By Prof Annie S. Anderson BSc PhD RD FRCP (Edin)
Professor of Public Health Nutrition,
Centre for Public Health Nutrition Research
Centre for Research into Cancer Prevention and Screening
It is almost 7 years since the World Cancer Research Fund produced their comprehensive review on Food, Nutrition, Physical activity and the prevention of cancer, and about a month since the last update (ovarian cancer) was published. The totality of evidence shows that around 43% of breast and 47% of bowel cancer can be prevented and yet these messages remain largely unacted. After tobacco use, excess body weight is the biggest modifiable risk factor but obesity and its association with breast cancer remains the major elephant in the room. I do wonder why we spend so much on research if this cannot be translated into practice and policy.
Everyone has such fab excuses…. its fate, its in the genes, it’s what you ate as a child that counts, its alcohol bingeing as a teenager, Uncle johhny is still alive at 90 despite no green ever passing his lips.
Despite a burgeoning evidence base on the importance of weight management in cancer survivors, both in terms of cancer outcomes, management of treatment side effects and well being the nutritional focus is dominated by malnutrition. Last week, our colorectal clinical nurse specialists sought reassurance that the obese patients shouldn’t really be encouraged to consume creamy drinks, pies and pastries, highlighting a local patient guide that implied otherwise.
More disappointing is talking to clinicians, where a set of reasons for not talking about diet and obesity including “the evidence doesn’t come from randomised control trials” (neither does smoking evidence!), not enough time, not trained, personally overweight, don’t want to spoil professional relationships, talking about obesity is ineffective…… and for more just see our paper on colorectal clinicians (Anderson et al, Colorectal Dis 2013, 15(8) 949-57).
We have conquered so much in terms of treatments and length of survival we really are overdue the focus on quality of years, the well being associated with weight management, the refreshing effect of a brisk walk, the taste of fresh fruit but major advocacy efforts are needed!
The Scottish Cancer Prevention Network (SCPN) was established 4 years ago to engage a range of stakeholders to work together to promote cancer risk reduction behaviours relevant for primary prevention and for cancer patients. SCPN gets funded through the Scottish Cancer Foundation and has grown a lot in these years, from a core of 80 people to over 800 signing up for our newsletter with cascades out to around 24,000 (including 4 health boards who flag the issues to all NHS staff). Patients are starting to say it is a duty of care to be informed about evidence on cancer prevention for them as survivors and for their families. The tide is starting to turn. Our annual conference has been a sell out for the last two years as the cancer charities get behind the idea that prevention must be a feature of their work and even CRUK have finally decided to invest in cancer prevention research. The health promoting health service initiative is a perfect opportunity to promote healthy lifestyle. One day we might even see some universal work around obesity with approaches that remove guilt and stigma and really flag opportunities for reducing cancer risk (as well as diabetes and cardiovascular disease).
Research (and teaching) are my key missions from my University overlords but in reality writing another paper to be read by 20 or so people versus a newsletter article that reaches thousands seems to me a better route to helping to change ways of life. It would be fab if more dietitians could be involved (sign-up for the newsletter by e-mailing firstname.lastname@example.org, follow on twitter @thescpn or e-mail us if you want to submit some content) and show professional solidarity for cancer risk reduction!