Cancer (Hansard, 3 July 2002)

§ Mrs. Marion Roe (Broxbourne)

As a former Chairman of the Select Committee on Health—I chaired it for five years, during which time we undertook an inquiry into breast cancer services—and as a current chairman of the all-party group on breast cancer, I am pleased to have an opportunity to speak about the important subject of cancer prevention. It is an issue that is often neglected, and remains in the shadow of treatment and care for cancer patients. Unfortunately even the medical profession does not always give it much thought, yet it is probably the factor that could have the largest impact on the lives of the British public if more people knew how to reduce their risk of developing cancer.

People are increasingly concerned about cancer, taking a fatalistic "que sera sera" attitude. Recent press discussion about genetic links' making cancer more likely in some families than in others has added to the fear surrounding the disease. In fact, only about 2 per cent. of cancers have any genetic link. It is more likely that common lifestyles and diets in families lead to higher incidences in some families than in others.

Although it is true that cancer is the biggest cause of death in the world, with more than 10 million new cases and 6 million deaths every year, it is not as out of control as we think. According to the World Cancer Research Fund, up to 40 per cent. of cancers are preventable through diet and lifestyle alone, and the figure rises to 70 per cent. if giving up smoking is included. In global terms, that means that appropriate diets could prevent more than 4 million cases of cancer each year. Keeping alcoholic intake within the recommended limits would prevent up to 20 per cent. of cases of cancer of the aerodigestive tract, colon, rectum and breast. So this is by no means a disease to which we must resign ourselves, although currently many people do not have an opportunity to reduce their risk because they have no access to the relevant information.

An expert report called "Food, Nutrition and the Prevention of Cancer: a global perspective" reviewed more than 4,500 leading research studies from around the world in the field of diet, nutrition and cancer. It was commissioned by the World Cancer Research Fund to provide up-to-date, reliable advice for individuals on how to make the changes that can protect them from cancer. The report is currently being updated, and is an ideal source of information for policy makers and opinion formers. Unfortunately there is a surplus of inaccurate information all around us, from a variety of ill-informed sources, about healthy eating and eating for health. The public feel inundated with information but are unaware of the health benefits of eating a diet rich in vegetables and fruits and low in fat and salt.

Here is an example of good promotional practice. Cancer Research UK has teamed up with Tesco, the supermarket chain, whose headquarters are in my constituency, to promote the "five a day" campaign to the chain's 16 million customers. By actively promoting the "five a day" message, we can encourage people to improve their diet and protect the long-term health of their families. The Government and other organisations are also involved in major "five a day" initiatives. 117WH However, how often do we see people who have given up smoking because they are afraid that they may develop cancer, but who still pile salt on their food and eat a diet high in red meat and fat or low in fresh vegetables and fruit?

Prevention is the only sensible approach to cancer. It benefits not only individuals but families, communities and national economies. The nation's health needs to improve and we can improve only if everyone, including the Government, co-operates to broadcast information such as that in the expert report to as wide an audience as possible.

As a result of the report's conclusions, the World Cancer Research Fund drew up a set of recommendations for cancer prevention that are straightforward to understand and are used by people who are concerned to reduce their risk of cancer. Many health professionals also find the recommendations an invaluable guide for advising patients on cancer prevention.

Nurses' close relationship with communities and patients means that they are ideally placed to promote healthy living. Their work ranges from that of the school nurse who gives advice on healthy eating to that of the public health nurse who explains to men in pubs about testicular cancer. Nurses work with minority groups to raise awareness of specific cancers and practice nurses play an essential role in early detection by screening and monitoring.

The trouble is that although the World Cancer Research Fund runs an extensive education and communications programme, it cannot possibly provide information to the whole population. It needs Government support in the cancer prevention arena to make progress. Its recommendations are: Choose predominantly plant-based diets rich in a variety of vegetables and fruits, pulses and minimally processed, starchy staple foods. Avoid being underweight or overweight and limit weight gain during adulthood to less than 5 kg (11 pounds). If occupational activity is low or moderate, take an hour's brisk walk or similar exercise daily, and also exercise vigorously for a total of at least one hour in a week. Eat 400–800 grams (15–30 ounces) or five or more portions a day of a variety of vegetables and fruits, all year round. Eat 600–800 grams (20–30 ounces) or seven or more portions a day of a variety of cereals, pulses, roots, tubers and plantains. Choose minimally processed foods and limit the amount of refined sugar you eat or drink. Alcohol consumption is not recommended. If consumed at all, limit alcoholic drinks to less than two drinks a day for men and one for women. If eaten at all, limit intake of red meat to less than 80 grams (3 ounces) daily. It is preferable to choose fish, poultry or meat from non-domesticated animals in place of red meat. Limit consumption of fatty foods, particularly those of animal origin. Choose modest amounts of appropriate vegetable oils. Limit consumption of salted foods and use of cooking and table salt. Use herbs and spices to season foods. Do not eat food which, as a result of prolonged storage at ambient temperatures, is liable to contamination with mycotoxins. Use refrigeration and other appropriate methods to preserve perishable food. When levels of additives, contaminants and other residues are properly regulated, their presence in food and drink is not known to be harmful. However, unregulated or improper use can be a health hazard, and this applies particularly in economically developing countries. 118WH Do not eat charred food. For meat and fish eaters, avoid burning of meat juices. Consume the following only occasionally: meat and fish grilled in direct flame, cured and smoked meats. For those who follow the recommendations, dietary supplements are probably unnecessary and possibly unhelpful for reducing cancer risk. The recommendations are consistent with guidelines for preventing other major diseases such as heart disease and strokes, and if followed will provide a healthy diet and lifestyle that will not just prevent cancer, but make people feel much better.

There is a consistent pattern showing that diets high in fruit and vegetables decrease the risk of many cancers. There is also conclusive evidence showing a link between being being overweight and higher cancer risk. In particular kidney, endometrium, colon, prostate, gall bladder, and postmenopausal breast cancers are all linked to being overweight. More than 90 per cent. of cancers have a hormonal link, and levels of hormones are all affected by overeating and being overweight. Changes in diet could prevent up to half of all cases of breast cancer and three out of four cases of stomach cancer.

The European prospective investigation into cancer and nutrition is the largest study of diet and health ever undertaken and is aimed at providing reliable information on dietary factors and cancer risk. Researchers in 10 European countries have together recruited a total of half a million men and women to the study. Cancer Research UK is providing core support for the UK arm of EPIC, which is being co-ordinated by two centres, located in Oxford and Cambridge.

In conclusion, my questions to the Minister are simple and straightforward. What are the Government's intentions with regard to cancer prevention education? Do the Government agree that cancer prevention is an important area to promote, and how do they plan to do that? How do the Government plan to make prevention of cancer a more integrated part of health service policy? I look forward to the Minister's reply.

§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)

I am very grateful to the hon. Member for Broxbourne (Mrs. Roe) for raising the extremely important issue of cancer prevention, and for focusing on the links between a healthy, nutritious diet and the cancers that she mentioned.

The area is very important and does not always receive the attention that it should, but I have a sense that it is becoming increasingly important and increasingly well known amongst the general public. We have an opportunity today to put some of those issues on the record and raise them even higher in the general consciousness.

As the hon. Lady said, cancer is clearly a major cause of mortality and morbidity in England. Every year, 200,000 people are diagnosed with cancer and 130,000 of those people lose their life to the disease. It is a major issue for us in this country, as it is internationally and globally. More than half of the deaths occur to people under the age of 75, so we are not just talking about elderly people approaching the end of their life. This is clearly an issue for many in the prime of life.

119WH There are also very wide inequalities in who gets cancer. People from deprived and less affluent backgrounds are more likely to get some types of cancer, and are more likely to die from them once they have been diagnosed. It is a very important issue for all of us. Since 1997, the Government have pledged to cut the death rate from cancer in people under 75 by at least a fifth by 2010. That is a very challenging target for us to meet. For all the families concerned, it is an incredibly important priority. In particular, we are aiming to improve the health of the worst-off, because they are more likely to suffer.

In the NHS cancer plan, we set out a comprehensive strategy to bring together prevention, screening, diagnosis and treatment, so that the whole service would be outlined within the plan. We shall try to set standards for each of those elements, because all parts of the process are equally important. It is pointless to have the most wonderful treatment in the world if we do not also focus on prevention and on getting to the causes of cancer, as the hon. Lady so ably outlined.

Preventing cancer is a key component of our approach to meeting the target for reductions. We recognise that unless we get prevention right we shall not reach the targets that we have set. Engaging the public and the professionals is absolutely key. I strongly feel that, in addition to getting the message across and dealing with health promotion, we must engage people in wanting to change their eating habits, in stopping smoking and in changing their whole lifestyle. Evidence has shown that it is not enough for Ministers to issue edicts and good advice. We need to engage people in realising why they need to change, and what they can achieve for themselves, so that they have a sense of being in control and taking responsibility for their health.

The hon. Lady rightly raised the role of smoking in causing cancer. That is pretty widely understood now. Smoking causes about a third of cancer deaths, and half of all lifelong smokers will die from their habit. Those are astounding figures. We have set tough targets on tackling smoking, and we have put a particular emphasis on trying to reduce smoking among the less affluent groups, and particularly among manual workers. Smoking has, in recent years, been more prevalent among such people than among professional groups, who have reduced smoking to a greater extent.

We have backed up the targets with pretty impressive investment. It is acknowledged in this country that we are world leaders in helping people to give up smoking. We do so through clinics, helplines, and one-to-one counselling sessions, which are incredibly popular across the country. Research shows that some 80 per cent. of smokers want to give up; only a small proportion of people want to continue. We therefore have a real responsibility to help people to give up.

We have put £46 million into public education about smoking to try to keep the message in the public consciousness. We also introduced a Bill to ban tobacco advertising, which is making its way through the House and the other place. The Bill will make good our manifesto commitment to ban tobacco advertising. Our action on tobacco is bringing about results. Between April and December last year, smoker services helped 120WH nearly 80,000 people give up smoking. That is a pretty impressive figure. Those people were followed up four weeks after they quit, and they were still not smoking then. Sometimes people relapse, and it is important that we give them a second, third and fourth chance to give up smoking, as that seems to be working.

The hon. Lady focused on the less-known relationship between cancer and diet. The link between cancer and smoking is now pretty well established in the public consciousness; another task is to get the link between cancer and diet equally well known in the wider community. There is good evidence to show that dietary factors account for about a quarter of all deaths from cancer. Dietary changes could prevent up to a third of cancers from occurring. Increasing consumption of fruit and vegetables is the most effective prevention strategy for cancer after reducing smoking. People who do not regularly eat fruit and vegetables are at greater risk of several common cancers, including colorectal and stomach cancers, as the hon. Lady said.

Eating at least five portions of fruit and vegetables a day could lead to reductions of up to 20 per cent. in deaths from chronic diseases, including heart disease and strokes as well as cancer. That is good news all the way. If we can get people to have a much better diet, not only will we strike at cancer, but we will make big inroads into heart disease and strokes. There are also less tangible benefits, including the fact that people will feel better in themselves. We need to get that message across.

Consumption of fruit and vegetables in the United Kingdom is pretty low. It is among the lowest in Europe. Although we recommend that people eat five portions of fresh fruit and vegetables a day, average consumption is just three portions a day for adults and two for children. We therefore have a long way to go. One in five children—20 per cent.—eat no fruit at all in an average week. That is a pretty damning statistic, but we are doing something about it, and I am optimistic for the future.

As in the case of smoking, there are wide class differences in people's access to fresh fruit and vegetables. Better-off professional groups eat about 50 per cent. more fresh fruit and vegetables than those in unskilled social groups. A big inequality issue is involved in this case, too, but we are making progress.

We have set up the "five a day" programme to improve access to and consumption of fruit and vegetables. The programme has several different strands. Like the hon. Lady, I was recently in a supermarket and was pleased to see that supermarkets are beginning to market their goods in relation to "five a day", trying to connect fresh fruit with processed foods and trying to give the idea that people can make a healthier meal than they have in the past. Encouraging manufacturers to be imaginative in making the programme attractive to people is important. Simply giving worthy advice will not be effective, but it is possible to affect people's shopping habits.

The new opportunities fund has made available £10 million to build on the success of the pilots that we launched in disadvantaged communities. Primary care trusts have introduced 66 new programmes in local neighbourhoods to try to make it easier for people who live in poorer areas to access fresh fruit and vegetables. 121WH At one pilot site, in Sandwell, it was revealed that few shops in the area sold fruit and vegetables. A home delivery service was therefore set up. It attracted 200 regular customers and within about seven months average monthly household spending on fruit and vegetables more than doubled, to more than £10 a month. There was an increase in average daily consumption for everyone, from one and a half portions to three portions. That delivery service worked. People wanted to eat fresh fruit and veg, but had no shops in their local neighbourhood, and if they did not have a car, found it difficult to travel. We shall build on such pilots as we roll out the new opportunities fund resources.

We are also trying to introduce a good communications programme to spread the message and promote health. We have a "five a day" logo, which people can easily recognise when out shopping and making choices.

The big push is the free fruit in schools scheme. As I said, one in five children eat no fruit in a week, which is why we decided to concentrate on that. We started with pilots and are achieving incredibly good results. Teachers have said that the children talk about the fruit and look forward to it. There was some scepticism at first about whether children would want to eat fruit, but more than 80 per cent. are taking it up and enjoying it.

The scheme has challenged misconceptions about the way in which children view fruit. Given the opportunity, in an attractive setting, with good quality fruit, they want to take part. In virtually all the schools, teachers have welcomed the scheme as supporting their teaching and learning materials. Concerns were expressed about whether it would be an extra administrative burden on teachers, but teachers have welcomed it and incorporated it into much of their health education for children.

The national school fruit scheme is being expanded on a region-by-region basis. It has £42 million from the new opportunities fund. In the current school term, the entire west midlands region is coming on line, which will mean that about 250,000 children in almost 2,000 schools will have free fruit. From the autumn, the next regional push will be in London.

In a new innovation, we are testing the inclusion of vegetables in the scheme. From this week, 7,000 children in Sheffield and Merseyside will eat carrots or tomatoes—little cherry tomatoes, I believe, which are quite attractive—one day a week. If that goes down well, we shall consider whether vegetables can be introduced more widely. There is a widespread conception that children do not like vegetables, but if they are well presented and easy to eat, we have a real chance to change attitudes in the longer term.

The direct support of providing fruit is backed up with curriculum and teaching materials designed to encourage lifelong habits of eating fruit and vegetables in young children. It is not a one-off or just something that they do at school; they take it home with them and, I hope, influence the wider family.

122WH The national healthy school scheme is a big programme. It is aimed at young people, in particular. It emphasises the need to consider a healthy lifestyle as a whole—not only diet, but smoking and the other issues raised by the hon. Lady, such as alcohol consumption. It is important to get across to adults the message about safe levels of alcohol consumption, too.

Regular physical activity is a key issue. It can reduce the risk of certain cancers, particularly colon cancer. We have recently announced that, with Sport England and the Countryside Agency, we shall be setting up nine physical activity community pilot schemes—one in each region—to test innovative ways to involve people in sport and active recreation, so that they can benefit from physical activity. One pilot scheme will focus on free swimming for young people. I am looking forward to when the bids come in and if hon. Members have imaginative ideas for their regions, I encourage them to ensure that they are submitted. Obesity can contribute to postmenopausal breast cancer, as the hon. Lady said, and endometrial cancer. A low-fat and low-energy diet with plenty of fruit and vegetables can lower the risk of such cancers and, together with physical activity, can make a major impact on obesity.

The hon. Lady mentioned alcohol. Its misuse is thought to be a major cause of about 3 per cent. of all cancers, especially cancer of the mouth, the larynx and the oesophagus. As the hon. Lady knows, our alcohol strategy is on track and it will be implemented by 2004. The cancer plan has brought our work together. It provided a commitment to ensure that we considered skin cancer, too, because that is all too common in the United Kingdom. Each year, there are 40,000 cases of skin cancer and about 2,500 people die from malignant melanomas. We must get the right message across to the community. Prevention is central to our strategy, in respect of not only cancer, but coronary heart disease and strokes—all those avoidable deaths, which are such a tragedy for the families involved.

It is difficult to persuade people to change the way that they live. We are all creatures of habit and, when we get into bad habits, it is difficult to get out of them. The public are well educated and they ask us for information. We must supply it. We must ensure that patients and young people—indeed, the whole community—feel that they are partners in their own care and share responsibility for it. They can make a difference to their health. That will have huge spin-offs; it will not only have a direct effect on diseases, but give people a sense of ownership of their own health condition. If people take control, that will provide health benefits. Such an agenda is becoming increasingly important to us all.

I encourage hon. Members to convey strong messages to their communities. We should take every opportunity to carry out health promotion work on public platforms and work with partners, in supermarkets, in manufacturing, or when we visit schools and talk to young people. The average daily consumption of fruit and vegetables in Greece is nine portions a day, yet our average is three portions for adults and two for children. The task before us is considerable. If the standard of our diet can reach some of the better standards of European countries, perhaps we shall experience their sunshine and that might do us some good, too. People in this country will benefit enormously from improving their 123WH diet. The Government are determined to do everything that we can to invest in such areas, and in exhortation and persuasion. I hope that it will make a significant difference in cancer cases and the whole range of avoidable diseases.