the survey presented us with fascinating information. We provided space for comments as much as possible in order to hear what they had to say, in their own words.

Survey Results

Respondents

• 355 young women, evenly distributed across the age range (16 – 20)
• The largest representation was from Toronto and the South West of Ontario, but all regions were represented
• The completion rate was 75% - despite the length of the survey
• Only 8.6% used the French language survey, which may be accounted for by the bilingual capacity of many Francophones in Ontario
• 29% reported having a close relative with breast cancer

Lifestyle and Attitudes

• Included drinkers and non-drinkers (16%)
• Drinkers reported they drink “a lot”, but aren’t worried about it and don’t plan to change
• 81% saw “heavy drinking” as a pattern in their age group, but not their own drinking
• I think I’m in the safe range
• When I do decide to “party” I make the most of it
• I’m young and want to have fun
• 80% saw reduced physical activity as a pattern with women their age
• 2/3 felt they should be more physically active
• Large majority saw poor nutrition as a pattern for their age group
• Large majority saw their nutrition and physical activity patterns improving in five years

Lifestyle Factors and Increased Risks for Breast Cancer

• They knew more about the links with physical activity and nutrition than alcohol
• 51% had not heard of the link with healthy eating, 68% had not heard of the link with physical activity and 84% had not heard of the link with alcohol
• More than 80% rated the information as important
• They would be interested in getting this information if it gave them lifestyle choices
• They felt that breast cancer survivors, peers, mothers and teachers would be appropriate for conveying the information

Challenges for the Message and the Messenger

Although the project team feels it is important to respond to the results of the assessment project with a program for informing young women about the links between lifestyle factors and breast health, we recognize the many challenges in doing so. At the forefront is the fact that breast cancer is a chronic disease, a delayed possibility, one that is in the future and does not impact the immediate world of young women. The possible negative consequences of their current lifestyle choices are too far off to have an impact, and young women are not willing to compromise their fun: Breast cancer seems very far away in the future, so one night at a party is not going to impact it. Women my age don’t listen to anything. We want to do our own thing.

Young women are cautious and distrustful of propagandizing. They want to have “proven links”: I have never heard of this correlation. The facts are not proven enough by scientists. Je voie pas le lien entre l’alcool et le cancer du sein.

The concept of risk is difficult. We are not positing a directly causal relationship between one thing and another – rather an increase in the potential to get breast cancer. And even with the current evidence there are many unanswered questions about whether the relationships with alcohol, eating patterns and physical activity are different for women at different stages of their lives, different for those who already have breast cancer and multiple other variables. The issue of cancer itself is one that invites denial – “everything causes cancer anyway”, is a phrase we heard very often.

Finally, we are sensitive about how possible messages could turn into a ‘blame the victim” type of mentality. We know women who are overweight, or not that physically active, or who drink alcohol a little or a lot and got breast cancer – and we know women in these categories who did not. We also know women with breast cancer who “did everything right”. And we know that’s not why – or why not – they got breast cancer.

Moving Forward

Such challenges do not abnegate our responsibility as health promoters, mothers and caring adults to provide information to young women.

As Diane Karnay, a member of the Pink Tulip Foundation, a new charitable organization of breast cancer survivors, mothers and other women concerned with breast cancer prevention, states:
“I believe that it is important to reach out to girls and young women on a prevention vein, because without knowledge and awareness of the factors that increase breast cancer risks, and the factors that decrease such risks, there is less opportunity for these girls and young women to make informed lifestyle choices. Although it is possible to make lifestyle changes at any time, establishing a healthy lifestyle early in life carries with it a greater potential for a healthy life, free of cancer (and other diseases). Since cancer is touching great numbers of our population all the time, these girls and young women are curious and puzzled – what can they do to minimize their own personal risk? And the adults involved in these girls’ lives want them to have the answers.”

The Planning and Assessment Survey provided us with a clear message that despite the challenges, it is necessary to move forward. Clearly, young women want to maintain a healthy lifestyle. Gaining information allows them to make informed choices. Our messages should be non-judgmental of their current lifestyle and show confidence that they will act in their own best interest. We need only to listen to young women’s recommendations:

• This information aids in my decision to watch the amount of alcohol I consume
• Express the fact that lifestyle changes are easy and not to panic
• Focus on how it can be prevented
• Have more “maybe” options instead of just yes/no
• Just talk about the importance of healthy lifestyles
• Let the young women ask the questions they want to know
• Start the education early, so that we can have a chance to make the right lifestyle choices from an early age

Rebecca Brown was an organizer of and participant in one of the focus groups held for Brock University students in 2005, when she was 19 years old. She was surprised at how candid her peers were in the discussion, particularly around what constitutes “heavy” or “binge drinking” and their concerns about feeling pressured to drink a lot. For her and her peers, five or more drinks on a single occasion was the norm at that stage in their lives. The opportunity to talk openly about drinking and other health and lifestyle issues was illuminating. Now, at age 21, she says: “I personally can’t speak for the others [in the group], but I have chosen not to drink as much. That’s not necessarily linked to a specific health hazard -- maybe it’s a result of getting older”.

Young women have the capacity to understand complicated information and learn from each other, to check out their choices and their behaviours – as long as it is made clear to them that this information is important for their lives and their futures.

We can provide an early start for breast health.

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Click here for a complete version of the Project Report

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