Further reading

Key takeaways:

• The CO21 CHALLENGE Trial found that a structured exercise programme after chemotherapy led to a 28% lower risk of cancer recurrence in colon cancer survivors compared with usual care.
• This is the first randomised controlled trial (RCT) to show that exercise directly improves survival in colon cancer patients. It confirms what observational studies have long suggested.
• The results were presented at a recent conference and made headline news. Experts say the CHALLENGE Trial marks a shift from viewing exercise as a “nice to have” to a “need to have” in cancer care.

Colon (part of the large bowel) cancer survivors who took part in a 3-year structured exercise programme had a 28% lower risk of cancer recurrence or a 2nd cancer. They also had a 37% lower risk of death compared with usual care.

These findings were shared at the 2025 Association of Clinical Oncology (ASCO) Annual Meeting. They were also published in the New England Journal of Medicine.

The ASCO Annual Meeting is the world’s largest oncology conference. It attracts more than 40,000 attendees from around the world. Every year, ASCO highlights the latest advancement in treatments. It also shares the directions that have the greatest potential for progress and patient impact.

Spotlight on exercise

The CO21 CHALLENGE Trial pulled back the curtain on a weapon that has been hiding in plain sight: physical activity. The results of the trial showed improvement in disease-free survival and overall survival in colon cancer survivors in the aerobic exercise intervention group. This trial is the first gold standard RCT to show what has long been indicated from observational studies. This is a big deal!

The impact of exercise on cancer outcomes has been a topic of great debate. Observational research has shown improvements in survival and quality of life linked to higher levels of physical activity. However, observational study designs are limited. They do not show cause and effect.

Plus, they are hard to implement in clinical settings due to concerns that the reported effects may not truly reflect the impact of exercise (and may be due to something else).

Our research

Over the past few years, World Cancer Research Fund International has done extensive reviews through its flagship Global Cancer Update Programme (CUP Global).

CUP Global includes partnerships with American Institute for Cancer Research, World Cancer Research Fund in the UK and Wereld Kanker Onderzoek Fonds in the Netherlands.

Our CUP Global reviews look at the extent to which diet, nutrition and physical activity impact people after a diagnosis of breast and colorectal cancers with regard to:

• cancer-specific mortality
• all-cause mortality
• risk of cancer recurrence
• health-related quality of life

An expert panel judged the strength of this CUP Global evidence. There were some limitations. Still, detailed recommendations were made to strengthen future research. One of the key recommendations was for well-conducted trials to look at the impact of nutrition or physical activity. The CHALLENGE trial is therefore very timely.

The CUP Global analysis was published in the International Journal of Cancer. It was cited several times in the CHALLENGE trial manuscript.

The CUP Global analysis compared highest with lowest levels of activity. We found that all-cause mortality was reduced by 23–40% depending on physical activity exposure.

We’re excited to announce that World Cancer Research Fund has joined Our Future Health, the UK’s largest health research programme, as an affiliate partner.

With cancer rates rising and modifiable factors contributing to around 40% of all cases, the partnership represents a bold step in harnessing large-scale health data and decades of scientific insight to prevent more cancers before they start.

The UK Director at World Cancer Research Fund, Steven Greenberg, said:

“It’s tremendously exciting to be a part of the UK’s largest, most diverse health research programme. We know that 40% of cancers can be prevented through modifiable factors such as diet and exercise. With a growing rate of diagnoses, collaboration to better understand these risks is more important and timelier than ever.

“By working together, we’ll be able to combine our own extensive knowledge and experience on cancer prevention with the knowledge and insight coming from Our Future Health to further understand how cancer risk can be affected by diet and lifestyle.

As an affiliate partner, we’ll contribute our global expertise in the links between diet, weight, physical activity and cancer risk, helping guide Our Future Health’s work in identifying preventable risk factors. In turn, we’ll benefit from collaborating with the UK’s largest health research programme – enabling new insights into early detection and public health strategies.”

About Our Future Health

Our Future Health is the UK’s largest ever health research programme. It is designed to help people live healthier lives for longer through the discovery and testing of more effective approaches to prevention, earlier detection and treatment of diseases. Our Future Health is inviting millions of people, from all backgrounds and from across the UK, to take part. Volunteers are providing information about their health and lifestyles to create an incredibly detailed picture that represents the whole of the UK.

Dr Raghib Ali, CEO and Chief Medical Officer of Our Future Health, said:

“We’re so pleased to welcome World Cancer Research Fund as our newest affiliate charity partner. We know that cancer will affect half of us in our lifetimes, and together we want to improve cancer prevention, so more people can live longer, healthier lives. Their expertise in funding life-saving research will be really valuable for Our Future Health.”

> About us

> Our partnerships

To celebrate Cancer Prevention Action Week and to kickstart summer, we’ve pulled together our favourite mocktail and alcohol-free drink recipes, which are perfect for events from parties to BBQs, day or evening.

Did you know that drinking alcohol increases your risk of 7 types of cancer, including breast and bowel?

Alcoholic drink can also have a lot of hidden calories. Reducing how much alcohol you drink may support weight management, which in turn can help lower your risk of cancer. Unlike many alcohol-free drinks you find in a shop or pub, our mocktail recipes are all lower in calories with no added sugar.

Our top 7

Alcohol-free G&T

Enjoy the crisp tones in our no-alcohol gin and tonic, with a grapefruit twist for something different this summer.

⏰ 5 minutes
🍎 1 of 5 A DAY
🧍‍♂️ serves 2

> Get the recipe

Berry sparkle

For a healthy alternative to prosecco, our refreshing berry fizz is a perfect option, and so easy to make.

⏰ 5 minutes
🧍‍♂️ serves 2

> Get the recipe

Pink lemonade

A family favourite, our rose-blueberry lemonade is a great addition to any BBQ.
⏰ 5 minutes
🧍‍♂️ serves 2

> Get the recipe

Watermelon slushie

Enjoy the tangy notes of watermelon, raspberries and lime with this healthy slushie.
⏰ 10 minutes
🍎 1 of 5 A DAY
🧍‍♂️ serves 2

> Get the recipe

Peach iced tea

In warmer weather, a hot cup of a tea isn’t always the best, so this peach iced tea is a refreshing alternative to enjoy during the summer months.

⏰ 10 minutes plus cooling
🍎 Less than 1 of 5 A DAY
🧍‍♂️ serves 8

> Get the recipe

Cucumber cooler

Refresh yourself on dry days with a summery cucumber cooler that kids will love.

⏰ 5 minutes
🧍‍♂️ Serves 2
> Get the recipe

‘Who Comes Here?’, ‘A Grenadier’ – Victorian nursery rhyme illustration (Getty Images). From “Nursery Rhymes – Ridicula Rediviva” illustrated by J.E. Rogers, with chromolith printing by R. Clay Sons & Taylor and published in London in 1876 by Macmillan and Co.

World Cancer Research Fund has been highlighting the links between alcohol and cancer for more than 30 years – but we weren’t the first to do this.

In fact, as Britain recovered after the First World War, beer producers launched campaigns to get people – especially men and boys – back into the pub, with slogans such as “Guinness is good for you” and “Beer is best”. Yet this move by beer makers was a reaction to the thriving temperance movement, which fought back with postcards that said: “Beer is best – for cancer”, listing the cancers alcohol was associated with including brain and mouth.

This is just one aspect of the long history of drinking – and sobriety – in Britain. Did people really drink beer because water was unsafe? Why did people turn to gin? And was Irn-Bru an original tipple of choice for teetotallers? Read on to find out.

Small beer gets bigger

We know through archaeological deposits that people have been drinking beer for around 13,000 years. Beer has certainly been an important drink – especially for poorer people – in the UK for more than 1,000 years. In the Medieval era (around 5th–15th centuries), beer was not just a staple drink. It was also a vital source of calories. At that time, beer and ale were graded according to how long the liquid had been fermented, its strength and the quality of the ingredients. “Small beer” was the weakest and most widely drunk option. Prof Phil Withington of the University of Sheffield says: “Small beer was an integral feature of British diets and was drunk at all times of the day from breakfast.”

A man dressed up as a medieval monk pours himself some beer. Getty Images

However, it’s not true that everyone had to drink beer because the water was unsafe. Most people at this time would have lived in rural areas, and local rivers and streams would have been a source of drinking water. Both beer and ale were safer than some water sources, though, because they are heated during production.

A major change in Britain’s drinking habits occurred in the 1700s onwards with the arrival of gin – dead cheap and often home brewed – which coincided with the start of the industrial revolution, when people moved on mass from rural, family dwellings to less sanitary urban and suburban areas. The pub became a respite for people after working long hours in factories and provided an escape from cramped multi-generational living conditions. “Drink was everywhere; it was economically important and culturally unavoidable,” Dr David Beckingham told History Extra.

Antique advertisement from British magazine: Dinner wine

Gin sends Britain wild

Gin was widely available, low-taxed and – incredibly – sold in pints as people were accustomed to drinking beer in pints. Gin is distilled rather than fermented – which means it’s a lot stronger. Stories we’re familiar with today – around binge drinking, the social impact of alcohol harm (especially when women and poorer people drink to excess), and attempts to curb drinking through public pressure, moral panics and legislation – all began with the Gin Craze. Then as now, alcohol had a class element, with the wine and champagne drunk by the rich seen as less damaging to society and health than the beer and gin of the poor.

And today’s sober curious movement has its history in the anti-drink movements that started at this time. Initially, the backlash against gin focused on temperance – encouraging people to limit their alcohol consumption, mainly by drinking weaker but still alcoholic drinks. The 1830 Beerhouse Act allowed people to brew beer from home – an attempt to reduce gin drinking. However, some strands of the movement favoured total abstinence.

The Band of Hope, established in 1847, became the biggest temperance organisation in Britain, with 3.5 million members by the end of the 19th century. It was a youth-led movement, and part of the attraction was that it offered young people an (often cheaper) alternative to the pub. As well as pressurising members with signed pledges, badges and magazines, temperance societies organised fun stuff: brass bands, sober cafes, music hall events and outings. The first temperance day trip was an excursion from Leicester to Loughborough in 1841, for 500 temperance society members. The man who arranged it was none other than Thomas Cook – the inventor of package holidays.

So what alcohol-free drinks were around in the 18th and 19th centuries? Initially, most concoctions were mixes of readily available herbs and water, often heavily sweetened: sarsaparilla “wine”, dandelion and burdock, cream soda and ginger beer – as well as tea. Some of the biggest brands in soft drinks also emerged at this time. Teetotallers drank fortifying iron brew (later Irn Bru), Coca-Cola and Vim Tonic, as well as milk drinks – precursors of today’s milkshake and bubble tea bars.

It wasn’t plain sailing for those trying to cut back on alcohol though. The temptations of alcohol versus the guilt of overindulgence are revealed in the diaries (written between 1830 and 1881) of Nottingham solicitor and mayor William Parsons, who talks about his attempts to go dry in January, and how hard it was to avoid booze in social gatherings: “Tea totalism in my position is not carried out without great difficulty.”

As well as persuading individuals to change their drinking habits, people who advocated for drink-free living leaned on politicians to legislate for restrictions on the sale of alcohol, and taxation to reduce its availability and affordability. The fact that we’re trying the same approaches hundreds of years later shows the difficulty of breaking up Britain’s relationship with the booze.

Temperance as a movement died off from the 1950s as alcohol became even more widely marketed and socially acceptable. This is perhaps reflected in the licensing changes. Since 1988, pubs have been able to open all day and 24-hour licensing was introduced in 2005. Despite this, younger generations seem to be drinking less than their elders. In England’s 2022 health survey, the highest prevalence of drinking on at least 1 day a week was among adults aged 65–74, whereas the lowest was among 16–24-year-olds (60% vs 36%).

Our theme for Cancer Prevention Action Week is Alcohol and cancer: let’s talk. The UK’s long history of drinking – and staying sober – shows that alcohol is deeply embedded in British society. Yet even though we’re no longer in the midst of a gin craze, the harms of alcohol are widespread. As those abstinence campaigners at the start of the last century knew, alcohol is a cancer-causing, psychoactive, toxic, and dependence-producing substance linked to more than 200 health conditions. Everyone deserves to know the history – and the truth – about alcohol.

Prof Richard Cooke

Prof Richard Cooke is interested in what motivates people to drink alcohol – he surveys people to find out how psychological variables such as the intention to drink, attitudes about drinking, and regret after drinking alcohol – can predict how much people consume.

“Most of my research has been done with young adults aged 18–30,” says Prof Cooke, “because they were traditionally seen as the group that drinks the most, but this has changed in the last decade. I’m now doing much more research with middle-aged people. I also do studies assessing awareness of drinking guidelines, comparing how young adults and policymakers talk about alcohol, and reviewing the effectiveness of alcohol interventions.”

‘We know it’s dangerous’

“I find alcohol consumption fascinating to study as drinking has high social approval even though we know it’s dangerous. This means that health messages about alcohol are trickier to create than smoking messages. Saying ‘Don’t smoke’ is quite acceptable; saying ‘Don’t drink alcohol’ is less so,” he says.

Prof Cooke has several theories about why alcohol remains so popular across cultures: “Alcohol is a social lubricant: it relaxes people, makes them feel more confident and more able to socialise, especially with strangers. It’s really tied to our psychology in many different, sometimes unexpected, ways.”

A former student of Prof Cooke, Dr Joel Crawford, did his doctorate degree on regret and drinking. He asked young people adults about the fear of missing out (Fomo). When they don’t drink, some people think they are missing out on an enjoyable experience, like missing a party because you have to work. Dr Crawford found that the young adults would rather experience alcohol harms, such as hangovers and feeling sick, than miss events that heavily included alcohol, saying “Fomo was more painful to them than a hangover!”

This study illustrates the social and emotional barriers people trying to drink less may encounter. “It’s the social acceptability of drinking in most situations that makes it a challenge to reduce; drinking is associated with celebrations – birthdays, weddings, getting a new job, becoming a parent– and commiserations – missing out on promotion or the death of a loved one. Alcohol is also linked to healthy activities, like ending a walk in the countryside with a drink in a pub.”

Drinking’s a habit

“At the individual level, drinking habits are an issue. People develop habits when they perform the same behaviour in a stable setting, like drinking every Friday night in the pub with your friends. Breaking this habit means unpicking your routines in ways that people often don’t want to do.”

However, based on current trends, there will be fewer people drinking into middle-age and later life: “This has the potential to dramatically change how we organise events,” says Prof Cooke, comparing it to the rise in the availability and acceptability of non-dairy alternatives to milk. “People will be asking for non-alcoholic drinks at parties, and maybe that will become as acceptable as asking for an alcoholic drink is now.”

Young people prefer to stay in control

We asked Prof Cooke about why there is a decline in young people drinking alcohol. “There are several theories about why this is happening. One is that young people spend a lot of time online, and they want to present the best possible version of themselves as someone who is in control. Studies of Facebook content show that people generally share positive alcohol content, rather than negative experiences.

“Another idea is that alcohol has become more expensive in the last decade or so, which has put young people off drinking. Finally, the rise of energy drinks may be part of the explanation too, especially for young people who like to play games online. Energy drinks, high in caffeine, are likely to aid video game performance. Alcohol is unlikely to do this.”

For people of any age trying to limit their alcohol, Prof Cooke recommends trying to understand the reasons why you drink. “Do you drink to be sociable, to enhance an evening out, to cope with negative emotions? Are there other ways you could meet those needs? Psychological interventions, such as feedback on drinking or setting goals to drink less, can also be effective ways to cut back.”

Prof Cooke’s latest research

Prof Cooke’s latest research is published in Drug and Alcohol Review. He says: “Our new paper shows that policymakers and drinkers talk about drinking in different ways. While policymakers focused on drinking behaviour, drinkers talked about how drinking made them feel different emotions: embarrassed, happy, guilty, sad. Policymakers need to construct policies to reflect the importance of emotions in drinkers’ narratives.”

> Read the paper: The language of alcohol: Similarities and differences in how drinkers and policymakers frame alcohol consumption

Alcohol and cancer: let’s talk

In the UK, alcohol is a major part of how many of us socialise, relax, and celebrate. But do we really know the risks we’re taking when we drink?

Our research shows that most people don’t know that drinking any amount of alcohol increases the risk of 7 types of cancer.

This Cancer Prevention Action Week, we want to spark a national conversation: with friends, family – and within government – about alcohol and cancer.

Alcohol and cancer: let’s talk – that was the theme of this year’s Cancer Prevention Action Week. For 7 days on 23–29 June, we talked to politicians, gave radio interviews and spoke to experts about alcohol and cancer. Plus, we shared news and views across our socials:

Facebook | LinkedIn | Instagram | Bluesky

How Cancer Prevention Action Week unfolded

Monday’s highlights

> Brits find it harder to talk about alcohol than sex or money

> Our campaign video launches

Yorkshire GP speaks out in support of CPAW:

Dr Nigel Wells, Medical Director and Executive Director Clinical & Care Professional Humber and North Yorkshire ICB and practising GP:

As a GP, I know people can be reluctant to talk about alcohol or share concerns about their drinking – so it doesn’t surprise me that only 2 in 10 people across Yorkshire and the Humber feel comfortable doing so.

But alcohol isn’t harmless – it increases the risk of 7 types of cancer, and, too often, people simply aren’t aware. If this campaign helps someone pause and ask whether alcohol might be affecting their health, and encourages them to speak to a healthcare professional, it will have made a real difference. We need to make these conversations as routine as those about smoking or diet – and that starts with creating a safe, non-judgemental space in every consultation.

We tabled an Early Day Motion in support of Cancer Prevention Action Week. And Alcohol Focus Scotland, a key supporter of this year’s campaign, tabled a motion in the Scottish Parliament on alcohol and cancer.

Tuesday’s highlights

Alcohol Focus Scotland organised a photo call at Holyrood with Members of the Scottish Parliament (MSPs). Photographed are 11 MSPs, including the Cabinet Secretary for Health Neil Gray; Jackie Baillie, Labour’s deputy leader and health spokesperson, and Presiding officer Alison Johnstone. Read more on LinkedIn

Sheridan Dixon, of South Tyneside, was interviewed on ITV Tyne Tees about how she has reduced her drinking as part of efforts to stay cancer free. We’re grateful to our partner Balance North East for helping us share Sheridan’s story.

Wednesday’s highlights

We headed to No 10 Downing St to present our petition to UK Prime Minister Sir Keir Starmer.

Prof Lord John Krebs, Chair of our Global Cancer Update Programme, tabled questions in the Lords on the links between alcohol and cancer, keeping the issue high on the political agenda: