Cancerwatch Homepage

Cancer Prevention Action Week

Cancer Prevention Action Week Part 2: Alcohol and cancer – we need to stop bottling it

by

This year’s Cancer Prevention Action Week (23rd – 29th June 2025) is focused on the link between alcohol and cancer. And for good reason. Because this link has rarely received the attention it deserves. Some causes of cancer are better known than others. Smoking, poor diet and UV radiation would perhaps be top of most people’s list. Most people might associate alcohol harm with liver disease, drink-driving, or addiction. Fewer are aware that alcohol is also classed as a Group 1 carcinogen – in the same category as tobacco – by the World Health Organisation. Alcohol is a risk factor in at least seven different types of cancer, including some of the most common cancers: breast, bowel and oesophageal. And in total, alcohol consumption is responsible for 11,900 cases of cancer a year in the UK, nearly one in 25 cases.

Yet awareness of this risk remains strikingly low. Why is that? It may have something to do with the complications of the relationship British society has with alcohol, and the scope and influence that gives to the alcohol industry.

Many of us have seen some of the harms associated with alcohol. Yet at the same time many of us will also associate alcohol with socialising, relaxation and celebrating. And for those reasons, it may be difficult, even jarring, to bring cancer into the conversation, and into our thinking about alcohol.

But understanding and managing risk is a part of life. It’s something we all have to do every day. If alcohol comes with cancer risk, that’s just something else we need to face. We can’t keep bottling it.

However, we also have an information gap that we need to tackle. Most people have just not been exposed to the facts on alcohol and cancer.

So this Cancer Prevention Action Week, CancerWatch has written to the Secretary of State for Health, Wes Streeting, to call for the government to take action and introduce mandatory health warnings on the labels of alcohol products.

The case for doing so is strong. Consumers deserve the ability to make informed choices. There is good evidence that having this information helps people to moderate consumption. But consumers are currently denied that information. Because, unlike foodstuffs, which have mandatory requirements for nutritional information on labels, there is little or no health information available on alcohol labels. And standards for alcohol labelling are maintained by a voluntary industry-led code.

There is a better standard that we could aspire to. The Irish Government has legislated to introduce mandatory health information, including cancer risk, on all alcohol products from May 2026.

The UK government has placed a lot of emphasis on the importance of prevention in its thinking about the soon-to-arrive 10 Year Health Plan and the National Cancer Plan. This is welcome, but an effective approach to cancer prevention will require us to recognise and address the cancer risks associated with alcohol. That starts with raising awareness of that link. We can do this by following the lead set by the Irish government. The government should stop bottling it and act now.

The CancerWatch Team – June 2025

Cancer Prevention Action Week: Part 1 What’s The Value of a Cancer Prevention Action Week?

by

This week (23rd-29th June 2025) is Cancer Prevention Action Week (CPAW). The focus for this year’s CPAW is that tricky subject – the link between alcohol and cancer. But what’s the purpose of CPAW and why this particular focus?

Thinking about and campaigning on cancer prevention is at the heart of what CancerWatch does as a charity and we do this all year round. But for most people, including health professionals and policy makers, that almost certainly isn’t the case.

Most of us think about cancer most intensely when it affects us directly through its impact on us, our friends and family. When this happens, we think about diagnosis, treatment, survival, recovery, fear of mortality, loss, and the preciousness of time. Generally speaking, this is what health professionals and policymakers tend to focus on as well.

For understandable reasons, policymakers are typically focused on how to improve all of these things – how to diagnose earlier, treat sooner and more effectively, so as to maximise people’s chance of survival and minimise deaths. And as for the approximately 60% of cancer cases that are not preventable – cases that as far as we are aware nothing could have prevented – those things are all we can focus on.

But around 40% of cancer cases are preventable. These are cancers caused by factors in our wider social and economic environment, cancers that, if those factors had not been present, would not have happened.

That 40% figure represents an awful lot of pain, fear, loss, and lengthy difficult treatments, all of which could potentially have been avoided. Therefore, it is absolutely right that we should take time to step back and focus on what our response to this should be.

And Cancer Prevention Action Week provides an opportunity to do precisely that – to focus a bit more attention on the 40% of cancer cases that are preventable, what we can do to reduce them, and what a serious strategy to reduce preventable cancers across the board might look like.

This will require us to look again at some of the key causal factors in preventable cancers, not just tobacco and smoking, but the role of diet and obesity, the links between alcohol and cancer, and exposure to UV rays in skin cancer.

CancerWatch exists because we believe this conversation should have much greater prominence, and it’s a conversation we pursue all year round.

We believe it’s time for policymakers to do the same. And there are some good signs here, with the “move from sickness to prevention” being identified in the consultations for both the National Cancer Plan and the 10 Year NHS Health Plan.

But what we need is an approach to cancer prevention that truly lives up to this rhetoric. And now is the time to start.

The CancerWatch Team – June 2025

Sector Review – Punching Below Our Weight – Cancer Prevention

by

To commemorate World Cancer Day 4th February 2024, we are publishing our latest report “Punching Below Our Weight: A Review of the Cancer Charity Sector’s Attitudes to Cancer Prevention”, in which we review almost 50 organisations in the cancer charity sector for their attitudes to cancer prevention.

Although a widespread commitment to prevention exists among cancer charities, prevention is often outcompeted by other priorities, particularly by care and treatment issues that can be more immediately relevant to the beneficiaries. When charities do campaign on prevention, their work tends to focus on secondary prevention, by campaigning for improved detection of cancer, or primary prevention in the form of information and awareness-raising work to shape individual choices. Primordial prevention, which requires structural change at a societal level, rarely features.

From the perspective of individual charities, these choices are entirely understandable. However, our report sets out how we could develop a stronger approach to prevention in the sector. Based on the input we received from the sector, we propose three core elements for the sector’s policy approach on prevention:

a. Stronger emphasis on primordial prevention emphasising social and environmental conditions including regulatory and other legal changes

b. Continued emphasis on the need for improved public health and prevention services

c. Stronger focus on solutions that will modify commercial behaviours.

For more information on the results from this wide-ranging review, the links to the review itself and its executive summary are given below:

https://cancerwatchuk.org/wp-content/uploads/2024/01/PunchingBelowOurWeight_review.pdf

https://cancerwatchuk.org/wp-content/uploads/2024/01/ExecSummary_PunchingBelowOurWeightReview.pdf

State of play: screening

by

Throughout this Cancer Prevention Action Week, we are reviewing the current state of public policy for the major risk factors in causing preventable cancers.

CancerWatch’s mission is to secure a reduction and ultimately the elimination of preventable cancers. Very technically, screening might seem to sit outside the scope of this work: if a screening programme identifies that someone has developed cancer, surely it’s too late to prevent it? In that case yes, but some screening is for pre-cancerous conditions rather than cancer itself.

What’s more, the screening programmes we already have are only part of the likely future picture. As the genetic causes of all sorts of diseases, including cancers, are increasingly understood, and with the cost of genetic testing now greatly reduced, it will become increasingly common for people to have the option to get their genome checked for potentially harmful mutations. The mutation of the BRCA1 and BRCA2 gene that greatly increases the likelihood of someone developing breast cancer, as perhaps made most famous by Angelina Jolie, is the highest profile example, but more genetic risk factors are regularly being discovered. More people will inevitably get themselves tested for more cancer risks in the future, and it is important that genetic counselling is available for anyone using these services.

However, concentrating on the here and now, there are currently screening programmes for cervical, breast and bowel cancer, all overseen by the UK-wide National Screening Committee. There may be scope for improving these programmes, although their effectiveness is surprisingly hard to identify, with figures on numbers of lives saved difficult to pin down with certainty.

That said, there certainly seems to be scope for expanding the scope of some of the programmes: according to Breast Cancer Now, a quarter of breast cancer cases occur in women aged 75 and over , but the screening programme only covers women aged 50 to 71. Similarly, the bowel screening programme covers people aged 60 to 74, but Bowel Cancer UK reports 59% of cases occurring over the age of 70, implying a significant number of cases occurring in people outside the scope of the programme.

There may also be scope for making greater use of the processes and infrastructure of the screening programmes, for instance by sending information on lifestyle choices to help reduce cancer risk alongside the communication to invite people in for tests. While our view is that the greatest gains are to be made from structural changes to reduce cancer risks, improved information to equip individuals to make healthy decisions has its place, and currently this feels like an obvious opportunity being missed.

Undoubtedly screening will become a larger part of the cancer treatment landscape over coming years, as new and better ways of identifying more types of cancer are developed. Screening for lung cancer is being rolled out, for example, alongside the new NHS lung health checks. It is important that these programmes are well devised, fully resourced, and regularly evaluated, to ensure that they are as effective as possible.

If you would like to know more about CancerWatch, or get involved with our work, please sign up using this form.

Image by NCI on Unsplash.

State of play: alcohol

by

Throughout this Cancer Prevention Action Week, we are reviewing the current state of public policy for the major risk factors in causing preventable cancers.

Like poor diet and smoking, alcohol can cause many illnesses. The most widely recognised are probably liver disease and the life-disrupting effects of alcohol addiction, but the causal link to cancer is also clear. Cancer is a known factor in causing seven cancers, and the alcohol itself is the problem: whether you consume it in wine, beer or spirits doesn’t matter. There is a further, secondary effect: alcoholic drinks can often be surprisingly calorific, and consuming excess calories raises the risk of obesity, which is itself a cause of cancer.

Among the main causes of preventable cancers, alcohol is the one where policy has diverged most sharply between the nations of the United Kingdom – or, perhaps more accurately, where English policy is lagging behind the rest of the country. Scotland and Wales have introduced minimum unit pricing (Northern Ireland consulted on it in 2022, with next steps still awaited), which has proved successful in restricting the availability of cheap high-strength alcohol.

More generally, English policy tends not to approach alcohol use as a population health issue in the way that the devolved nations tend to. There has been no new strategy on alcohol harm since 2012, when a bold strategy was published that promised minimum unit pricing, banning multi-buy alcohol promotions in shops, obliging local authorities to consider public health when making alcohol licensing decisions, and other population-level interventions. For the most part, these commitments were simply not implemented, often without any formal announcement or explanation. No further significant action on alcohol has been announced since then.

What action would be useful? As with the other main causes, change needs to be structural in nature. There will be a place for measures to equip individuals to make their own decisions, such as through better labelling of alcoholic drinks, but the interventions that will make the biggest difference will be those that shape our environments to make the healthy choice the easy one. Restrictions on the display of alcohol in shops would be one avenue to explore, as would many of the 2012 proposals, not least tightening the framework for local decision-making about licensing alcohol sales and, of course, minimum unit pricing.

If you would like to know more about CancerWatch, or get involved with our work, please sign up using this form.

Image by Chuttersnap on Unsplash.

State of play: diet and food

by

Throughout this Cancer Prevention Action Week, we are reviewing the current state of public policy for the major risk factors in causing preventable cancers.

There is a clear link between obesity and numerous cancers – 13, according to Cancer Research UK. This link is both statistically clear, and increasingly well understood in biomedical terms: fat cells do not simply sit in the body, but interact with its processes, particularly influencing growth and sex hormones and causing inflammation, all of which increases rates of cell division and therefore the risk of a cancer developing.

However, tackling obesity is a complex and sensitive topic. As we discussed in a previous article, the temptation to blame individuals for making poor choices is strong, but wrong-headed. The rise in obesity levels over recent decades has been overwhelmingly caused by changes in diet. The prevalence of obesity doubled from 1990 to 2020, following major structural changes to the food we buy and how we buy it. From the 1970s onwards, ready-made, “ultra-processed” foods high in salt, fat and sugar became more common in our diets: the UK has the highest consumption of these foods in Europe.

At the same time, supermarkets came to dominate food retail, spurred on by changes to planning laws that made large out-of-town shops feasible. Supermarkets achieved a dominance that enabled them to drive down prices for consumers, but also exert enormous influence over what is available for us to buy, and how attractive different products can seem.

Takeaway food options have also expanded enormously over recent decades, most commonly offer tasty but unhealthy meals, and are more common in economically deprived neighbourhoods.

The need for changes to diet and food supply

It is CancerWatch’s view that major structural changes are needed in order to reduce levels of preventable cancer. This must mean making changes to our food chain and distribution: while changing individual behaviours has its place in the mix, this sort of change is always easiest for people who are already relatively well-off and relatively advantaged. But that is not where change is most needed: the problems with our food supply are a key factor in health inequalities. Sir Michael Marmot’s second review of health inequalities identified the characteristics of an unhealthy high street: they include higher density of payday loan, alcohol, gambling and fast food outlets. And over a million people in the UK live in “food deserts”, meaning they lack access to cheap and nutritious food (in practice, this usually means access to a supermarket).

We therefore argue that this issue should be approached and framed in terms of food and diet, rather than obesity. There are several advantages to taking this approach. One is that it encompasses other food-related factors in causing cancer, such as processed and red meat, which are clearly established factors in causing bowel cancer, and heavily implicated in stomach and pancreatic cancer as well.

Even more importantly, discussion of healthy eating is more acceptable to public opinion. Obesity is still widely understood (or misunderstood) as a personal failing arising from individual choices, and many people are inclined to reject messaging suggesting that individual choice is not the main problem. However, people are generally more receptive to messages about healthy eating, or diet as a factor in improving their overall health, rather than focusing just on wider causes of obesity. Messages pointing out the role of health inequalities also tend to be better received when they relate to access to food, rather than to levels of obesity. This is therefore the route to achieving public buy-in for structural change (although entirely discounting the role of personal responsibility is understandably greeted with scepticism: people expect to continue to see it as part of the policy mix).

Cancer Research UK’s much-publicised advertising campaign in 2019, drawing attention to the link between obesity and cancer, therefore somewhat fell into the obvious trap. CRUK’s policy positioning on what is needed to reduce the incidence of preventable cancers by reducing obesity is entirely right, and it is true that the link between obesity and cancer is not as widely known as it needs to be. But their posters might have done better to call for a specific policy change to improve diets: without that, their messages were directed at an audience of individuals, which carried the implication (whether intentional or not) that it was for those individuals to do something about it, and nobody else.

Policy options, and action to date

So, what action could be taken, and how much is already on course to happen? The good news is that action can be taken on many fronts: there is no shortage of possibilities. Planning reforms could be deployed to address unhealthy high streets, for example, and food deserts could be targeted through a collaborative approach between supermarkets and government both locally and centrally. The power of supermarkets more broadly could be leveraged to good effect: they are being prohibited from heavily promoting unhealthy foods from October this year (albeit this measure is much delayed), but could potentially use their dominant market position to promote healthy choices more heavily.

Measures to prompt the reformulation of food and drink to be more healthy could also be developed. The Soft Drinks Industry Levy (better known as the sugar tax) led many manufacturers to reformulate their products, and has enjoyed widespread public support. More measures of this sort are surely viable.

Public Health England undertook much valuable policy development work in this area, prior to its abolition (for example this paper on calorie reduction and this on a whole system approach to obesity). Unfortunately the Government Food Strategy published last year falls well short of taking the bold structural action needed, including failing to adopt many of the recommendations of the independent National Food Strategy that it had previously commissioned. Until much stronger action is taken, the costs of our current food supply and dietary problems will continue to be passed on to the NHS, and many people will continue to develop preventable cancers.

If you would like to know more about CancerWatch, or get involved with our work, please sign up using this form.

Image by Call Me Hangry on Unsplash.

State of play: smoking

by

Throughout this Cancer Prevention Action Week, we are reviewing the current state of public policy for the major risk factors in causing preventable cancers.

Tobacco use is the area where historically there has been the strongest policy action to prevent harm. Much of the progress in extending life expectancy over the later part of the twentieth century and early part of the twenty-first can be attributed directly to success in reducing levels of smoking, and the UK has been a world leader in this. It is also the lifestyle factor whose link to cancer is most widely known and accepted.

Why do people smoke?

Why people start smoking and why they continue to smoke are subtly different questions, but the answers to both lie in wider determinants of health: socio-economic background and personal circumstances are major drivers of smoking behaviour.

Analysis by the Office for National Statistics and Public Health England shows that the likelihood of someone smoking increases in line with the level of deprivation in their neighbourhood. Smoking also correlates very clearly with a person’s housing tenure (renters are more likely to smoke than owner-occupiers) and occupational group (workers in routine and manual occupations are more likely to smoke).

Smoking uptake flows through generations: young people who are exposed to smoking behaviour, for instance via their parents, are more likely to see smoking as normal, more likely to have ready access to tobacco, and more likely to try it. Once they are addicted, they also find it harder to quit: in communities where smoking is still very visible, quit rates are lower (although attempts at quitting are no less common), and these trends reinforce each other. The reverse is seen in communities where smoking is less common: each generation is less likely to see it as normal, less likely to take it up, and more likely to find it easy to quit when they try.

As this implies, changing patterns of smoking behaviour is hard and takes time. Growing awareness of the harms caused by smoking brought rates down in the later decades of the last century, but more so among better off and more educated people. The ban on smoking in indoor spaces in 2007 built on many years of shops, restaurants and other facilities first having no-smoking areas, and then often banning smoking entirely. These changes made smoking more and more inconvenient, and marginal in society, an effect amplified by a ban on tobacco advertising, and requirements to sell cigarettes in plain packaging, and hide them from view in shops.

Smoking cigarettes has also been made more expensive. From November 1993, there was a commitment to increase tobacco duty by at least 3% per year, and by at least 5% from 1997; and it had been on a rising trajectory even before that. A slightly more complex set of rules was introduced in 2017, which has maintained the effect of annual rises.

Current policy

However, despite a history of strong action in the past, tobacco policy in the UK appears to be faltering. The Government set a strong ambition in 2019, for England to be smoke-free (defined as only 5% of the population smoking) by 2030. Wales has also set a target of 2030, and Scotland 2034. However, the independent Khan Review, which published its findings last year, reported that the English target will be missed by seven years without further policy action, and by 14 years in the least well-off parts of the country. Cancer Research UK has separately estimated that the England target is due to be missed by nine years.

The Government has yet to respond to the Khan Report: it has committed to doing so as part of a health disparities white paper, which has been subject to delay and was even reported to have been cancelled by the Truss administration (although health ministers later confirmed that it would be published). A new Tobacco Control Plan should then follow, but is similarly overdue. The bold interventions recommended in the report would, if implemented, be a striking but welcome departure from recent policy approaches. The recommendations include:

  • Increasing tobacco duty markedly more steeply than recent rises
  • Significant investment in smoking cessation services across the NHS
  • Progressively increasing the age at which tobacco may be bought, effectively prohibiting its purchase by people born after a certain date
  • Licensing for tobacco sales, to reduce the number of outlets where it can be bought
  • A “polluter pays” approach, in which the costs of these measures would be met at least partly by a levy on tobacco manufacturers.

Scotland, Wales and Northern Ireland all have tobacco control plans of their own, although some of the tougher actions proposed in the Khan Report would require UK-wide legislation by Parliament.

If you would like to know more about CancerWatch, or get involved with our work, please sign up using this form.

Image by Nafis Al Sadnan on Unsplash.

Cancer prevention needs structural change: individual responsibility isn’t enough

by

It’s a remarkable statistic that around 40% of cancers in the UK are preventable. It offers great hope for improvements in the future, but at the same time makes depressingly clear how many people are becoming ill and dying who would otherwise have enjoyed years of good health.

Overwhelmingly, the things that make these cases preventable are to do with lifestyle: the major factors in causing cancer that can be changed, and therefore bring that figure down, are smoking, diet (mostly by causing obesity) and drinking alcohol. Yet this immediately creates the temptation to argue that individuals simply need to make better choices for themselves. Unfortunately, “simply” is the most important and most misleading word in that sentence: in truth, there is nothing simple about altering people’s lifestyles to reduce cancer. If it were simple, we would have cracked it by now, and that 40% figure would have been reduced to almost nothing.

Our central aim as CancerWatch is therefore to push for the structural changes that are necessary to reduce and eventually eliminate avoidable cancers. This article explores what that means: why the tempting narrative of personal responsibility has led to policy failure, and what sorts of changes are actually necessary. Over the rest of Cancer Prevention Action Week, we will be publishing articles looking at the state of play in each relevant policy area: smoking, diet, alcohol, and screening.

What drives people’s choices?

Advocates of an approach that focuses solely on personal responsibility often argue that people can be relied upon to make rational choices. They are of course correct – indeed, more correct than they realise.

For someone leaving work late and tired after a long day, picking up food from one of the many takeaway outlets on their way home, rather than cooking a healthy meal from scratch, will be a rational choice. For someone who has to feed a family on a tight budget and who doesn’t have the use of a car, buying cheap processed food from the nearby convenience store, rather than finding a way to travel to a large supermarket to buy fresh food, will be a rational choice. For someone who has grown up around people smoking and drinking regularly, joining in with the behaviour of their peers will be a rational choice. Satisfying a craving, or even a passing fancy, whether for a cigarette, a drink or a slice of cake, will often be a rational choice, compared to expending the effort and enduring the distraction needed to resist it – provided, of course, that the cigarette, drink or cake are easily at hand.

It will be clear from these examples that a person’s circumstances have a huge bearing on the choices they make. This includes people’s social and economic circumstances, which determine what they can afford to do, what they have time to do, and what other people around them encourage them to do. The basic geography of where they live will matter a great deal: most commonly in the United Kingdom, cheap and healthy food can only readily be obtained at a supermarket, so if you live a long way from one of those but nearer to numerous takeaways and convenience stores, location is likely to shape your choices. Equally, if you are under ongoing financial pressure, or live in a poor quality home, or have to deal with a difficult family life, things like quitting smoking or cooking healthy meals will very naturally not seem like high priorities.

From this, it will be obvious not only how circumstances shape people’s health, but also how this drives inequalities across our society, with the people who consistently make healthy choices generally being those who have the money and time to do so.

The argument is not won

Set out in this way, it all seems like common sense to suggest that wider factors need to be addressed, and that unhealthy choices are not simply the product of individual failings. Unfortunately, recognition of this idea, let alone support for it, is lacking.

Research by Nesta and the Behavioural Insights Team in 2021, which looked specifically at food and diet choices, found that the public overall tends towards the “personal responsibility” view. There is a correlation between the level of support enjoyed by a public health measure and the extent to which people believe it will be effective: the more likely people feel it is to work, the more likely they are to support it. Unfortunately, there is widespread belief that the best way to improve health is to enable individuals to make healthier decisions, mostly by providing information and encouragement. Other interventions to change the food choices available to people, or the incentives for different choices, clearly enjoy less public support.

Where stronger interventions have been applied, such as with the ban on smoking in enclosed public places or the sugar tax that prompted many manufacturers to reformulate their products to reduce sugar levels, they have enjoyed public support and there is no significant public pressure to repeal them. It may be that stronger measures can be expected to attract support after their implementation, but certainly many potential interventions appear unlikely to enjoy much support at the moment.

However, those earlier successful measures show the path we need to be taking. Crucially, this does not simply involve regulation to curtail personal freedom. That may be part of the mix, such as tougher restrictions on smoking in public places, whether enclosed or not. But often regulatory solutions will address business behaviours: it might mean restricting advertising of unhealthy products further, using planning rules to reduce proliferations of takeaways, or incentivising more reformulation of unhealthy products. None of those measures would strictly prevent people from consuming unhealthy substances, but it would need to be a deliberate and active choice, rather than the natural or obvious one.

For Cancer Prevention Action Week, therefore, we need to be clear about what sort of action is needed. By all means, people should be given information and encouragement to make healthy choices, but the action that is required above all else is bold, structural change. Healthy choices should be made the easiest, most convenient and most affordable choices for everyone. Substantial reform of how tobacco, food and alcohol are consumed and regarded in our society is the only way to achieve this.

If you would like to know more about CancerWatch, or get involved with our work, please sign up using this form.

Image by Howard Lake on Flickr, reproduced under Creative Commons licence BY-SA 2.0