Exploring UK breastmilk donor’s perspectives on breastfeeding as a protective factor against breast cancer: a qualitative study
File(s)
Author(s)
D'Alessandro, Sophia
Griffin, Sam
Weaver, Gillian
Flanagan, James
Brown, Amy
Type
Journal Article
Abstract
Objectives: Breastfeeding is associated with a reduced risk of breast cancer, yet awareness of this maternal health benefit remains limited. Public health messaging in the United Kingdom has traditionally emphasised infant benefits of breastfeeding, with less attention to long-term maternal outcomes. This study aimed to explore breastmilk donor awareness of breastfeeding as a protective factor against breast cancer and their perspectives on communicating this information.
Design: Qualitative study using semi-structured interviews analysed through reflexive thematic analysis, adopting a constructivist epistemological position.
Setting: Participants recruited from across the United Kingdom through the Hearts Milk Bank took part online, using Microsoft Teams. Interviews were conducted between June and July 2025.
Participants: Twelve milk bank donors recruited as part of the Breastmilk Epigenetics Cohort Study (BECS). Participants discussed breastfeeding experiences, awareness of breast cancer risk factors, perceptions of personal risk, and views on breastfeeding-related health messaging.
Results: Five themes were generated. “Know more, breastfeed for longer?”, describes uneven awareness of breastfeeding as a protective factor against breast cancer. “Breast cancer is seen as fate, not risk, and breastfeeding is not a part of the picture”, describes risk perceptions related to breast cancer. “A communication system that centres the baby, not the mother-infant dyad”, highlights the lack of maternal-focused education postnatally. “Information reaches women by chance, not design”, explores the routes by which participants find breastfeeding and breast cancer information. And finally, “What women want: clear, shame-free, integrated communication”, represents participants’ clear preferences for non-judgemental, evidence-based information delivered by trusted sources.
Conclusion: Breastfeeding-related breast cancer risk reduction appears poorly integrated into routine health communication for women of reproductive age in the United Kingdom. The fact that breastmilk donors, a niche group of women who are highly motivated and capable of donating excess supplies of breastmilk, had a variable awareness of the maternal benefits of breastfeeding, is not only significant in its own right, but carries broader implications; if awareness gaps exist at this level of commitment, they are almost certainly more pronounced across the general breastfeeding population. As such, though not completely representative of breastfeeding women in the UK, this offer a compelling case for the reform of how breastfeeding benefits are communicated. Future research with broader and more diverse populations is needed to examine whether these patterns extend beyond highly motivated breastfeeding women, and to develop and evaluate targeted communication strategies.
Strengths and limitations of this study
· This qualitative study uniquely captures the perspectives of milk donors, a highly motivated and experienced breastfeeding population, whose widespread surprise at the breastfeeding-breast cancer protective association highlights the scale of this public health messaging gap.
· In-depth semi-structured interviews enabled exploration of complex perceptions around breast cancer risk, health messaging and the emotional sensitivity of linking breastfeeding with cancer prevention.
· Participants were milk bank donors with extensive breastfeeding experience, allowing rich reflections on breastfeeding related health information and decision making that would be difficult to access in less motivated populations.
· The small, purposively sampled group of highly motivated breastfeeding women provided depth of insight but limited transferability to the broader population of women of reproductive age, making the findings exploratory and hypothesis-generating rather than generalisable.
· As participants were already engaged in breastmilk donation and associated research, awareness of breastfeeding benefits is likely to be higher than in the general population, and findings should be interpreted with this in mind.
Design: Qualitative study using semi-structured interviews analysed through reflexive thematic analysis, adopting a constructivist epistemological position.
Setting: Participants recruited from across the United Kingdom through the Hearts Milk Bank took part online, using Microsoft Teams. Interviews were conducted between June and July 2025.
Participants: Twelve milk bank donors recruited as part of the Breastmilk Epigenetics Cohort Study (BECS). Participants discussed breastfeeding experiences, awareness of breast cancer risk factors, perceptions of personal risk, and views on breastfeeding-related health messaging.
Results: Five themes were generated. “Know more, breastfeed for longer?”, describes uneven awareness of breastfeeding as a protective factor against breast cancer. “Breast cancer is seen as fate, not risk, and breastfeeding is not a part of the picture”, describes risk perceptions related to breast cancer. “A communication system that centres the baby, not the mother-infant dyad”, highlights the lack of maternal-focused education postnatally. “Information reaches women by chance, not design”, explores the routes by which participants find breastfeeding and breast cancer information. And finally, “What women want: clear, shame-free, integrated communication”, represents participants’ clear preferences for non-judgemental, evidence-based information delivered by trusted sources.
Conclusion: Breastfeeding-related breast cancer risk reduction appears poorly integrated into routine health communication for women of reproductive age in the United Kingdom. The fact that breastmilk donors, a niche group of women who are highly motivated and capable of donating excess supplies of breastmilk, had a variable awareness of the maternal benefits of breastfeeding, is not only significant in its own right, but carries broader implications; if awareness gaps exist at this level of commitment, they are almost certainly more pronounced across the general breastfeeding population. As such, though not completely representative of breastfeeding women in the UK, this offer a compelling case for the reform of how breastfeeding benefits are communicated. Future research with broader and more diverse populations is needed to examine whether these patterns extend beyond highly motivated breastfeeding women, and to develop and evaluate targeted communication strategies.
Strengths and limitations of this study
· This qualitative study uniquely captures the perspectives of milk donors, a highly motivated and experienced breastfeeding population, whose widespread surprise at the breastfeeding-breast cancer protective association highlights the scale of this public health messaging gap.
· In-depth semi-structured interviews enabled exploration of complex perceptions around breast cancer risk, health messaging and the emotional sensitivity of linking breastfeeding with cancer prevention.
· Participants were milk bank donors with extensive breastfeeding experience, allowing rich reflections on breastfeeding related health information and decision making that would be difficult to access in less motivated populations.
· The small, purposively sampled group of highly motivated breastfeeding women provided depth of insight but limited transferability to the broader population of women of reproductive age, making the findings exploratory and hypothesis-generating rather than generalisable.
· As participants were already engaged in breastmilk donation and associated research, awareness of breastfeeding benefits is likely to be higher than in the general population, and findings should be interpreted with this in mind.
Date Acceptance
2026-09-07
Citation
BMJ Open
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted