Together we can: World Cancer Research Fund’s 10 ways to reduce cancer risk

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This handy desk calendar contains useful at-a-glance information on cancer and lifestyle and highlights health awareness campaigns throughout the year.

World Cancer Research Fund is the leading authority on cancer prevention research related to diet, weight and physical activity. One in three people are affected by cancer but about a third of the most common cancers are preventable1. Together we can help people make informed lifestyle choices to reduce their cancer risk in ways that are achievable and sustainable.

1. Stay in shape for lifeBeing overweight is strongly linked to breast, bowel, ovarian, kidney,

pancreatic, gall bladder, oesophagus, womb and advanced prostate cancer2. We could prevent about 1 in 6 of these cancers if everyone was a healthy weight. Read our spotlight box inside for more information on body weight and cancer.

2. Move moreAs well as helping people to stay in shape, research shows that being

active has a direct role in preventing bowel, breast and womb cancer. To reduce risk, we should aim to be moderately active for at least 30 minutes every day.

3. Put plant foods firstResearch shows that eating plant foods such as wholegrains, pulses,

vegetables and fruits probably reduces the risk of a range of cancers, including mouth, throat, oesophagus, stomach, bowel and lung. They may protect against cancer because they help keep the body healthy and strengthen the immune system. They also contain phyto-

chemicals, which can help to protect cells from damage that may lead to cancer, and fibre, which reduces the risk of bowel cancer.

4. Avoid high-calorie foods and drinksThese foods and drinks can make

it hard to stay in shape because it’s easy to consume a lot of calories from a small amount of food. Being overweight or obese increases the risk of nine types of cancer.

5. Drink less alcoholAlcohol is linked to cancers of the mouth, throat, oesophagus, bowel,

breast and liver. Drinking too much can also contribute to weight gain. We recommend no more than two drinks a day for men, and one drink a day for women.

6. Eat less red meat and cut down on processed meatsTo reduce bowel cancer risk, we

advise eating no more than 500g (cooked weight) per week of red meat, like beef, pork and lamb, and eating as little processed meat (like ham and bacon) as possible.

7. Eat less saltSalt is linked to stomach cancer; scientists think this might be

because salt damages the lining of the stomach. Daily intake of salt should be less than 6g (around a teaspoon).

8. SupplementsEvidence shows that taking high- dose supplements of some nutrients

can affect your risk of different cancers in »

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Features in this issue:1 Top tips for a healthy Christmas2 Is being a vegetarian the best way to reduce cancer risk?3 How to make every contact count

ISSUE 56 WINTER 2014

Find out more:

www.wcrf-uk.org/ uk/here-help/ workplaces

On the web

In January we are launching the first of our free healthy workplace challenges. Make it a Habit will help participants to form healthy habits and stick to them. You can take part on your own or get a group of colleagues involved.

2015 DESK CALENDARRequest your free copy today!

Cancer Prevention Newsletter for Health Professionals

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Find a healthy recipeCooking from scratch can help people to lower their salt, fat and sugar intake. Search or browse healthy recipes on our website:www.wcrf-uk.org/recipes

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Happy New Year! Prime time for change: did you know that doing more exercise, losing weight and eating more healthily were the top three New Year’s resolutions in 2014?

www.wcrf-uk.org

www.wcrf-uk.org

For more information please contact us:

World Cancer Research Fund UK

22 Bedford Square, London WC1B 3HH

Tel: 0207 343 4200 Email: informed@wcrf.org

Registered in London, England No: 253618. Registered with the Charity Commission in England and Wales

(Registered Charity No: 1000739) Registered Office: 22 Bedford Square, London WC1B 3HH

© 2014 World Cancer Research Fund. WEYBDC Next review date: September 2015

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« unpredictable ways. That’s why we advise against using dietary supplements for cancer prevention, and recommend that, for most people, the best source of nutrition is a healthy diet.

9. Breastfeeding is bestIt is best to breastfeed

babies exclusively for the first six months. Breastfed babies are less likely to become over-weight or obese later in life. Breastfeeding also lowers the levels of some cancer-related hormones in the mother’s body. After breastfeeding, the mother’s body gets rid of any cells in the breasts that may have DNA damage, which may reduce the risk of breast cancer developing in the future.

10. Cancer survivors There is growing evidence that

physical activity and other lifestyle choices that can help you maintain a healthy weight may help to prevent cancer recurrence. However, research is still emerging. Until we know more, the best advice is to follow the recommendations above, where clinically appropriate. ¢

For more information on all of our recommendations visit:www.wcrf-uk.org/ preventing-cancer

References

1. WCRF/AICR. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007

2. WCRF International. Continuous Update Project (CUP) [online]. 2014. Available at: www.wcrf.org/int/research-we-fund/continuous-update-project-cup

Have a healthy ChristmasOn average, people put on around a pound of body weight during the winter months and up to five pounds (~two kilos) over the Christmas period1.

This weight often stays on come the New Year, which means that, year-on-year, people may be putting on weight that can lead to health-threatening conditions such as cancer.

The British Dietetic Association estimates that people eat around 6,000 calories on Christmas Day, which is about three times as much as the average woman needs. Use our tips to help people have a healthy Christmas this year:

Encourage healthy swaps to save calories

SWAP

High-calorie snacks such as crisps, chocolates and peanuts

Vegetable sticks, satsumas and plain popcorn

FOR

Cooked breakfast Porridge with fruit, or poached eggs and grilled tomatoes on wholemeal toast

Pâté or pastry tartlet starters

Salmon, melon or soup starters

Turkey drumstick with skin

Turkey breast without skin

Potatoes roasted in lard

Boiled new potatoes

Brandy butter Reduced-fat custard or low-fat yoghurt

Mince pies in short crust pastry

Mince pies in filo pastry

References

1. British Dietetic Association. Eat, drink and be healthy at Christmas (online). 2011. Available at: www.bda.uk.com/foodfacts/christmas

A: There is no evidence that links fish or lean poultry to an increased cancer risk, so we don’t suggest cutting out meat and other animal products altogether to lower the risk of cancer. Instead, we recommend a balanced diet that includes plenty of wholegrains, pulses, vegetables and fruits and limits red meat consumption to no more than 500g (cooked weight) per week. We recognise that meat and fish provide an important source of nutrients as part of a balanced and healthy diet, but a vegetarian diet can also be healthy providing it’s nutritionally balanced. Our advice is for people to follow the two-thirds/one-third rule by filling two-thirds or more of their plate with plant foods and one-third or less with animal foods like meat, fish and dairy.

Q: Is being a vegetarian the best way to lower your risk of cancer?

ASK THE EXPERT We answer your questions on cancer and lifestyle

56 WINTER 2014

Suggest our top tips

n Have plenty of vegetables with your Christmas meal. Carrots, Brussels sprouts, runner beans, kale, broccoli and cabbage are all filling and count toward your 5 A DAY. Vegetables are low in calories and may help reduce cancer risk.

n Be aware of how much you drink. Drinking alcohol can be a major source of hidden calories over Christmas and it can also increase cancer risk. Alternating between alcoholic drinks and low-calorie soft drinks or water can help to reduce alcohol intake.

n Keep active by going for a walk after Christmas lunch, or put some music on and dance with the family. Aim to be active for at least 30 minutes every day.

If you have a question to ask the expert, email us at informed@wcrf.org

Festive Chocolate and Orange Trifle

1/3

2/3

Use our alcohol calorie calculator to demonstrate hidden calories to patients:www.wcrf-uk.org/uk/ here-help/health-tools

Method1. Drain the juice from the mandarins into a bowl and set aside.

2. Put the vanilla yoghurt, crème fraiche, almond essence, orange zest, one tablespoon of mandarin juice and most of the grated chocolate into a bowl, and mix thoroughly.

3. Set four mandarin segments aside for decoration. Into two individual serving glasses, layer the mandarin segments, crushed amarretti biscuit and the yoghurt mix.

4. Decorate with the remaining mandarin segments and chocolate and chill until ready to serve.

Serves 2 One serving provides: 165 kcal, 4.4g fat, 0.1g salt 1 of your 5 A DAY

Ingredientsn 298g can mandarin segments in fruit juicen 2 tablespoons fat-free vanilla yoghurtn ½ tablespoon half-fat crème fraichen 2–3 drops almond essencen Zest ½ orangen 1 tablespoon mandarin juice (from can)n 10g dark chocolate (70% cocoa), gratedn 6 small amarretti biscuits, crushed

RECOMMENDATION SPOTLIGHT

Many health professionals are familiar with the NHS Future Forum’s ‘Making Every Contact Count’ message. However, it can sometimes be difficult to start a conversation with a patient about their weight or lifestyle choices.

We know that health behaviour advice from professionals has a positive impact on people. In one study of cancer survivors, about 90 per cent of people thought it was the “doctor’s duty” to provide advice on diet, activity and weight and they found information beneficial, helpful and encouraging1.

A pilot by the National Obesity Forum found that sales of fruit in supermarkets increased by 20 per cent when life-size cut-outs of local health workers were displayed alongside to encourage shoppers to eat more healthily2. So it’s important that health professionals encourage and help people to make healthy choices that will benefit their long-term health. But how should you go about starting that vital conversation?

It’s necessary to understand an individual’s needs and identify the right course of action at the appropriate time. Everyone is different, with multiple and complex needs, so the contact needs to be tailored accordingly3.

Here are some top tips for effective conversations4:

nTake a non-judgemental and holistic approach

n Use active listening (listen and rephrase client’s answers)

n Ask open questions

n Gain trust

n Provide accurate and up-to-date information to allow people to make informed choices

n Signpost to services if appropriate

Even if the conversation does not result in behaviour change straight away, it may help someone to change their lifestyle when they are ready. This is why it is important to keep making every contact count. ¢

References

1. Williams K et al. Health behaviour advice to cancer patients: the perspective of social network members. BJC. 2013;108:831-835.

2. National Obesity Forum. Let’s Shop Healthier [online]. 2014. Available at: www.healthierchoicespilot.com

3. Anderson A. How to make every contact count: starting the journey to better health. Presented at the World Cancer Research Fund Busting the Cancer Myth conference 2014.

4. Thomas K. The language of change. Presented at the World Cancer Research Fund Busting the Cancer Myth conference 2014.

Make every contact count

Measuring BMI and waist circumference are good ways of assessing a patient’s weight. Check out our online BMI calculator and waist measurement tools at:

www.wcrf-uk.org/uk/here-help/ health-tools

The FIVE A’s

Brief interventions are also useful when approaching the topic of health. The FIVE A’s can be applied to most lifestyle issues such as obesity, smoking and alcohol.

ASK: Ask permission to discuss the topic. For example, ‘Would it be alright if we discussed your weight?’

ASSESS: eg. measuring BMI or alcohol intake

ADVISE: Give accurate and up-to-date information about the health risks associated with the behaviour and the benefits of change

AGREE: Agree on SMART goals (Specific, Measurable, Attainable, Realistic, Timely)

ASSIST: Signpost to support where necessary, addressing any barriers and suggesting coping strategies

Stay in shape for lifeMost people know that staying in shape reduces the risk of Type 2 diabetes and heart disease, but many people are surprised to learn that it reduces the risk of cancer too. In fact, 22,100 cases of cancer could be prevented each year in the UK if we were all a healthy weight.

There are several possible reasons for the link between body fat and cancer. For example, we know that fat cells release hormones such as oestrogen and this can increase the risk of cancers like breast cancer. Studies have also shown that storing too much fat, particularly around the waist, encourages the body to produce growth hormones. Having high levels of these hormones is linked to a higher risk of cancer.

Email informed@wcrf.org to join the mailing list or to sign up to receive our eNews for health professionals www.wcrf-uk.org

As part of our ongoing work to spread the cancer prevention message, we held our first regional event for community health professionals in September. Our aim was to bust the myth that there’s nothing people can do to protect themselves against cancer.

World Cancer Research Fund’s General Manager, Amanda McLean introduced the day, and our Deputy Head of Health Information, Maya Monteiro, talked about the scientific evidence behind

our cancer prevention advice.Other speakers included Professor Annie Anderson, from the University of Dundee, who spoke about the importance of making every contact count, and health consultant Karen Thomas, who gave tips on how health workers can approach a conversation with clients about changing health behaviours.

The event helped delegates feel more confident talking about cancer risk factors and the link between cancer and lifestyle. In fact, the number of delegates who felt

confident talking about cancer prevention more than doubled, from 34 per cent to 82 per cent.

What all the speakers and delegates had in common was a passion to help people lead healthier lives and reduce the number of people developing preventable diseases, including cancer. With hardworking, inspiring health professionals like you, we hope to reach even more people with our cancer prevention message so that they can make informed choices and lead healthier lives free from cancer. ¢

Busting the cancer myth: working together to prevent cancer

To find out about our future events visit:

www.wcrf-uk.org/ uk/here-help

Follow World Cancer Research Fund online

Have you visited our blog? Posts focus on the full range of our work, from research and health information, to some of the amazing fundraising activities our supporters carry out to allow us to continue with our life-saving cancer prevention work. We also talk about new research studies on cancer risk, cancer prevention-related stories in the media and policy issues surrounding risk factors such as obesity and alcohol.

Read our latest posts: www.cancer-prevention.org

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We hope you like our refreshed new look! If you have a comment about Informed, we’d love to hear from you. Email us at informed@wcrf.org

Editorial committeeFounder: Marilyn GentryHead of Health Information: Kym LangEditor: Rachel ClarkDesign: Davina Serle

Newsletter copy reviewersPaul Rumsby PhD, Dr Chris Stray, Dr Jason Jones,Becky Day RNutr, Pippa Burge RD, Amy Hall APHNutr,Jaqui Walker RGN and members of the World Cancer Research Fund Science and Health Information teams.

World Cancer Research Fund UK 22 Bedford Square, London WC1B 3HHTel: 020 7343 4200 Fax: 020 7343 4201 Email: wcrf@wcrf.org

www.wcrf-uk.orgRegistered with the Charity Commission in England and Wales (Registered Charity No: 1000739) Registered Office: 22 Bedford Square, London WC1B 3HH. WCRF UK is part of the WCRF global network.©2014 World Cancer Research Fund ISSN 1472-6335

IN THE NEWS

Is overweight the new norm?The latest evidence to show that we are no longer aware of what a healthy weight looks like comes from researchers at the Rush University Medical Center in Chicago1. They asked African-American volunteers to look at a ‘body image scale’ made up of illustrations of different sizes of women, and to choose which drawings represented a healthy weight and which they thought were ‘too fat’. They were also asked to choose a drawing that was closest to their own body size.

The study found that the only drawings they thought of as being ‘too fat’ were the images representing ‘severely obese’ women. When it came to choosing the image most similar to themselves, many of them guessed incorrectly: 56 per cent of overweight women and 40 per cent of obese women chose images that were of women of a healthy weight. They perceived overweight to begin at a BMI of 35, not 25 as is the reality.

This small study reinforces concerns that, as people become more overweight, their perceptions of a healthy weight change. The researchers suggest that visual aids could be effective tools when talking to people about weight.

Scale used in study. Image 2, 3 and 4 represent a healthy weight:

References

1. Journal of Nutrition Education and Behavior. Body Size Perception Among African American Women [online]. 2014. Available at www.jneb.org/article/S1499-4046(14)00097-9/abstract