A brief intervention for improving alcohol literacy and reducing harmful alcohol use by women attending a breast screening service: a randomised controlled trial

To the Editor: Grigg and colleagues must be commended for their randomised controlled trial (RCT).1 However, their conclusion that “the effectiveness of brief alcohol interventions for reducing alcohol consumption in women attending breast screening should be further investigated” deserves comment.

First and foremost, it is unacceptable that no national program for cancer screening has yet implemented evidence‐based interventions to reduce the burden of avoidable causes of cancers (tobacco, alcohol, and obesity).

• In the RCT by Grigg and colleagues, none of the secondary outcomes investigating alcohol consumption, even using subgroup analyses, supported a hypothetical effectiveness.1
• Although brief intervention is usually recommended, its effectiveness remains controversial.2,3 It is time to acknowledge that “brief intervention” is a bazaar of techniques without a defined method. In contrast, motivational interviewing, a cornerstone of care,4 is a well defined and effective technique that can be learned.
• How could a brief intervention be effective against the sophisticated marketing mix of the alcohol industry when public policies are so inadequate? No country has developed a comprehensive policy and key measures are typically avoided. Scotland is the only country to have recently implemented a minimum unit price (£0.50/8 g ethanol),5 similar to that in the Northern Territory (AU$1.30/10 g ethanol).6 This reduced the prevalence of hazardous drinking but not of harmful levels.5 With respect to health warnings, the Canadian territory of Yukon was a worldwide exception when it mandated cancer warnings in 2017, but this only lasted a few months due to alcohol industry interference.7 Ireland has approved extensive health labelling on alcoholic beverages, including cancer warnings and a calorie count, which is expected to come into force in May 2026.8