08 June 2016

In a series of interviews, guest reporter Owen Haskins from Dendrite Clinical Systems, will be previewing this year’s ACPGBI annual meeting in Edinburgh, Scotland, July 4-6. He talked to Professor Annie Anderson (Professor of Public Health Nutrition, School of Medicine, University of Dundee) who discussed the issues of prevention and public awareness of colorectal cancer…

Research by the World Cancer Research Fund and Cancer Research UK has estimated that some 47% of colorectal cancer cases are preventable through changes in diet, alcohol, physical activity and body weight. In particular, it is known that diet is a known risk fact and people with a low fibre intake and a high intake of red and processed meat are at a higher risk of developing bowel cancer.

“It is not just the calorific amount people are consuming it is the quality of the food they are consuming. Although we have national government recommendations for the amount of red and processed meat that people should consume on a weekly basis, we know that about half the population regularly exceed those recommendations,” explained Professor Anderson. “So we have to develop programmes with the aim of preventing colorectal cancer. For example, if we have a patient who presents with an adenoma, who asks: ‘Why have I developed these pre-cancerous polyps, what can I do about it, how can I decrease my risks?’ then we have an ideal opportunity for a brief intervention (with written back up) on diet and physical activity.”

In addition, to improve patients’ lifestyle choices, she also said that it was important patients understood how their genes can increase their risk of developing bowel cancer. Conditions such as Lynch syndrome (or hereditary nonpolyposis colorectal cancer) is an inherited disorder that is known to increase the risk of colorectal cancer, as well as cancers of the stomach, small intestine, and urinary tract, amongst others. Lynch syndrome is believed to account for 3-5% of colorectal cancer cases each year. Recent research has indicated that people with Lynch Syndrome are at high-risk of developing cancer and this is likely to be higher in those who have excess body weight.

“My own feeling is that whilst there is a role for educational programmes that highlight issues such as diet, most people do not believe that by doing all the right things (health diet, limiting alcohol intake, not smoking) they are decreasing their risk as they all know someone who lived a healthy lifestyle and still developed cancer. So we have to clearly explain to people that whilst it is not possible to prevent the disease, the evidence shows that it is possible to reduce the risk by about half. And I think that is a very honest approach.”

Whilst she actively encourages her patients and the wider public to increase their levels of physical activity, diet remains crucial to reducing the risk of developing colorectal cancer.

“The public is yet to be convinced that a poor diet can increase their cancer risk in the same way smoking does. There is a perception that they can have a bacon sandwich in the morning and work it off by exercising later in the day. Wrong - you cannot out run a bad diet, it is as simple as that! What does work is exercise and improving your diet.”

Awareness

She added that all healthcare professionals, as well as people who work for charities, the media etc have a role to play in communicating a message of awareness that it is possible to reduce the risks of developing cancer. However, she stressed those organisations whether they are governments, charities, schools and workplaces must help facilitate and support these efforts, both on a group and individual public level. One such organisation is the Scottish Cancer Prevention Network (SCPN), which Professor Anderson helps to run. The SCPN is committed to promoting cancer prevention measures not only to individuals, but health professionals, policy makers and government. The organisation believes that it is not enough for individuals to attempt to change but health professionals, cancer charities and other agencies that have a vested interest in this field should be informed about the latest research on how to support that change. Furthermore, they also state that policy makers and government have a role to play in ensuring the environment and legislative structures enable change, rather than inhibit it. She explained that such changes would not be hugely expensive or require lots of additional resources, rather resources put where they will be most effective.

“What we have learnt is that whilst many healthcare professionals would like to inform patients about prevention, they do not have the training, they do not have the information and they do not have the resources. Yet, we know that when patients do receive such information they listen and make changes to their lifestyle. So we must recognise such opportunities and implement changes to ensure patients are given the best information by the people most qualified to provide it.”

Simple messages

She added that the public often complain that they sometimes receive mixed, contradictory or unclear advice. For example, the current recommendation for red meat is no more than 70g per day and Professor Anderson said patients and the wider public were not always sure what constituted 70g. “I believe the message to the public has to be clear and simple. We don’t expect them to weigh red meat each time they cook a meal, so I say to people have a small amount of red meat at most, three times a week. Such a simple message will see them begin to reduce of amount they consume without them having to make changes they may see as inconvenient. I also encourage patients to replace a piece of meat with extra vegetables and encourage greater uses of pulses such as peas, beans and lentils.” Professor Annie Anderson's lecture is on Monday 4th July at 2pm. More information about the SCPN

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