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This week is cervical cancer prevention week. This is well worth marking, because cervical cancer is one of the most common causes of cancer in women, yet deaths from cervical cancer are among the most preventable.

Cervical cancer is the 12th most common cancer in women in the UK, and the 4th most common globally.^[1]

Over the last half a century, cervical screening has had a major impact in preventing cervical cancer deaths. A recent US study found that nearly half (43%) of deaths from cervical cancers that have been averted between 1975 and 2020, were entirely down to cervical screening, as opposed to improvements in treatment over this period.^[2]

It is estimated that in England cervical screening currently prevents 70% of cervical cancer deaths. However, if everyone attended screening regularly, it is estimated this could be much higher, with as many as 83% of deaths from cervical cancer being prevented.^[1]

This suggests that more can and should be done to ensure that more women are able to access screening and prevent cervical cancer deaths. 

The most important steps women can take to prevent cervical cancer are:

1. Attending cervical screening when invited. If you are a woman aged 25-64 and registered with a local GP, you will get a letter telling you when it is time for your cervical screening appointment. Sexual health clinics in your area may also offer cervical screening if you do not wish to see your GP.  More details here on the NHS website. 

2. Taking up the HPV vaccine if you are 11-18 years old. The HPV vaccine is recommended for those from 12 to 13 years and those at higher risk. In the UK, it is I available free on the NHS to all girls under 25 and most of those who are at higher risk. More details here.

3. Being aware of the symptoms of cervical cancer. Symptoms of cervical cancer include: heavier periods than you normally have, vaginal bleeding between periods, after sex, or after the menopause, pain during sex, or pain in your lower back, between your hips, or in your lower tummy. More information on symptoms can be found here.

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^[1] World Cancer Research Fund: https://www.wcrf.org/preventing-cancer/cancer-types/cervical-cancer/

^[2] National Institutes of Health: https://www.nih.gov/news-events/news-releases/five-cancer-types-prevention-screening-have-been-major-contributors-saving-lives

^[3] NHS England: https://www.gov.uk/government/publications/cervical-screening-description-in-brief/cervical-screening-helping-you-decide–2 NB: The coverage of screening programmes in much of the rest of the world is significantly lower, and therefore globally prevention is lower and death rates are higher.  

There has been a lot of coverage in the press about skin cancer just recently.  Bearing in mind, it is August and the long awaited (and no doubt) fleeting British summer has arrived, accessing the great outdoors and enjoying the sun may well be on many people’s minds.  However, all is not well in the great British summer. 

Melanoma

 Cancer Research UK has recently released data to outline the rise in incidences of melanoma – the most common form of skin cancer that is mainly caused by exposure to the sun’s UV rays.  CRUK estimates there will be 20,800 new cases of melanoma in the UK this year, continuing a trend in which cases have risen by more than a third in the past decade. In a temperate climate like the UK it is always important to have some sun exposure in order to access Vitamin D, but that is a totally different order from lying for hours on some beach in the Mediterranean, where people turn themselves into lobsters in the sun without a moment’s thought to the harm that the sun’s rays are doing to their skin.  The rise in melanoma cases is thought to be due to an increase in holidays in hot climates abroad by people with little understanding of the dangers of excessive sun.

There were 17,500 cases of melanoma in 2019 and 1,500 deaths in the UK, and this cancer is particularly fatal when it spreads to other organs.  Nevertheless, this is one of the most preventable of cancers, with almost 90% of all cases being considered preventable. Greater awareness of the dangers of the sun and the requirement to keep out of the hot midday sun and cover up when in the sun at any time, would be an important starting point.

Australian Campaigns

One of the most successful skin cancer prevention campaigns has been fought over the last 40 years in Australia where, as a white skinned population in a near tropical climate, the Australians are acutely aware of this particular cancer.  Their high profile “Slip (on some clothes), Slap (on a hat), Slop (on some sunscreen)” is one of the most well-known and successful cancer campaigns of all time.  The UK would do well to emulate it.

In the meantime in the UK ….

In the meantime, in the UK the LibDems have highlighted the growing incidence of skin cancer and the long waiting list for skin cancer treatment on the NHS.  They are suggesting removing VAT from the price of sunscreens in order to make them more affordable.  In practice, as many people have pointed out, if VAT were removed, the price would likely stay the same and the manufacturers would pocket the difference as profit.  Nevertheless, it has been an excellent publicity event and has highlighted the dangers of skin cancer as well as the long waiting lists to get it treated.

Better Information on Sunscreens

It would also be helpful if bottles of suncreen carried information about the dangers of the sun in a font that is large enough to be legible.  It is worth trying to read the details on the back of a container of sunscreen and seeing how much can be easily read.  It is often a mass of words where the print is too small to be comprehensible.  This is one of the rare examples in health campaigning where it would be highly beneficial if commercial interests were stronger and the manufacturers of sunscreen would promote their produce in a more effective manner. 

In Conclusion

CancerWatch will be promoting its SunSmart campaign every August to increase awareness of skin cancer and the hidden harm in the sun’s rays. We hope you will accompany us on this journey.

UPFs: what are we talking about?

The term ‘ultra-processed foods’ (UPFs) arises from the NOVA food classification system. This distinguishes between unprocessed foods (i.e. wholefoods); processed culinary ingredients (e.g. salt, butter); processed foods (e.g. fresh bread, tinned vegetables, cheese, cured meats); and ultra-processed foods. Commonly consumed UPFs include mass-produced bread, microwave meals, sandwich ham, and biscuits.  

UPFs are typically industrially produced. They are normally manufactured to be ready to eat, drink or heat, typically with significantly longer shelf lives than less processed foods, which often means they are more convenient and cheaper. They usually contain high numbers of ingredients, including additives and chemicals used to preserve the food or to give them a certain look or taste that can make them more immediately or superficially appealing.

UPFs and health: recent evidence

The problem is there is a significant and growing body of evidence that these foods are bad for our health. To some extent, this is common sense. Many UPFs are high in saturated fats, sugar and salt, which we know are bad for us when consumed in high quantities. 

However, there is growing evidence of links between UPFs and a wide range of serious diseases, including cancer. The largest review of global evidence conducted so far found a direct link between consumption of UPFs and increased risk of cancer, heart disease, and type 2 diabetes, among 32 harmful health outcomes. 

Research from Imperial College found higher consumption of UPFs was associated with greater overall risk of developing cancer, and specifically with ovarian and brain cancers. 

What does it mean?

These findings do need to be placed in context. These studies are showing a link between UPFs and cancer. But we do not have evidence that this is a direct causal link. And the category is a broad one – some UPFs are likely to be significantly more harmful to our health than others. 

However, there are strong grounds for believing there is an indirect link between UPFs and cancer, through their impact on obesity – a major cause of preventable cancer – and through squeezing out of our diet those healthier foods that we know can help to prevent cancer. This should give us cause for concern, especially given the ubiquity of UPFs, which account for 56% of calories consumed in the UK and 64% of calories in school meals.

If we are looking to tackle the root causes of the thousands of cases of preventable cancers we see each week, then the impact of UPFs should be in our sights. 

Taking action: cut UPF in school meals

This is why in our 2024 Cancer Prevention Manifesto CancerWatch called for a target to cut the amount of ultra-processed foods being used in school meals. How this target was set would need to be considered, and it might well make sense to target a group of UPFs which we know are worst for our health. 

But the general principle is a strong one. By introducing children from all backgrounds to eating healthier food from a young age, over time this could have an enormous impact on improving health outcomes and reducing preventable cancers. It would be a real example of the kind of structural change we need to see in the fight against cancer. 

And we are not alone in this. Last year, a group of charities and high-profile chefs and food writers and charities, wrote to the Prime Minister (then Rishi Sunak) calling for action on UPFs in school meals, including a percentage reduction target. The letter was organised by the Soil Association and was supported by the Children’s Food Campaign, run by Sustain as well as the Food Foundation and School Food Matters, among others. 

With a new Government now in office, together we need to continue to build pressure for healthier school meal and the beginning of real action to reduce the prevalence of ultra-processed foods.   

About CancerWatch

CancerWatch is a charity made up of people whose lives have been affected by cancer, and who are passionate about eliminating preventable cancers in the future. We campaign for more effective action to prevent cancer. We believe that currently too little is being done to tackle preventable cancers at their source. 

Cancer prevention: the forgotten mission

There are around 1,000 new cancer cases in the UK every day. Taken together those cases are a statistic. Individually each one of those cases is a story of someone whose life will be seriously affected or lost to cancer, with family and friends who also suffer.

All of us know someone whose life has been affected by cancer. Yet the evidence tells us that up to 40% of cancer cases could have been prevented. Each year many thousands of people are becoming ill and dying who would otherwise have enjoyed many more years of life and good health, because of cancers which could have been prevented. 

This is a call for a new national mission to minimise and eventually eliminate preventable cancer in the UK. As we achieve this we will:

• Reduce the pain, ill-health, and loss of life caused by preventable cancer. 
• Free up precious healthcare resources to spend on treating non-preventable cancers and other healthcare priorities. 
• Reduce health inequalities, of which preventable cancers are a key driver.

It is not enough to focus only on treating and researching cancer, as vital as these aspects are. We now need a national drive to eliminate preventable cancers at source. We are calling on all major UK political parties to pick up this challenge and set out in their coming manifestos how they intend to tackle the scourge of preventable cancer. 

Preventable cancer and its causes

It is clear that the biggest causes of preventable cancer are lifestyle factors. Key among these are:

• Smoking tobacco: Smoking is considered to be the most preventable cause of cancer. About 13% of the British population still smoke, and about 36,000 people a year die from lung cancer each year.
• Drinking alcohol: Alcohol is an important risk factor in many cancers, including breast, bowel and oesophageal cancer. Drinking patterns have changed over time, and can be improved with appropriate action.
• Food and diet: Diet is a major risk factor, particularly in relation to obesity, processed and red meat, and insufficient fibre, with growing evidence of a link between ultra-processed food and cancer risk. Obesity is a major cause of cancer, responsible for some 13 different types. Soaring obesity levels in the UK, among the worst in Europe, are largely down to changes in diet and food supply.

Other causes of preventable cancer include excessive sunlight which causes skin cancer, and viruses that cause cervical cancer.

Lung cancer and prevention: There are about 46,000 cases of lung cancer a year in the UK with about 36,000 deaths. Lung cancer accounts for about 20% of all cancer cases in the UK. As smoking is the main risk factor, it is estimated that about 90% of these cases are preventable. 

Bowel cancer and prevention: There are about 42,000 cases of bowel cancer (also known as colorectal cancer) a year in the UK, with about 16,000 deaths. It is estimated that 55% of these cases are preventable, with the keys to prevention being high fibre diets, low red meat consumption, physical exercise and reducing both smoking and alcohol.

All the above statistics are available from the www.cancerresearchuk.org website.

System change is needed

If we are serious about minimising and eventually eliminating preventable cancer, then our approach needs to go beyond relatively shallow discussions about individuals making healthier choices. The decisions producers and consumers make are shaped by a wide variety of social and economic factors, which can serve to make healthier choices extremely difficult, and unhealthy choices sometimes the rational choice to make. 

To seriously bear down on the rates of preventable cancer, we require structural change. We need structural change which seeks to shift our economy and society to a position where cancer-causing products and choices are less prevalent, and healthier alternatives are much more prevalent. Such structural change could also be one of the most important tools we have to tackle the ingrained health inequalities we see in our society. 

Structural change should not be principally a matter of restricting personal freedoms. Rather key elements of this approach should include:

1. Modifying commercial behaviours – incentivising or requiring businesses to reformulate their products and marketing so as to minimise consumption which risks cancer.
2. Additional incentives to consumers to change their patterns of consumption
3. Advice, support and information which allows people to consider their behaviours and the risks of these. 
4. Strong public health messaging and education.

Three key ideas: A 2024 manifesto for cancer prevention 

1. A ‘polluter pays’ tax on tobacco industry profits to fund comprehensive smoking cessation programmes

The tobacco industry continues to make extraordinary profits on the back of products which kill and place a major burden on public resources.  Raising tobacco duties has proved effective in encouraging smokers to reduce and halt their consumption, but these taxes fall almost entirely on consumers. We should finally apply the ‘polluter pays’ principle to the tobacco industry in order to, among other things, fund the smoking cessation support we need. Examples of ‘polluter pay’ levies on the tobacco industry exist in other countries, including the US and France, and as recently as 2019 the Westminster government called for ideas on how a polluter pays model could work here. 

Smoking cessation support is a highly cost-effective policy intervention, but it needs sustained and higher levels of funding to effectively support smokers to quit, especially the most deprived and hardest-to-reach groups. Stronger support for smoking cessation is fully complementary to the existing smoke free generation policy, and will also be a necessary element if we are to achieve the goal of a smokefree UK by 2030

In order to ensure that any levy on the tobacco industry comes out of tobacco profits, we support the idea of a ‘utility style price cap’ developed by the APPG on Smoking and Health which would cap manufacturers’ prices for tobacco products at a level that would cover the costs of production and distribution plus a more moderate profit. The APPG estimates that this could raise up to £700 million a year, more than enough to fund a comprehensive smoking cessation service. This measure would also have the additional structural impact of incentivising this industry to begin to shift its investment and interest out of cancer-causing tobacco and into less dangerous products.

2. Mandatory alcohol labelling that provides information on key health risks

Alcohol is an important risk factor in seven cancers, including breast, bowel and oesophageal cancer. Yet, awareness of this risk is relatively low. There is strong evidence that health warning labels on alcohol can be effective in raising awareness of health risks and reducing consumption. Unlike smoking, drinking alcohol is not something we should be seeking to eliminate. But we should be seeking a healthier relationship with alcohol. Alcohol labelling can play an important role in this, helping to generate greater awareness and encourage people to moderate their use. Unlike food labelling which must meet mandatory standards, alcohol labelling in the UK currently follows voluntary and industry-run best practice guidelines.  At the moment, consumers are given far more health information on a bottle of orange juice than a bottle of wine.

Unlike smoking, drinking alcohol is not something we should be seeking to eliminate. But we should be seeking a healthier relationship with alcohol. Alcohol labelling can play an important role in this, helping to generate greater awareness and encourage people to moderate their use. Unlike food labelling which must meet mandatory standards, alcohol labelling in the UK currently follows voluntary and industry-run best practice guidelines. 

The Irish Government has recently introduced comprehensive health labelling for alcohol products. From 2026, alcohol in Ireland will need to meet mandatory labelling standards, which will include calorie content, risk of consuming when pregnant and risk of liver disease and certain cancers. The UK should follow suit and ensure that consumers in the UK have all the information they need to make informed decisions about their alcohol consumption.

3. A target to minimise the use of ultra-processed foods in school meals

Obesity is a major cause of cancer, and a risk factor for 13 different types of cancer. These include cancers of the breast and bowel (two of the most common types), pancreatic and oesophageal cancer (some of the hardest to treat), as well as cancers of the womb, kidney and liver. The relationship between diet and cancer is complex, but we could make significant in-roads into reducing preventable cancer by improving our food and diet. 

One area in which we need to look to do this is ultra-processed foods. The UK has the highest consumption of ultra-processed foods in Europe. Growing evidence links ultra-processed foods with increased risk of obesity and some cutting-edge research suggests a 10% increase in ultra-processed food intake is associated with a 10% increased cancer risk.

We should begin by reducing the amount of ultra-processed foods being fed to children in school meals. A study by Imperial College, which looked at the content of school lunches between 2008–2017, found that 64% of the calories in school meals come from ultra-processed foods. We should set and implement a target to drastically reduce this figure. By doing so we can enable structural change by introducing children from all backgrounds to, and encouraging them to enjoy, eating healthier food from a young age. 

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