Following the publication of the latest worldwide cancer prevention report from World Cancer Research Fund, Dr Giota Mitrou, director of research, discusses the next steps for fellow scientists, the general public and policymakers.
Lifestyles featuring little exercise and fast and processed food are fuelling overweight and obesity, resulting in dramatic increases in cancer rates worldwide, according to ‘Diet, Nutrition, Physical Activity and Cancer: a Global Perspective’, the report published on 24 May 2018 by World Cancer Research Fund (WCRF).1
The burden of unhealthy lifestyles
Our 2018 report follows the landmark WCRF cancer prevention reports in 1997 and 2007, and stems from our ongoing Continuous Update Project (CUP). The CUP is a review of decades of evidence by a panel of independent experts from across the globe, who judged the evidence on the links between diet, weight, physical activity and cancer prevention and survival, and made recommendations. Our report found that overweight or obesity is a cause of at least 12 cancers – liver, ovary, prostate (advanced), stomach (cardia), mouth and throat (mouth, pharynx and larynx) join bowel (colorectum), breast (post-menopause), gallbladder, kidney, oesophagus (oesophageal adenocarcinoma), pancreas and womb (endometrium) – five more than WCRF findings a decade ago.
As more countries adopt ‘Western’ lifestyles, and with more than 1.9 million deaths each year, cancer represents the second most important cause of death and morbidity in Europe. Europe comprises only one eighth of the total world population but has around one quarter of the global total of cancer cases with some 3.7 million new patients per year.2 Further, as WCRF’s latest report indicates, the quality of diet and levels of activity of most people do not encourage healthy ageing, so further impact on obesity and subsequent cancer rates is anticipated as populations age worldwide.
Diet, nutrition, physical activity and cancer: headline news
When we presented our findings, on the day we published our report, at the 25th European Congress on Obesity in Vienna (ECO 2018), we were aware that obesity and cancer were newsworthy. So were other key findings in our report, such as:
- Regularly drinking sugar-sweetened drinks increases cancer risk because it causes weight gain, overweight and obesity;
- Being physically active can help protect directly against three cancers – bowel (colon), breast (post-menopause) and womb (endometrium) – and also helps people maintain a healthy weight, further reducing their cancer risk;
- A healthy diet featuring wholegrains, vegetables, fruit and pulses and low in red and processed meat reduces cancer risk; and
- Drinking alcohol is strongly linked to an increased risk of six cancers – Bowel (colorectum), breast (both pre- and post-menopause), liver, mouth and throat (pharynx and larynx), oesophagus (squamous cell carcinoma) and stomach. This is one more (stomach cancer) than WCRF findings a decade ago.
But the huge scale of worldwide media interest in our report – from Finland to South Africa, New Zealand to Brazil and with every UK national newspaper running a story – was largely a very welcome surprise. Many journalists chose to ‘headline’ on our report’s findings about the links between consumption of alcohol, red meat and processed meats and cancer risk, when, in fact, our research shows it’s unlikely that specific foods or nutrients are important single factors in causing or protecting against cancer. Rather, different patterns of diet and physical activity throughout life combine to make you more or less susceptible to cancer.
Nevertheless, all the coverage enabled us to introduce large, new, general public audiences to our Cancer Prevention Recommendations, updated in light of our new report and launched simultaneously. They provide strengthened evidence for a comprehensive package of behaviours that, along with not smoking and when followed together, represent the most reliable blueprint available for living healthily to reduce cancer risk, because they are based on evidence that has now proved consistent for decades.
WCRF is committed to giving people the most up-to-date and authoritative information about cancer prevention and survival, and disseminating it, including our Cancer Prevention Recommendations, in accessible and engaging ways. Hence, a really welcome outcome of all the media interest is that in the first month alone since we launched our report and our updated recommendations, there was a 455% increase in visits to the relevant pages of our UK website.
WCRF CANCER PREVENTION RECOMMENDATIONS
• Be a healthy weight: Keep your weight within the healthy range and avoid weight gain in adult life;
• Be physically active: Be physically active as part of everyday life – walk more and sit less;
• Eat a diet rich in wholegrains, vegetables, fruit and beans: Make wholegrains, vegetables, fruit, and pulses (legumes) such as beans and lentils a major part of your usual daily diet;
• Limit consumption of ‘fast foods’ and other processed foods high in fat, starches or sugars: Limiting these foods helps control calorie intake and maintain a healthy weight. (Following these recommendations is likely to reduce intakes of salt, saturated and trans fats, which together will help prevent other non-communicable diseases.);
• Limit consumption of red and processed meat: Eat no more than moderate amounts of red meat, such as beef, pork and lamb. Eat little, if any, processed meat;
• Limit consumption of sugar-sweetened drinks: Drink mostly water and unsweetened drinks;
• Limit alcohol consumption: For cancer prevention, it’s best not to drink alcohol. (Not smoking and avoiding other exposure to tobacco and excess sun are also important in reducing cancer risk.);
• Do not use supplements for cancer prevention: Aim to meet nutritional needs through diet alone. (‘Diet, Nutrition, Physical Activity and Cancer: a Global Perspective’ recognises that in some situations – for example, in preparation for pregnancy or when diet is inadequate for some reason – supplements may be advisable. But for cancer prevention, we are confident that for most people eating the right food and drink is more likely to protect against cancer than taking dietary supplements.);
• For mothers – breastfeed your baby, if you can: Breastfeeding is good for both mother and baby; and
• After a cancer diagnosis – follow our recommendations, if you can: Check with your health professional what is right for you.9
There are some findings in ‘Diet, Nutrition, Physical Activity and Cancer: a Global Perspective’ that were not included in WCRF’s Cancer Prevention Recommendations even though the evidence for them is strong; however, locally applicable actions are recommended. Among these are some food and drinks that are only consumed in specific parts of the world: namely maté (a hot tea drunk scalding hot mainly in South America), foods preserved by Asian-style salting, and Cantonese-style salted fish.
Translating research into policy action
Meanwhile, leading researchers, scientists, policymakers and other opinion-formers met at the Royal Society in central London on 24 May to debate our new report’s implications for future cancer research directions, how to translate them into public health policy actions, and the implications for cancer survivorship.
Cancer prevention depends not only on individual choices but also on governments creating an environment that encourages lifelong healthy eating and a physically active lifestyle. WCRF has therefore been calling on governments to prioritise cancer prevention through the development and implementation of effective policies to address the rising burden of cancer.
The prevention of cancer and other non-communicable diseases (NCDs) is one of the most significant public health challenges of the 21st Century, requiring a whole-of-government, whole-of-society approach in response. However, countries are not currently taking sufficient action to meet global NCD targets.3
WCRF representatives attended the 71st World Health Assembly in Geneva in May 2018, reinforcing this message and presenting our new policy brief accompanying our 2018 cancer prevention report: ‘Driving action to prevent cancer and other non-communicable diseases’.4 Our policy brief highlights the latest research on the links between diet, nutrition, physical activity and cancer; outlines why public policy is critically important to preventing cancer and other diet-related NCDs; and presents a new policy framework to support governments to take action. We developed this using our unique NOURISHING framework as a foundation: NOURISHING highlights where governments need to take action to promote healthy diets and reduce overweight and obesity, and is accompanied by a regularly updated database providing an extensive overview of implemented government policy actions from around the world.5
It is vital that research is translated into policy actions. WCRF International is concerned about the rising rates of childhood overweight and obesity. Governments must focus on childhood obesity as a priority, as 31% of 5-17-year-olds in the UK are now expected to be overweight or obese by 2025.6
The CO-CREATE opportunity
Very timely, WCRF International’s Policy and Public Affairs team have also recently begun work, as part of a consortium of 14 international research and advocacy organisations, on a new project to tackle childhood obesity in Europe.
The new project, called CO-CREATE, will devise, inform and disseminate policies to tackle obesity among young people, who will be centrally involved in designing policies and advocating practices they believe will help improve adolescent health.7 Funded by the European Union’s Horizon2020 research and innovation programme, the project will provide a programme of activities across a five-year period. WCRF International will be developing a physical activity framework and database to complement NOURISHING, supporting policymakers to implement policies promoting healthy diets and physical activity.
Co-incidentally, the EU-funded project’s initial meeting with all the CO-CREATE consortium members took place in Oslo, Norway (27-28 June 2018), just days after the UK government revealed ‘Chapter Two’ of the next phase of their childhood obesity plan.8 This includes consultations on TV advertising restrictions for unhealthy products and on banning the sale of energy drinks to children, plus legislation for mandatory calorie labelling on menus in restaurants, cafés and takeaways.
There is an urgent need for action. It is not only in the UK that the number of overweight and obese children and adolescents is expected to increase in the near future, but on a global scale. Cancer now causes one in six deaths worldwide and has overtaken cardiovascular disease as the leading cause of death in many parts of the world. Hence, collaborative projects such as CO-CREATE and the evidence-based findings of WCRF’s latest cancer prevention report are much-needed and very timely.
- Full copies of ‘Diet, Nutrition, Physical Activity and Cancer: a Global Perspective’ are available online at: www.wcrf.org/dietandcancer. For this latest WCRF report, the panel reviewed studies on 17 cancers, comprising 51 million people of whom 3.5 million were diagnosed with cancer
- European cancer statistics: Ervik M, Lam F, Ferley J, et al. Cancer Today. 2016. International Agency for Research on Cancer. Accessed 23 June 2017; available from http://gco.iarc.fr/today
- The global NCD targets: www.who.int/nmh/ncd-tools/definition-targets/en/
- ‘Driving action to prevent cancer and other non-communicable diseases: a new policy framework for promoting healthy diets, physical activity, breastfeeding and reducing alcohol consumption’: https://www.wcrf.org/int/policy/our-publications/driving-action-to-prevent-cancer
- NOURISHING framework and policy database: www.wcrf.org/NOURISHING
- ‘Obesity Statistics’ by Carl Baker. House of Commons Library briefing paper number 3336, 20 March 2018
- The CO-CREATE project has received funding from the European Union’s Horizon 2020 research and innovation programme for Sustainable Food Security under Grant Agreement no. 774210. For more information: https://www.wcrf.org/int/latest/news-updates/eu-funding-secured-prevent-childhood-obesity
- New UK government measures to halve childhood obesity by 2030: https://www.gov.uk/government/news/new-measures-announced-to-halve-childhood-obesity-by-2030?utm_source=9963f301-95dd-4e70-a28c-eb696cf38fad&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate
- World Cancer Research Fund’s Cancer Prevention Recommendations can be found online at: www.wcrf-uk.org/10ways
Dr Giota Mitrou
Director of Research
World Cancer Research Fund International
This article will appear in issue 6 of Health Europa Quarterly, which will be published in August.