The science of healthy habits

Understanding healthy and unhealthy behaviours through research is crucial

We all know the old ‘maxim prevention is better than cure’, and this is certainly true of cancer. More than 300,000 of us develop the disease in the UK each year. Each diagnosis is devastating for the person and their loved ones.

Huge progress is being made in treating cancer, but it would clearly be better if we could prevent people developing the disease in the first place.

There are many things that affect our cancer risk that we can’t control – including our age and genes. But there are several things that we can do to reduce the risk.

Smoking, being overweight or obese, eating an unhealthy diet, and drinking too much alcohol are all preventable causes of cancer, and more than four in ten cases could be prevented by changes to lifestyle.

So it’s easy then is it – all we need to do is lead a healthy lifestyle to cut our cancer risk?

That’s easier said than done. Ever found yourself making a conscious effort to stop eating from the bowl of crisps on the table only to find yourself reaching out for them without realising it? Made plans to go for a jog but never quite got around to it because something urgently needed tidying?

We’ve all been there.

That’s why we fund groups like the Health Behaviour Research Centre at University College London, run by Professor Jane Wardle.

The Centre carries out research on lifestyle behaviour, to find ways to help people achieve their healthy ambitions. The work isn’t about coming up with flash-in-the-pan health fads, but developing evidence-based ways to help people adopt a long-term healthier lifestyle, and improving how information about health is communicated.

The centre focuses on three broad areas: food choice and weight (the ‘Energy Balance Research Group’); cancer communication and screening; and the tobacco control group.

Some of their recent work includes:

• showing that the relatively cheap drug cytisine can help people stop smoking;
• debunking the claim that being vaccinated against HPV (to protect against cervical cancer) promotes risky sexual behaviour;
• showing that men, younger people, non-white ethnic groups and people from poorer backgrounds have a lower awareness of the signs and symptoms of cancer;
• demonstrating that genes can influence weight through their impact on appetite.

In this post we’ll look at some of the HBRC’s current projects, including whether weight loss can help cut cancer risk, what advice cancer survivors want about their lifestyle, and how people make decisions about whether to go for cancer screening.

The Energy Balance Research Group

The INTERCEPT study

Does losing weight affect bowel cancer risk?

INTERCEPT is exploring how losing weight affects bowel cancer risk. Researchers have known for some time that the risk of developing bowel cancer (and several other cancers) is increased in people who are overweight or obese.

But at the moment, they don’t know whether this risk falls when people lose weight. And they know very little about what happens in the bowel tissue when people lose weight, or how weight loss affects inflammation in the body.(Chronic inflammatory diseases like Crohn’s disease can increase a person’s cancer risk.)

Obese adults will take part in a programme to help them lose weight. A blood sample and a small biopsy of bowel tissue will be taken at the start and end of the programme. This will be used to see how weight loss influences inflammation and the cells in the bowel.

The ASCOT study

The ‘Advancing Survivorship after Cancer: Outcomes’ Trial (ASCOT) will ask a large number of health professionals and cancer survivors from all regions in the UK what they think about receiving lifestyle advice, and what kind of advice (if any) they would like to receive.

This is an important question. More and more people survive cancer every year. Living more healthily after a cancer diagnosis could improve survival rates (at least for some types of cancer). But we don’t know very much about whether cancer patients are given advice about how to live a healthy lifestyle already, nor whether they would like any.

Based on the study’s initial findings, the team will then develop a simple and affordable programme that brings together the latest scientific evidence on behaviour change, specifically for people with breast, prostate or bowel cancer – the types of cancer where lifestyle changes could make the biggest difference to survival rates. If the new programme is useful, it will become available to a much larger number of people.

We wrote last week about the first study to come out ASCOT, which showed that more than 80 per cent of friends and family members of people with cancer think that doctors should give lifestyle advice to patients.

Cancer Communication and Screening Group

ABACUS – attitudes and beliefs about cancer

How do people like to access information about cancer?

We’re often told about the latest scientific findings and breakthroughs in the media and online. But where or who do we go to when we want more information? In this project the HBRC is developing an annual survey that aims to find out how people access information about cancer.

The Attitudes and Beliefs About Cancer UK Survey (ABACUS) will ask where people get information about cancer, how they use it and what they think about it. This will help identify any gaps in people’s information sources and what improvements could be made. Researchers will also be able to link health information preferences to personal characteristics such as age, gender and ethnicity and answer questions like ‘Do women prefer health information from their GP, whereas men prefer to look online?’

Informed Decision Making in Cancer Screening

When we make decisions about our health we’re often given a number of options to choose from. Do I eat the healthy salad for lunch? Shall I indulge in a chocolate cake afterwards? Equally, when it comes to making decisions about cancer screening, current NHS policy clearly states that people should analyse the advantages and disadvantages of all possible outcomes and decide the best course of action for them.

But information about cancer screening can be complicated, and often contains unfamiliar words and phrases. People don’t always want to spend time weighing up the advantages and disadvantages of screening.

The HBRC is running a project to explore people’s preferences in decision making about screening. It will look at questions such as, how do preferences differ between different groups of people? Are we good at balancing information about harms and benefits of screening? Are people given too much or too little information? Improving our understanding of this should help make sure that people can make a decision they’re happy with.

Breast cancer screening is a case in point. The recent Marmot review found that while screening has clear benefits (preventing around 1,300 breast cancer deaths each year in the UK), it also has risks, with around 4,000 women aged 50-70 having treatment for a cancer that would not have troubled them, each year in the UK.

With criticism already levied at the existing leaflet accompanying screening invites, making sure women have access to clear information is vital so they can understand both the potential harms as well as the benefits.

The Tobacco Research Group

The Smoking Toolkit study

Supporting people to give up smoking

New tobacco legislation is regularly considered and implemented. Recently this has included a ban on smoking in public places and a consultation on standardised packaging of cigarettes. And new treatments to help people quit such as cytisine, are on the horizon.

Monitoring these changes alongside trends in people’s attitudes and behaviours helps us understand the impact of such events and to design new, more effective ways to help people give up their habit or discourage a new generation of smokers.

The smoking toolkit study involves large monthly national household surveys of people in England. It provides a ‘real world’ measure of how effective strategies to help people stop smoking are.

Promoting quit attempts

The group are also testing new ways to get more smokers to try to quit and to support those who do make an attempt to give up. Right now they’re evaluating a new training programme for GPs to deliver brief advice to stop.

Training includes support rather than just advising smokers to stop. Similarly, the group are running a trial to look at the effect of upgrading the support provided by pharmacists all over country to that recommended by the National Centre for Smoking Cessation and Training.

Finally, there are several studies considering whether websites like ‘StopAdvisor’, apps like ‘SmokeFree28’, and text messaging can help people when used alongside standard NHS support.

It’s not all about cures

These are just a few highlights of the research going on at the HBRC – research that is a crucial part of our fight against cancer, and will underpin future life-saving advances.

New cancer cures are vital, but so is research to understand how and why we make different lifestyle decisions that can have a big impact on our risk of developing some cancers.

Emily

Further information

• The HBRC have their own blog, which is well worth following. They’re on Twitter too.