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National Cancer Plan falls short of ‘prevention first’ approach

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The National Cancer Plan is a huge step forward but it should have been much stronger on primary prevention

This week has seen the launch of the National Cancer Plan for England, fittingly published on World Cancer Day 2026, Wednesday 4 February.

The publication of the Plan is itself an important step forward. We need a fully-formed national strategy and a plan to continue to drive forward improvements in prevention, diagnosis, research and care.

And this is a genuinely ambitious plan which sets targets to radically improve survival rates for those diagnosed with cancer and includes a commitment to meet all cancer waiting time targets by 2029. This and much else in the Plan is extremely welcome.

A mixed picture on prevention

However, in CancerWatch’s area of interest – cancer prevention – the National Cancer Plan appears to be more of a mixed picture. An important distinction here can be made between primary prevention and secondary prevention.

Secondary prevention consists of early detection measures targeted at people who are appear asymptomatic or generally healthy, with a view to detecting the disease early and improving outcomes for those who do have cancer. Cancer screening programmes are the most obvious example of this.

Primary prevention consists of measures to prevent cancer from occurring by eliminating or reducing key risks factors, through for instance altering unhealthy behaviors, or reducing the prevalence of risk factors in the environment.

The National Cancer Plan is strong on secondary prevention, but significantly weaker on primary prevention.

On screening and early detection (secondary prevention)

The National Cancer Plan is particularly strong on the extension and improvement of cancer screening programmes.

Some of the stand-out elements of this include:

  • Completing the roll out of targeted lung cancer screening by 2030.
  • Trialling the use of ling cancer screening to screen for other smoking-related cancers (described as ‘moving the scanner down’).
  • Increasing the sensitivity of Bowel Cancer screening and the Faecal Immunochemical Test (FIT).
  • Completing the rollout of self-testing to women who have not taken up the offer of cervical screening.

We warmly welcome all of these measures, and we would like to see the government and the UK National Screening Committee continue to look for ways to extend and improve cancer screening programmes. Clear evidence of net benefit should always be the test of this, but lack of resources should not be a blocker.

Given the importance to patient outcomes of diagnosing early, not to mention the cost effectiveness of doing so, there should always be a winning argument for investing in sufficient screening capacity wherever we know it can make a difference.

On tackling the key risk factors (primary prevention)

But taking a truly preventive approach to cancer requires looking beyond screening and early detection and focusing more intently on the major modifiable risk factors for cancer, the biggest drivers of those 40% of cancer cases that we know could have been prevented.

The National Plan is not silent on this. It very clearly sets out the key risk factors – smoking; weight and poor diet; alcohol consumption; UV exposure. It also makes clear the central role that the key cancer risk factors play in shaping wider health inequalities. And it outlines some important steps the government is taking to tackle these risk factors.

Tobacco and smoking

On smoking, the Plan understandably trumpets the smokefree generation policy which sits at the heart of the Tobacco and Vapes Bill. This is truly a world-leading piece of legislation, which will have an enormous impact in reducing cancer cases by preventing future generations from ever starting smoking. The Plan also mentions the roll out of opt-out smoking cessation support into all routine care across the NHS, and ongoing funding support for local government stop smoking programmes.

These are welcome measures, even if previously announced, but it is disappointing that the opportunity wasn’t taken to set out how we can bring forward a smoke free future by making faster progress on helping existing smokers to quit, including more focused support for the most disadvantaged and hardest to reach groups.

Diet and obesity

On obesity and poor diet, the key measure in the Plan is the proposal to introduce mandatory healthy reporting for large food companies and the use of this to develop a healthy food standard (already announced in the 10 Year Health Plan). Alongside this, there is clear a focus on accelerating the uptake of weight loss medicines, but little else. Given the urgency and broader public health imperative to tackle the obesity epidemic, this policy response feels distinctly underwhelming.

Alcohol

On alcohol, the Plan re-commits to the introduction of mandatory health warning labels on alcoholic drinks. This is something CancerWatch has long campaigned for, because we believe it could be a vital first step in raising awareness of cancer risk and encouraging people to reduce their drinking. But if this policy is to be truly effective in raising health literacy and helping people make better choices, then we believe it is vital that health warning labels explicitly mention cancer risk.

The Plan also commits to encouraging growth in the use of ‘no and low’ alcohol drinks, but it stops there. It is disappointing to see no commitment to bringing forward an alcohol strategy, no targets for reducing alcohol consumption and no mention of minimum unit pricing or restrictions on alcohol marketing – measures proven to be effective in reducing alcohol consumption.

UV exposure

On UV exposure, the Plan commits the government to significantly tighten up the regulation of commercial sunbeds, including banning unsupervised sessions and introducing mandatory ID checks to verify users are over 18. These are new measures, not previously announced, and represent a welcome step forward. But they are still relatively small beer compared to more robust approaches being taken in other countries.

Conclusion: still no systemic approach to cancer prevention

So, the National Plan is not silent on primary prevention and the government is bringing forward some groundbreaking measures, most obviously the smokefree generation policy and alcohol labelling. There is also talk of taking ‘a whole society approach to prevention’, which sounds worth pursuing, but the Plan fails to really set out what it means by this.

What is lacking is a truly comprehensive approach to the key cancer risk factors, and a clear sense of determination and forward momentum in tackling some of the key causes of preventable cancer, especially obesity and alcohol consumption. The suspicion is that food and alcohol industry efforts to discourage and stymy tougher measures have played a significant role in this. This is disappointing from a government that came to power promising a ‘prevention revolution’ and that made ‘sickness to prevention’ one of the three key shifts at the heart of the 10 Year Health plan.

The strong emphasis on secondary prevention (screening and early detection) makes real sense in the context of the Plan’s strong focus on improving survival rates and the lengthening the life expectancy of those with cancer.

But it does less to address the threat posed by rising incidences of cancer in the UK, with a projected 14% rise in cases over the next 15 years. If we want to manage down the enormous human and economic toll of this and avoid more and more health service resources being given over to treatment, we need to see a much more robust, ‘whole systems’ approach to cancer prevention. The same can be said in relation to efforts to reduce the serious health inequalities we face in the UK.

That systemic approach to cancer prevention would use every effective tool we have in our toolbox, including restrictions on sales and marketing, incentives to businesses to change or reformulate their products, incentives on consumers to change behaviour, as well as information and awareness-raising.

The National Cancer Plan may be a big step forward, but on this measure it falls a long way short, and that feels like a missed opportunity. So, we need to keep working to ensure implementation of the many good measures within the National Cancer Plan and to develop that truly systemic approach to cancer prevention that could save so many lives, with a view to the next national cancer plan being one which fully embodies that ‘prevention first’ approach.

Letter to Wes Streeting, MP, Secretary of State for Health and Social Care

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CancerWatch has today written to the Secretary of State for Health and Social Care, Wes Streeting MP to urge the Government to take action to improve consumer understanding of the cancer risk associated with alcohol.

The link between alcohol and cancer is the theme of this year’s Cancer Prevention Action Week 2025 (#CPAW25). Alcohol accounts for nearly 12,000 cases of cancer each year in the UK and is an important factor in at least seven types of cancer.

Because of this, CancerWatch is joining other health charities in calling for a stronger priority to be placed on tackling the public health challenges posed by alcohol, including cancer risk.

Specifically, CancerWatch has urged the Secretary of State to include alcohol as a key policy priority within the forthcoming National Cancer Plan and to:

  1. Introduce mandatory health warnings on all alcohol products to improve consumer awareness of the health risks of drinking alcohol.
  2. Ensure that mandatory health labelling includes a specific warning about the link between alcohol consumption and cancer
  3. Transfer enforcement of standards for alcohol labelling to an independent regulatory body, such as the Foods Standards Agency.

You can read the full letter below:

Reg Charity No. 1206140

Rt Hon. Wes Streeting MP.,
Secretary of State for Health and Social Care,
DHSC, 39 Victoria Street,
London SW1H 0EH

23rd June 2025

Dear Secretary of State,

Cancer Prevention Action Week – 23-29 June 2025
Cancer and Alcohol – Mandatory Health Warnings

We are writing to you in Cancer Prevention Action Week 2025 to ask you to take steps to address the risk of cancer to the British population caused by the consumption of alcohol. 

Every day in the UK, there are 1,000 new cancer cases and yet, an estimated 400 of these could have been prevented. One of the major risk factors for cancer is alcohol consumption, which the World Health Organisation classifies as a Group 1 carcinogen. Alcohol is an important causal factor in at least seven types of cancer, specifically those of the breast, bowel, oesophagus, liver, mouth, throat, and voice box. That is why this year’s Cancer Prevention Action Week is focusing on the cancer risks of alcohol. 

We very much welcome that one of the three “shifts” detailed in the 10 Year NHS Health Plan is to move from sickness to prevention, and that prevention featured prominently in the recent consultation on the National Cancer Plan. However, effective action to prevent cancer requires us to recognise and address the cancer risks associated with alcohol.

This must begin by raising people’s awareness and understanding of those risks. Therefore, we strongly urge you to include alcohol as a key policy priority within the forthcoming National Cancer Plan and to take the following actions:

1. Introduce mandatory health warnings on all alcohol products to improve consumer awareness of the health implications of drinking alcohol.

2. The mandatory health labelling should include a specific warning about the link between alcohol consumption and cancer. This would reflect the recommendations of the WHO Europe[1], and would also mirror the legislation being implemented by the Republic of Ireland from 2026.[2] British labelling should aspire to at least match these standards.

3. Regulation around new mandatory standards for alcohol labelling should be transferred to an independent regulatory body, such as the Food Standards Agency, to ensure that the regulation of alcohol labelling in the UK is at least as rigorous as it is for foodstuffs

Evidence suggests that:

  • Alcohol causes around 11,900 cases of cancer per year in the UK.[3]
  • Around 1 in 10 breast cancer cases are caused by drinking alcohol, equating to about 4,400 cases per year.[4]
  • Worldwide, alcohol accounts for around 400,000 deaths from cancer each year.[5]

All these cases and deaths are potentially preventable. Prevention begins with awareness and there is good evidence that health warning labels on alcohol can be effective in raising awareness of health risks and helping to moderate consumption. As such, we believe mandatory health labelling on alcohol is an important and necessary step in the National Cancer Plan’s aim to reduce lives lost to cancer. 

Unlike food labelling, which must meet mandatory standards, alcohol labelling in the UK currently follows industry-run best practice guidelines, and this voluntary system of labelling is failing to support people to make more informed choices. By taking action to ensure mandatory health labelling on alcoholic drinks, the government will be empowering consumers to make informed choices about the health risks and implications of alcohol, at the same as supporting its preventative approach to health. 

We would be pleased to meet with you and your officials to discuss in more detail how we might work together to bring forward these policies and to help improve awareness of the links between alcohol and cancer. Please contact Andrew Dixon at  to arrange this. 

We look forward to hearing from you and working together to improve health outcomes and cancer rates across the country.

Yours sincerely,

Jill Clark

Jill Clark, Chair
CancerWatch

[1] Brown, K. et al., The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland and the United Kingdom in 2015. British Journal of Cancer, 2018.

[2] Cancer Research UK, How does alcohol cause cancer?

[3] Nuffield Department of Population Health, New genetic study confirms that alcohol is a direct cause of cancer

[4] WHO, Alcohol health warning labels: a public health perspective for Europe.

[5] WHO, What’s in the bottle: Ireland leads the way as the first country in the EU to introduce comprehensive health labelling of alcohol products.

The National Cancer Plan

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The National Cancer Plan (NCP) consultation was announced earlier in the year and closed at the end of April 2025. Like the consultation for the NHS 10 Year Plan it has attracted enormous interest, not only from health organisations such as CancerWatch but also from other organisations interested in the fight against cancer, and from interested individuals. We are told that the consultation for the NCP has attracted some 11,000 submissions and will inform the nature of cancer services in England in future years.

The structure of the NCP submission was in the form of sections, covering key issues such as prevention and awareness; early diagnosis; treatment; living with cancer; research; and inequalities, with each section preceded by a dropdown menu with various choices asking you to identify your top three priorities for that subject. You were then given the opportunity to explain your answer in a limited number of words.

As a cancer prevention charity, not all the sections were relevant to CancerWatch. However, the sections that we felt were relevant, were prevention and awareness, early diagnosis (where we have an interest in screening), research and inequalities.

For CancerWatch, it is immensely encouraging that the first section in the consultation is awareness and prevention and the priorities that that suggests (as was the case of the NHS Change consultation earlier in the year). Although consultations tend to emphasise the NHS, the Dept of Health and Social Care who administer the consultation, has made it clear that the outcome of the consultation will also be used to inform the future of public health, for which they are also responsible. We believe that is a huge step in the right direction for the battle against cancer in this country.

With respect to our submission on the section on prevention and awareness, unsurprisingly we chose smoking, obesity and alcohol as the key problems in the drop down menu to be addressed. In the opportunity to explain our answer we also commented on viruses, UV rays and chemicals in the workplace as opportunities for preventing cancer. We believe that the link between alcohol and cancer is one that deserves much greater attention and awareness. As such, we have taken this opportunity to encourage the government to legislate for compulsory health warnings on bottles of alcohol, which is our main campaign this summer.

With respect to the section on early diagnosis, we took the opportunity to recommend increases in symptoms awareness, and advances in diagnostic test access and capacity. With respect to screening, there have been advances in lung cancer and targeted screening for specific groups, all of which we applaud. As cancer is often a disease without symptoms, we recommended a greater emphasis to be placed on screening.

In the section on research, we made the point that there is plenty of research on how cancer can be prevented, but very little of the research is ever put into practice, not least because is requires legislation or regulation to carry out.

A particularly important section for CancerWatch was the section on inequalities. The most important drivers of health inequality (certainly in terms of life expectancy) are also the most important causes of preventable cancer. 50% of all inequalities in mortality between the richest and poorest in the UK are considered to be caused by smoking, with another 30% or so of these inequalities caused by obesity. This was revealed in the 2014 Marmot Report on public health. In our response to the NCP, we took the opportunity to highlight how little has been achieved in tackling these inequalities since.

Finally, although we felt all of the sections of the consultation were important, we believe it is a considerable step forward for the consultation to plan so much emphasis on prevention and awareness. The default position has always tended to be to emphasis treatment and “cure” with respect to cancer. We really do need to move beyond this. The real advance available to us now is the eradication of the 40% of all cancers that are considered preventable. That was what CancerWatch was set up to achieve.

Obesity and Planning Permission

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The obesogenic nature of our inner cities has long been a cause of concern for activists campaigning against poor health, and the key instrument for control of inner city environments is planning permission. In the post war years such permission has become fiercely complex and very much the realm of lawyers, yet normal inhabitants of any town have to interact with it if they want to complain about commercial and retail development in their urban environment.

Planning permission determines the character of the built environment, and nowhere is this more true than in the case of restaurants and retail food outlets. For those of us who are concerned about obesity, the fast food and hot food takeaway sector is an area of significant focus. We are not talking about lunchtime takeaway shops, whose staple is sandwiches and salads, many of which are quite healthy We are talking about the evening purveyors of kebabs, chips, fried chicken wings, oversized pizzas, king sized burgers and such like, where the calorific content is significant but the nutritional contents in minimal.

The poor quality of inner city environments also has the effect of discriminating against the poorer and less advantaged members of society, due to the high level of social housing and poor quality of rented accommodation that often exists in the inner city. The middle class leafy suburbs have traditionally been more insistent at keeping low quality fast food restaurants and take-aways out of their areas; they have a better understanding of the damage these retail units do to the environment in which they live.

Public health is not normally considered an adequate reason for refusing planning permission, but increasingly local councils with poor health metrics in their areas are taking action. Within the planning system, local government can control development by using Planning Directives, and these are increasingly being used. Other such tools include Supplementary Planning Documents, and a number of local councils, such as Dagenham and Coventry City council have used these as tools to reduce the prevalence of fast food takeaways in their areas.

It is unfortunate that local authorities often use child (as opposed to adult) obesity as a diversionary tactic, emphasising how they prohibit hot fast food take-aways from operating close to schools, and other no doubt worthy child health policies, but they fail to address the key issue of adult obesity caused by the overall poor quality of the inner city environment. Making the matter especially difficult, of course, is that at a time of hollowing out of town centres, councils try to attract retail outlets to their inner city areas, encouraged by the need for councils to attract business rates to their locality at a time of budgetary cuts from central government.

Unfortunately, there is no quick fix for obesity. In practice to make policies effective they have to be used with other anti-obesity tactics. But anti-obesity campaigners should increasingly ask why these poor quality hot fast food retails outlets exist in their cities at all.

The Problem with Children’s Obesity

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During the lockdown, my front door has been the recipient of countless leaflets promoting take-away food of a distinctly dubious nutritional quality. This caused me to write to my local council complaining about high fat, fast food take-aways and the effect they had on obesity. I received a fulsome letter back from the local councillor in charge of health, but it talked only about childhood obesity.

Good cause to worry? UK children are the fattest in Europe and have become fatter since the lockdown according to figures released in autumn 2020 by the National Child Measurement programme.

When children start school more than a fifth of four year olds are classed as overweight and a tenth as obese, meaning they have a BMI of 30 or above. By the time they go to secondary school more than a third of children are overweight and a fifth are obese. Across England, childhood obesity has risen while the gap between the rich and the poor has widened.

The Conservatives pledged to “tackle childhood obesity” in the party’s 2019 manifesto. In 2018 the Tories had committed to halving the problem by 2030.

The campaign is very worthy and well meaning, but there is a more subtle aspect to it. Obesity is a major risk factor for many lifestyle (ie preventable) cancers, so it is important that obesity should be controlled and eliminated.

A number of cancers are caused by obesity: bowel cancer, uterine cancer, oesophageal cancer, breast cancer and others. Indeed, some campaigners are now saying that obesity causes more cancer than smoking. Other lifestyle diseases, such as diabetes or cardiovascular disease are also diseases of the overweight.

However, a characteristic of lifestyle cancers is that they tend to affect the elderly, not the young. For example the average person who gets cancer of the oesophagus is aged 70. The average age of a child is half 18, thus aged 9. So there is a 60 year gap between the cancer itself and the precautionary action being taken. In a sense, you could argue that in the case of cancer of the oesophagus, for example, you have to wait 60 years to know if the child obesity campaign has really been successful. Similar figures would apply to other lifestyle diseases.

No government department works to a 60 year time horizon so why did the Department of Health and Social Care (DHSC) embark on this? The answer is that it is an easy option for them. It is “doable” (Amsterdam has already succeeded), it is measurable, and because children are involved, everybody sees it as a “good thing” rather than part of a so-called nanny state.

Unfortunately, worthy as it is, in my opinion, the campaign against child obesity is also acting as a decoy, a diversionary tactic for what really needs to be tackled, which is adult obesity. It is adult obesity that needs to be tackled now, not in 60 years time. It may be easier and more convenient for the DHSC to turn a battle against “obesity” into a battle against “child obesity” but the two are very different, and the battle against the latter risks sidelining the battle against the former.

After all, the battle against adult obesity would lead you into concepts such as “fat taxes”, finger wagging and concepts alien to a “free society”, whatever that is. It is easier to advocate policies that have already been shown not to work, but apply them to children, where you have more control, and therefore make weak policies seem more successful.

Of course, the assumption is that if you can fix child obesity you will fix adult obesity. I would argue that the logic is the other way around, not to mention that the time horizons are just too long to carry any meaning. Perhaps you can hope that putting emphasis on preventing obesity generally through the child obesity drive will leach through to adult obesity. But I say fix adult obesity first, then you will find child obesity will fix itself.

JMC March 2021

Briefing Note – Bowel Cancer

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Briefing Note on Bowel Cancer in the UK

Bowel cancer is one of the most common cancer types. Sometimes it is referred to as colorectal cancer, which is another name for the disease. Bowel cancer in general has been rising in the past few decades and there are many theories for this rise. Please read below for the latest developments in bowel cancer and also tips on how to prevent it.

Background

Bowel cancer accounts for 11% of all new cancer cases in the UK. Every year, about 42,300 people are diagnosed with bowel cancer in the UK. 1 in 15 men and 1 in 18 women will get bowel cancer during their lifetime. Many risk factors influence your bowel cancer risk: age, obesity, and diet are the main risks. 

However, shorter term, the overall trend for bowel cancer in the UK is decreasing. Although bowel cancer cases were rising between 1971 and 1998, there was then a period of no new increases until 2012. Since 2012, we seem to be getting on top of the disease. The rate of new cases decreased by 4% in the last decade.  However, still around 70 in 100,000 people are diagnosed with bowel cancer in the UK every year.

What are the risk factors?

The main risk factor is age: your risk of getting bowel cancer increases dramatically with your age. The majority of people with bowel cancer are typically above 80 years old and the rest above 50. The rate of new cases in people aged below 50 years old is extremely low (Cancer Research UK, 2015-2017). The average age at the time of diagnosis is between 63-72 for colon and rectal cancers. 

This may be due to your lifestyle that affects your risk during your lifetime. There are many risk factors that are well-known to increase risk of bowel cancer:

  • Diet especially lack of dietary fibre and over consumption of red meat
  • Obesity and being overweight
  • Smoking
  • Alcohol
  • Previous cancer history
  • Medical conditions (IBS, colitis, chronic inflammation)
  • Radiation
  • Infections
  • Hereditary conditions

Some reports in the media may also mislead you into thinking that mobile phones, artificial sweeteners, genetically modified foods or plastic bottles are risks. However, not all these ‘facts’ are true. Many of them are not backed up by scientific studies. You can read more about the biggest myths around bowel cancer here:

https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/cancer-myths

The key fact is that eating fibre reduces your risk of bowel cancer by at least 20%. 9 out of 10 people in the UK are not eating the recommended amount of fibre every day. Many scientific studies have linked the reduction in bowel cancer cases with dietary fibre. Interestingly, increased refrigerator use was linked to reduced gastric cancer risk in Asia –possibly also in Western countries. Similarly, antibiotics were linked to some types of bowel cancer, but were found to prevent others. Aspiring use, calcium and vitamin D are thought to prevent your risk of bowel cancer. Chronic inflammation and changes in your gut microbiome may also contribute to your bowel cancer risk. However, care is needed when interpreting bowel cancer risk factors from isolated studies. Scientific studies need to be repeated across continents to establish a relationship between a risk factor and cancer. 

Bowel cancer in young adults

Worryingly, since 2010, the number of new cases among people aged 20-39 years old increased sharply by 5-19%. Since bowel cancer is significantly associated with lifestyle and diet, the main explanation would be the rising levels of obesity and diabetes in younger population. Moreover, young people nowadays tend to be less physically active and may have a higher consumption of red meat, increasing their bowel cancer risk.

Source: Cancer Research UK, https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/incidence#heading-Two, Accessed 05/2020

Bowel cancer and sex

Bowel cancer is more common among men than women. Men form almost 56% of all cases, whereas women only 44%. This may be due to different lifestyle habits: women tend to be more interested in healthy diet, exercise and general healthy lifestyle than men, reducing their bowel cancer risk. Perhaps interestingly, women also tend to have a better prognosis than males. This was in past linked to differences in hormonal levels.

Source: Cancer Research UK, https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/incidence#ref-2, Accessed 05/2020

Bowel cancer prevention

The main factor contributing to decreasing levels of bowel cancer is screening. The UK has a national screening programme for bowel cancer,  that helps to reduce bowel cancer incidences and severity thanks to early diagnosis. In 2011, a ‘Be Clear on Bowel Cancer’ campaign was launched to promote bowel cancer awareness. This helped to improve the bowel cancer statistics drastically, possibly by removing the stigma around diagnostic procedures. If people feel that going for colonoscopy can be part of a yearly check-up and there is no shame associated with it – more people seek early diagnosis and treatment for bowel conditions, in turn helping to prevent bowel cancer. Probably thanks to improved screening and awareness, the survival for bowel cancer patients has been steadily improving by almost 60% since 1971.

Source: Cancer Research UK, https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/survival#heading-Two,accessed 05/2020

Bowel Cancer in the UK

Despite the awareness campaign the age standardised incidence rate of bowel cancer in the UK is amongst the highest in the world. Many Western countries have high rates of bowel cancer among their population, including Germany, Spain, Canada and Australia. This may be due to low levels of dietary fibre, poor lifestyle, consumption of red meat, alcohol and smoking.

Lifestyle factors are likely to contribute to a poorer survival rate in the UK than in other countries. France, Canada and United States have higher survival rates for colorectal cancer than the UK. Although the UK has been improving its survival rate over the last decade with the screening programmes playing a significant role in catching bowel cancer in its earliest stages and improving patients’ prognosis. Awareness around bowel cancer and its risk factors is still low in the UK, in contrast to the US.

A main difference between the UK and US is also in clinical recommendations. UK NICE guidelines do not recommend endoscopy or imaging for people with irritable bowel syndrome (IBS). However, almost half of IBS patients in the US receive endoscopy, possibly detecting early-stage tumours more often. Colonoscopy is the primary screening method for early-stage colorectal cancers. Getting people at risk of bowel cancer to the doctor in the UK earlier will improve the risk and prognosis.

Source: The colorectal epidemic: challenges and opportunities for primary, secondary and tertiary prevention. (Brenner and Chan 2018)

The future and prevention of bowel cancer

Prevention and early detection play significant roles in reducing your risk of bowel cancer, and your prognosis if you are diagnosed. Eating a high fibre diet, avoiding tobacco and alcohol consumption, eating less red meat and improving your exercise habits will all help in reducing your risk of bowel cancer.

But the good news is that there are several trials underway to further reduce your risk, for example scientists are trialling low dose aspirin for preventing bowel cancer, as well as improvements to bowel cancer screening.  We encourage you to join our campaigns against the incidence of bowel cancer as well as other life threatening cancers.

Taking care of your body and gut will not only improve your bowel cancer risk, but also lifestyle and quality of life. 

Produced by the CancerWatch team, Summer 2020 

References

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Brenner, H., Chen, C., 2018. The colorectal cancer epidemic: challenges and opportunities for primary, secondary and tertiary prevention. British Journal of Cancer 119, 785–792. https://doi.org/10.1038/s41416-018-0264-x

Center, M.M., Jemal, A., Smith, R.A., Ward, E., 2009. Worldwide Variations in Colorectal Cancer. CA: A Cancer Journal for Clinicians 59, 366–378. https://doi.org/10.3322/caac.20038

Exarchakou, A., Donaldson, L.J., Girardi, F., Coleman, M.P., 2019. Colorectal cancer incidence among young adults in England: Trends by anatomical sub-site and deprivation. PLOS ONE 14, e0225547. https://doi.org/10.1371/journal.pone.0225547

Keum, N., Giovannucci, E., 2019. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nature Reviews Gastroenterology & Hepatology 16, 713–732. https://doi.org/10.1038/s41575-019-0189-8

Kunzmann, A.T., Coleman, H.G., Huang, W.-Y., Kitahara, C.M., Cantwell, M.M., Berndt, S.I., 2015. Dietary fiber intake and risk of colorectal cancer and incident and recurrent adenoma in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial12. Am J Clin Nutr 102, 881–890. https://doi.org/10.3945/ajcn.115.113282

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Why is Smoking Becoming a Working Class Tragedy?

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The Background

About 8m (2016) people, some 15% of the population still smoke. This contrasts with the situation after the Second World War when over 80% of the population smoked.  During the 1970s and 80s in particular there were considerable declines in smoking as the medical science behind the dangers of smoking became better known in the population.

But this obscures a key unpalatable truth, that most of the reduction in smoking has been as a result of the middle classes giving up smoking, rather than an across-the-board reduction which policy makers assume.  Among people in lower socio-economic groups the decline has been much smaller.

Key Statistics for Smoking and Inequality

Indeed, there is a close link between cigarette smoking and social class.  In 2017 studies by Action on Smoking and Health (ASH) showed that about 26% of adults in manual occupations smoked compared with 11% in managerial and professional occupations.

Additionally the working classes are more likely to be heavy smokers (defined as adults who smoke more than 20 cigarettes a day).   A YouGov survey commissioned by ASH in 2019 found that 30% of current smokers in higher social groups AB smoked less than 6 cigarettes a day compared to 17% in lower social group E.  

Additionally, 18% of smokers reported smoking 20-30 cigarettes a day in the lower socio-economic groups with only 5% smoking that number of cigarettes a day in the higher socio-economic groups.  In other words, the higher the social class, the fewer the cigarettes smoked by smokers.

Higher smoking prevalence is associated with almost every indicator of deprivation or marginalisation in society compared to the population as a whole.  For example, smoking is more common among the unemployed; people with mental health problems; people who live in social housing; people without qualifications, and people in contact with the social justice system.

How much health inequality is caused by smoking?

There have been various studies to try and identify this.  Using the incidence of mortality in large datasets probably give the best results.  For example, in a long term study of over 10,000 civil servants in London, smoking was found to account for around a third of the difference in death rates between the lowest and the highest socio economic groups over a period of 25 years. (1)

In an international study of deaths among men aged 35-70 which included data on 600,000 men, smoking was found to account for about half the difference in mortality between the top and bottom socio economic groups in England. (2)

In general, long term studies have found that around a third to a half of health inequalities are caused by smoking.  For reference, of the other causes, about 30%  of health inequalities are considered to come from obesity, with the final 20% or so being the result of alcohol and a variety of other causes relating to poverty.

Why does nobody seem to care?

Nearly all British government health institutions, such as the Dept. of Health and Social Care, the NHS, and quasi-government institutions such as Public Health England, and Health and Wellbeing boards run by local government, claim to put health inequalities at the heart of their work, and in many cases are legally obliged to do so.  In practice, the phrase “health inequalities” is a euphemism for good intentions, but where little action is taken. Indeed, smoking cessation services (which have been delegated to local authorities) have been severely reduced in recent years due to constant budget cuts. 

It is the case with many public health matters, that there is still a reliance by policy makers on “individual responsibility”, in other words, smoking among lower socio economic groups is the responsibility of those specific groups; as far as the health authorities are concerned it is a case of tut, tut, hands up, – nothing to do with me, mate!  Or better still, blaming it on the cigarette companies.

But perhaps the really reason that officials are indifferent to the health inequalities of smoking is that cigarettes bring in some £12.5bn a year of taxation (incl. VAT) for central government, not an insignificant amount and roughly equivalent to the amount raised from stamp duty taxes.

Why should we care?

We should care because cigarettes cause some of the deadliest of all cancers and diseases, and it is an abomination that people suffer from these diseases and have shorter lifespans just because they were born into lower socio-economic groups.  Smoking causes harm to every organ of the body, but as far as cancer is concerned the most relevant cancer is lung cancer, one of the most deadly of cancers.  But it also causes some twelve other cancers, among them bowel, bladder, kidney, oesophageal and pancreatic cancer.

Who should take action?

Everybody should take action to lobby against these types of health inequalities, not just cancer campaigners like CancerWatch, but also groups campaigning for greater social justice such as the Child Poverty Action Group, food banks, trades unions representing lower paid workers, providers of social housing, politicians who campaign of behalf of lower income groups, not to mention other health charities.  These groups and associations all have their part to play and CancerWatch will be encouraging them to play it.

The CancerWatch Team

Summer 2020

Notes:

  1. Stringhini S, Sabia S, Shipley M et al. Association of socioeconomic position with health behaviors and mortality. JAMA 2010; 303(12):1159-1166 
  2. Jha P, Peto R, Zatonski W, et al. Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America. The Lancet 2006; 36: 367–370.