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.