Setting the Global Direction
The Road to the 4th High-Level Meeting (HLM4) on the Prevention and Control of Non-communicable Diseases (NCDs) and the Promotion of Mental Health has been a long one.
Kendra Chow (Senior Policy & Public Affairs Manager) and Dr Helen Croker (Assistant Director of Science and Policy) were in New York – alongside government officials and policymakers from around the world, civil society and lived-experience advocates – joined in a busy week of side events and bilateral meetings leading up to the HLM4 at UN Headquarters on 25 September in New York.
Amid a bustling and busy New York scene, the week’s events offered a rare opportunity for governments to set the global course to address NCDs and (for the first time) mental health.
The Political Declaration – a document that has been negotiated by Member States from May through September – was set to be adopted that day. The Declaration is a critical tool that will shape global health priorities until 2030 – a crucial window for progress on cancer and other NCDs.
And although, in the end, it was not officially adopted on the day of the HLM4 (due to concerns raised by a small number of Member States), the number of Member States that did voice their support for the Declaration’s contents and commitments indicates that it is likely to approved in the General Assembly after a voting process.
We have been actively engaged along the entire road to the HLM4 – participating in the multistakeholder hearing in May, meeting with Member State Missions in New York and Geneva, and emphasizing that prevention is the most effective and equitable way to reduce cancer and NCD burden (read our High-level Meeting advocacy brief).
Cancer gains, but gaps remain
There is welcome recognition in the Declaration that cancer is a global priority, with an emphasis on research, evidence and innovation. This is a win for us because we repeatedly pressed Member States for the urgency of cancer to be included in the final Declaration, and these gains in visibility matter.
One in 7 deaths worldwide is caused by cancer. The Declaration includes specific commitments on reducing cases of cervical, childhood and liver cancer, which is meaningful progress.
The need for prevention
The Declaration also includes an ambitious target: by 2030, at least 80% of countries should have operational, multisectoral NCD and mental health strategies in place. This milestone matters, and WCRF International welcomes it as a step forward. But for these strategies to truly succeed, they must be rooted in prevention. Without embedding prevention, policies risk becoming too heavily focused on treatment-focused, missing the opportunity to save lives and reduce costs through avoiding disease in the first place.
Evidence shows that 40% of cancers are preventable by acting on key risk factors—unhealthy diets, alcohol, tobacco, obesity, and air pollution. The Declaration acknowledges these risks but stops short of committing to strong preventive measures.
Alcohol is one clear example: the text refers only to “harmful use”, but we know there is no safe level of consumption. Stronger, clearer language is needed if prevention is to drive meaningful change.
The case for health taxes
Health taxes are a proven part of the solution. The evidence is clear: fiscal measures on tobacco, alcohol and sugar-sweetened beverages are among the most effective public health tools available. They deliver health gains, generate economic returns, and are among the WHO best buys (and WHO EURO’s “quick buys”).
Despite this overwhelming evidence, the Declaration fails to deliver firm commitments on health taxes, reflecting the political sensitivity of fiscal measures. WCRF International believes finance ministries, alongside other sectors, must show leadership by adopting prevention-focused fiscal policy.
Tackling political and commercial pressures
The cautious language in the Declaration also reflects our current global political climate. Evidence-based measures such as health taxes and alcohol regulation faced strong pushback during negotiations, amplified by lobbying from unhealthy commodity industries that distort science and confuse the public.
This weakens trust in health policy and emboldens opposition, making it harder for governments to commit to bold action.
Conflicts of interest remain another challenge. Industries that encourage people to buy and use unhealthy products should not shape health policy.
Without institutional safeguards, prevention risks being sidelined in favour of commercial. We continue to call for clear protections to ensure that public health, not profit, drives decision-making.
Dr Helen Croker and Kendra Chow at the UN HLM High Level Meeting in New York
Civil Society’s role
Civil society participation is another area where commitments could have been stronger. People living with NCDs and the organisations that represent them should be central to governance and accountability. Yet compared with previous Political Declarations, this text weakens those commitments. For implementation to succeed, participation must be meaningful, resourced, and embedded in national coordination mechanisms.
Building from here
The NCD burden is urgent and rising, but the solutions are within reach. Prevention is non-negotiable. Health taxes, alcohol control acknowledging no safe level of consumption, and healthier food environments must sit at the centre of national responses. Tackling misinformation, industry interference, and weak implementation is just as important as designing strong policy.
Taken together, these dynamics highlight why the Declaration must be seen as a floor, not a ceiling. Emphasis on the cancer burden and the target for national plans provide a platform to build upon, but prevention must be prioritised if we are to make real progress.
Governments will need political courage, strong leadership, and cross-sector collaboration to deliver on their promises.
We will continue to advocate for prevention as the most effective and equitable approach to reducing cancer and NCDs, and are ready to work with UN agencies, Member States, and partners such as the NCD Alliance and UICC to translate the Declaration’s commitments into national action.
> Read our statement prepared for the UN High-level Meeting on NCDs and mental health
More policy-related news and blogs
Why are we thinking about the food of the 1990s? Well, 3 decades ago, we funded an exciting project on women’s health. Now, 30 years later, scientists and women from the study have gathered to look back on what the UK Women’s Cohort Study has achieved.
It’s an incredible moment for us because many research projects only last a couple of years. Such a long-term project can provide scientists with richer, more detailed information to help prevent cancer.
Read more
The UK Women’s Cohort Study (UKWCS), which we provided initial funding for, recently celebrated its 30th anniversary! This is an incredible achievement because many research projects only last a couple of years. Such a long-term project can provide scientists with richer, more detailed information to help prevent cancer.
The UKWCS, led by Prof Janet Cade from the School of Food Science and Nutrition at the University of Leeds, is one of the largest cohort studies investigating diet and cancer in the UK, comprising over 35,000 middle-aged women and representing a wide range of different eating patterns, which can help scientists research what protects against cancer and coronary heart disease. Participants are regularly followed up to examine what effect food and nutrient intakes have on their long-term health.
Preventing cancer through what we eat
The first survey was funded by World Cancer Research Fund and the data produced from this survey and later ones has been used to investigate:
- meat and fibre intake and breast cancer
- vitamin C supplementation and breast cancer
- fibre intake in type 2 diabetes and cardiovascular disease
Over 3 decades, these investigations have provided interesting findings. For example, women who eat more fibre have a lower risk of stroke, and women who eat more red and processed meat have a greater risk of developing breast cancer.
Of course, we do not eat specific nutrients alone, so dietary patterns have also been identified and explored. Compared with meat eaters, vegetarians and fish-eaters (non meat-eaters who do eat fish) may have some protection against post-menopausal breast cancer.
This wide-ranging set of data can be used to identify common trends and to help target health information. For instance, women who eat more fruit and vegetables tend to be vegetarian or vegan, to take vitamin or mineral supplements, to be married, to be non-smokers, and to be educated to at least A-level or degree level.
To celebrate the milestone, World Cancer Research Fund hosted a party for colleagues who have worked with UKWCS over the last 30 years, in person and online from all over the country. Prof Cade talked about the UKWCS, and gave us some reminders of how different the world was 30 years ago. Diet is complex, so we need to understand how various factors interact to influence our health. It was fantastic to hear about all the findings so far from the project, and see so many people in the room who could share memories of working together.
Dr Darren Greenwood shared some reflections about the history of the UKWCS and its origins, from when we awarded the University of Leeds funding to investigate links between diet and cancers. The UKWCS grew and grew as more researchers worked with the data, and were awarded further funding. Sadly some members of the original cohort have died since the study launched. Yet Dr Greenwood reminded us that this data tells a story that helps us decode how to prevent cancer, and help people live longer, healthier lives.
This legacy is one of the enduring strengths of the UKWCS. The study has been cited in at least 9 government policy documents, providing direct life-changing information to help improve health and lives on a population scale.
Dr Diane Threapleton is one of the researchers who has used UKWCS data, including looking at how increasing fruit and vegetable intake slows weight gain. She focussed on the women of the study, highlighting how the data, time and samples they provided open a vital window into how what we eat interacts with real life. This was a timely reminder of the contributions of the women of the study, without whom none of this would have been possible.
Insights into ageing and beyond
After this, we heard from Yuanyuan Dong, who is working with the UKWCS to examine how diet affects the risk of rheumatoid arthritis. Yuanyuan joined us online from China, highlighting the global reach of the experts working with the cohort.
Finally, Dr Sarah Jing Guo told us about her plans for the UKWCS data – looking to the next 30 years! She gave us details of what her PhD student, Xinyue Liu, is examining with her project looking into how replacing processed meat with unprocessed meat or dairy products affects the risk of developing type 2 diabetes. She also gave us insights into how the cohort data could aid research into an ageing population, looking at Parkinson’s disease, Alzheimer’s or musculoskeletal disorders.
This amazing piece of long-term research is an important reminder of how small seeds of funding can have an impact over many decades and even lifetimes. We’re truly grateful to the donors of 30 years ago who helped make this research happen.
> More details about the UK Women’s Cohort Study, including information about publications
Documents from the UK Women’s Cohort Study
Help us fund the research of the future
Gifts in Wills help us fund long-term research projects like Prof Cade’s
We spoke to Dr Renate Winkels (pictured) and Dr Laura Winkens, at Wageningen University & Research, to discover more about their studies in bowel (also known as colorectal) cancer.
Your team looked at what influences people’s health behaviours after they’ve been treated for bowel cancer. What do you mean by health behaviours and what did you find out?
Health behaviours are the everyday choices people make that affect their health. In this study, we focused on 2 things:
- healthy eating (more fruit, vegetables, whole grains and beans; and less fast food, red meat, processed meat, sugary drinks and alcohol)
- physical activity
For people who’ve had bowel cancer, healthy behaviour may be associated with living longer, feeling better and having fewer problems like fatigue.
However, in previous studies, we found that many bowel cancer survivors don’t make big changes after treatment. Survivors are dealing with side-effects from the cancer or its treatment (such as gastrointestinal problems, fatigue or body image distress), which can make it hard to eat well and stay active.
Our study looked at what helps or gets in the way of healthy behaviour for people who have finished treatment for bowel cancer. We found:
Personal factors matter
How much time people have, their motivation, what they believe about healthy habits, what they know, and the skills they have can all influence whether they eat well and stay active.
Support helps
Encouragement and support from family and friends, or feeling like healthy habits are normal in their social circle, can make a big difference.
Environment plays a role
Access to gyms, parks, or even just good weather can affect how easy it is to be active.
Cancer symptoms can get in the way
Ongoing physical issues after cancer treatment, like fatigue or bowel problems, often make it harder for people to stick to healthy habits. But if someone is feeling physically well, they’re more likely to eat better and stay active.
Mental health may be important
Depression or being unhappy with one’s body seem to be linked with less healthy behaviour.
In short, to help people with bowel cancer lead healthier lives after treatment, we need to focus on motivation, knowledge, support, and overcoming the challenges they face physically and emotionally.
Towards a more complete picture
Your team conducted a “systematic review”. What is that and why is it important?
We wanted to find out what other scientists had studied, so we could build our study on the latest evidence. Moreover, we wanted to provide an overview of the topic. We looked at 21 papers, but we started with around 800 publications, and had to sift through them to identify the relevant ones.
You divided the studies into quantitative or qualitative. Why did you choose to look at both?
Quantitative studies collected a lot of numbers and measurements. The studies used standardised questionnaires to collect data on dietary intake and other aspects of lifestyle. Those studies answer questions like “how many” or “how much”.
Qualitative studies focus more on experiences. Such studies are mostly interviews to better understand why people do what they do, or how people behave.
Together, they provide a richer, more complete picture of the challenges and motivations colorectal cancer survivors face.
Were you surprised that people find it hard to change their behaviour?
Not really. Most people will recognise how challenging it can be to always make healthy choices. After cancer, when you’re rebuilding your life, that can be even harder.
How important is mental health for people living with and beyond bowel cancer?
Mental health is a very broad topic. People who have had bowel cancer may have a stoma, or be suffering from fatigue, or from bowel functioning problems. These can have a real impact on your life, and it’s important to address them. Some care teams really have an eye on this, but it’s not always the case. One patient told me that she did not dare to discuss her feelings of severe fatigue with her oncologist, as the oncologist told her that “fatigue was not a thing” for people with bowel cancer. We need more awareness and integrated care that addresses both mental and physical health to truly support survivors’ wellbeing.
You’ve also looked at whether following our Cancer Prevention Recommendations can reduce fatigue for people with bowel cancer.
We set up a study to assess whether following the Recommendations would help people to feel less fatigue. Cancer-related fatigue is a symptom that many bowel cancer patients experience during treatment and after completion. What is disturbing is that this type of persistent, overwhelming sense of physical, emotional or mental fatigue is not proportional to activity nor relieved by resting or sleeping.
We recruited participants for the trial who were experiencing cancer-related fatigue. In a randomised study, half of the group received lifestyle coaching to improve their adherence to the Recommendations, while the control group did not.
The coaching really helped the participants to adopt a healthier lifestyle: over time, this group reported eating more fruit and vegetables, and less processed meat and sugar-sweetened beverages. Also, physical activity levels went up more in the group that received coaching than in the control group.
Nevertheless, those changes didn’t result in less fatigue. This suggests that while these changes have many benefits, managing fatigue may require additional, targeted interventions.
This grant was funded by Wereld Kanker Onderzoek Fonds based in the Netherlands, as part of the World Cancer Research Fund International network.
Promoting, protecting and supporting breastfeeding should be a key goal of public health in the 21st century. Yet many women struggle to breastfeed or opt not to, often in the absence of adequate support across policy, societal, and healthcare systems.
This blog sets out why policies to support as many parents as possible to choose breastfeeding are more needed than ever.
Less than half of babies breastfed worldwide
Once common, lower breastfeeding rates are associated with the advent of pasteurised and commercial infant formula milk. However, as modern science advanced, we now understand much more about the benefits of breastfeeding.
While infant formula may adequately meet the nutritional needs of babies, and should be available and affordable when needed, breastfeeding offers multifaceted benefits for both mothers and babies that cannot be acquired via breastmilk substitutes.
These benefits for babies include:
- protection from infection
- better dental health
- better digestion
- learning important feeding responses such as knowing when they are full.
These benefits are not temporary; they help mothers and babies over their life. Our research shows that breastfeeding protects mothers against breast cancer, and protects children against excess weight gain, and living with overweight and obesity.
Yet, globally, fewer than half of all babies under 6 months old are exclusively breastfed, as recommended by the World Health Organization. Current and future generations will, thus, miss out on these important benefits and increase their vulnerability to ill-health in their futures.
Supporting women to breastfeed
Nonetheless, breastfeeding comes with challenges for many parents. We’ve set out what governments should prioritise in our policy factsheet on breastfeeding and cancer risk. This outlines the importance of offering support in healthcare settings, alongside fiscal and legal policies such as appropriate parental leave, and stricter marketing regulations on infant formula and other follow-on milks marketed for babies and young children.
We know that supportive environments are key in ensuring that appropriate and well-designed support for breastfeeding is offered in healthcare and community settings. This means counselling on feeding is offered as part of antenatal care, as well as when a baby is born, to support continued and exclusive breastfeeding up to 6 months and beyond.
In many settings, these services may be understaffed or not prioritised. Yet they are key to helping parents and mothers feel supported, rather than left to manage a complex process by themselves.
Legal policies are also important, and include:
- parental leave,
- enabling women to breastfeed at work and study, or
- protecting breastfeeding in public areas.
They can create an environment where the needs of mothers and babies are prioritised and normalised. For example, the UK does not offer maternity, paternity or shared parental leave that meets the national minimum wage. Undoubtedly, this creates an environment where parents must prioritise their return to work over their feeding choices.
Breastfeeding is also influenced by commercial factors. Governments should do more to ensure that the marketing of infant formula does not affect the feeding choices people make. Studies in the UK have shown that parents will often choose more expensive formula for infants in a false belief that they are investing in their child’s future, even when the products are nutritionally equivalent.
This shows there is a strong argument that price controls or own brand formulas are warranted given that all products are tightly regulated and comparable in nutritional value.
New products are also emerging at a fast rate, such as milks for babies older than 6 months old. These products are unnecessary, often very high in sugar, and aggressively marketed. Many of these formulas include inappropriate claims on packaging, such as statements about promoting babies’ growth. These are not appropriate and are infringing on international standards set in the International Code of Marketing of Breastmilk Substitutes.
Smart investment by governments
Investment in policies to support breastfeeding are not a cost, but rather key investments in the health of future generations and likely lead to cost savings across health systems by avoiding ill-health.
Breastfeeding also has environmental benefits, with the environmental costs of producing, packaging and exporting formula considerable. This cost is set to grow as the infant feeding market is booming, with milks for toddlers as well other commercial baby foods such as food pouches increasingly targeted for commercialisation. The associated profits and importance for local economies hides costs such as environmental degradation, as well as health harms.
Individuals, societies and governments need to recognise the proven benefits of breastfeeding. Policies cannot fall behind what is important for the health, wellbeing and wealth of future generations and must protect parents from inappropriate marketing practices so they can make informed choices about feeding their baby, aided by the necessary support.
World Breastfeeding Week is celebrated every year in the first week of August, championed by WHO, UNICEF, Ministries of Health and civil society around the globe. It’s a time to recognise breastfeeding as a powerful foundation for lifelong health, development, and equity.
Explore more on breastfeeding
“I was 19 years old when my Mum was diagnosed with bowel cancer. We were told it was terminal and she had up to 6 months to live. But after 6 days, she closed her eyes and never opened them again.
“There are certain milestones a parent should see with their child, way beyond their first steps. First home, finding love, children of their own. There are special days families should be together, my wedding day being one of those. My Mum should have been there. Every parent should be there.”
Mum Julia is not the only person James has lost to bowel cancer. A few years earlier, his Nan died of the disease, and his Mum’s sister Mary also tragically succumbed to bowel cancer – the 3rd most common cancer in the UK.
Doctors discovered that a genetic disorder called Lynch syndrome runs in James’ family. Since the death of 3 of the most important women in his life, James and his brother are regularly tested to try to ensure the disease doesn’t take any more of his family.
James has completed some epic events to raise money for World Cancer Research Fund, including 2 marathons and many shorter races. He often fundraises and competes with his friend Carl Villiers, fondly known as the Twiglet because of his slender build. Cancer research is also a cause close to Carl’s heart, as he has a mutated gene linked to cancer and also benefits from regular screening.
Determined to make a difference
James Radford at one of World Cancer Research Fund’s supporter events.
Yet sadly, it’s not just bowel cancer that has struck in James’ family. Another of James’ aunts, Helen, and his Step-Mum, Lyn, died from different cancers. The devastating impact on his family hasn’t just made James sad – it’s made him angry and determined to make a difference.
“To all those who knew Helen, she was the light in the room. She always had something to say. She passed away quietly and pain free in Milton Keynes Hospital, with family close by holding her hand.
“Then when Lyn died, watching one of the strongest people I have had the pleasure of meeting losing her battle with cancer made me angry. Cancer doesn’t care who you are or how strong you are. It’s an evil disease.
“I’m often asked, how do you keep motivated to fundraise for World Cancer Research Fund? Honestly, it’s simple. I think of the people I’ve lost to cancer and all that it’s robbed me of.
“I wouldn’t wish this on anyone, so if raising money can maybe one day stop others being robbed of memories, I won’t give up.”
The UK government published its 10-year Health Plan on 3 July, setting out its ambitions to reform the health system and shift the focus from sickness to prevention.
As a cancer prevention charity with a vision of a world where no one dies from a preventable cancer, we welcome the Plan’s direction but there are many key areas of health policy where it simply falls short of what the public needs.
Positive inclusions
Many of the commitments in the Plan had already been announced and were warmly received, such as the expansions of free school meals and the Soft Drinks Industry Levy.
Encouragingly, the Plan also includes new mandatory measures that mark a meaningful step towards creating healthier environments for all.
These include:
- Mandatory healthy food sales reporting for all large companies in the food sector.
- Mandatory healthy food standard to improve the healthiness of sales.
- Updates to the nutrient profile model, used to set marketing restrictions on junk food.
- 10% uplift to restore the value of the Healthy Start scheme from 2026–27.
- Mandatory labelling on alcoholic drinks to include consistent nutritional information and health warning messages.
- Place-based approach to physical activity, including £250m for 100 places via Sport England, at least £400m for local community sports facilities, and new school sport partnerships.
- National walking and running campaign led by Sir Brendan Foster.
- Development of a new physical activity strategy.
These measures are welcome steps forward in improving our food and drink environment and enabling people to be more physically active.
We hope the forthcoming National Food Strategy will drive deeper systemic changes to ensure affordable, accessible healthy food for everyone in England.
Critical missed opportunities
On alcohol, the Plan falls short of prioritising the range of evidence-based policies proven to reduce alcohol consumption, which causes around 17,000 UK cancer diagnoses each year.
Notably, it fails to include minimum unit pricing (MUP) for alcohol in England, despite the success of MUP in reducing alcohol-related deaths in Scotland and Wales. Worryingly, England continues to lag the devolved nations on this crucial policy.
The Plan also makes no mention of strengthening marketing restrictions on alcohol, and so enables industry to continue to normalise drinking as an aspirational lifestyle choice.
Given the rising number of alcohol-related deaths each year, we are urging the UK government to deliver a National Alcohol Strategy for England. As outlined in our recent letter to the Prime Minister, Keir Starmer, during Cancer Prevention Action Week, we continue to call for bold action on alcohol-related cancer.
Equally disappointing is the absence of action to strengthen protections and support for breastfeeding and infant feeding. There are no new mandatory, independently enforced regulations on the composition, marketing and labelling of baby and toddler foods. This is a missed opportunity, particularly in light of the UK government’s stated goal to raise the healthiest generation of children ever.
We will continue to urge the government to adopt the recommendations of the Competition and Markets Authority’s market study on infant and follow-on formula.
Turning ambitions into action
This Plan arrives as Labour marks its first year in government under Starmer. This government now has the opportunity – and responsibility – to turn its prevention agenda into lasting structural change that improves the nation’s health.
The upcoming National Cancer Plan for England presents a further chance to address modifiable risk factors and fill the gaps left by the 10-year Health Plan.
We welcome the Prime Minister’s willingness to challenge accusations of “nanny statism” and urge the government to ensure all health strategies are protected from undue industry influence.
We want prevention to be the foundation of all health strategies. We stand ready to bring our scientific and policy expertise to the table – and we’re calling on the UK government to work with us to turn bold ambition into real change, helping millions live longer, cancer-free lives.
In our resource library
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.
Prof Anne May, University Medical Centre, Utrecht
During our review of the literature concerning the impact of post-diagnosis physical activity on colorectal cancer prognosis for the Global Cancer Update Programme (CUP Global), we were unable to draw strong conclusions due to lacking evidence from randomized controlled trials. The Challenge trial provides exactly the evidence we were waiting for.
The summary estimate for studies that assessed activity dose was measured in MET hours per week.
- A 10 MET hour per week increase in activity was linked to a 24% reduction in all-cause mortality.
- A change of 10 MET hours per week was also the intervention goal in the CHALLENGE trial.
The effect sizes in this first, gold-standard RCT are remarkably well-aligned with the CUP Global analyses of observational studies.
During the presentation of the trial results at ASCO, the authors shared this chart. It includes the treatment benefits from approved therapies for colon, lung and breast cancer.
With 7–8% gains, you can see that exercise compares very favourably with other approved therapies in terms of absolute overall survival gain.
Collecting clinical trial evidence
The CHALLENGE trial confirms the clinical benefits that had been reported from observational studies. However, previous RCTs have also hinted at the accuracy of the results from observational studies. For example:
- The LEANer trial was published in 2023. It showed that triple negative breast cancer patients randomised to a diet and physical activity intervention before chemotherapy had a 53% higher rate of treatment success (eliminated cancer cells).
- A trial published in June 2025 showed that an exercise programme during and after chemotherapy increased the immune system responses in oesophageal cancer patients.
World Cancer Research Fund will fund the Optimus trial in the UK. Dr David Bartlett and Prof Adam Frampton at the University of Surrey will lead this study. It was proposed due to these findings.
Next steps
Dr Kerry Courneya co-led the CHALLENGE trial. At ASCO, he said these results could change practice for high-risk stage 2 and stage 3 colon cancer.
He expressed reservation that these results could be generalised to other sites and cancer stages. But he was optimistic that similar trials could be done more quickly than the CHALLENGE trial by taking advantage of newer methods. This could include using remote exercise assessments or activity trackers.
Dr Courneya noted that “support from funding agencies like WCRF/AICR is critical to moving this field forward because of limited access to funding for lifestyle research”.
AICR recently funded a project linked to the CHALLENGE Trial. It is led by Dr Kristin Campbell at the University of British Columbia in Canada. It will look at how muscle and fat tissue respond to exercise and how that may contribute to the observed survival benefits.
The response to the CHALLENGE Trial has made media headlines. Cancer researchers, doctors and patients are also excited by the news. This suggests that adding exercise as an additional part of treatment will gain further momentum.
While more trial data will be needed to support broader implementation, we are likely leaving the “nice to have” approach to exercise oncology and entering the “need to have” phase!
Research grants on physical activity
A selection of some of the grants we have funded that focus on the impact of physical activity on people living with and beyond a cancer diagnosis.
Latest news and blog posts
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.”
Latest news and blogs
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
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
Pink lemonade
A family favourite, our rose-blueberry lemonade is a great addition to any BBQ.
⏰ 5 minutes
🧍♂️ serves 2
Watermelon slushie
Enjoy the tangy notes of watermelon, raspberries and lime with this healthy slushie.
⏰ 10 minutes
🍎 1 of 5 A DAY
🧍♂️ serves 2
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
Cucumber cooler
Refresh yourself on dry days with a summery cucumber cooler that kids will love.
⏰ 5 minutes
🧍♂️ Serves 2
> Get the recipe
Devour some health in a glass
On the blog
As part of Cancer Prevention Action Week 2025, on Wednesday we handed in an open letter and petition, alongside breast cancer survivors Dr Liz O’Riordan and Nikki Bednall, and the Alcohol Health Alliance.
The letter (below) – signed by more than 25 organisations and health experts – and the petition called on Prime Minister Sir Keir Starmer and his government to introduce a National Alcohol Strategy to Prevent Cancer, as part of our Cancer Prevention Action Week (CPAW) activity.
This year, CPAW is highlighting the links between alcohol and cancer – our research shows that most people don’t know that drinking any amount of alcohol increases the risk of 7 types of cancer.
What’s more, around 17,000 new cases every year are down to alcohol – so we’re urging the UK government to introduce a long-overdue National Alcohol Strategy for England – one that tackles alcohol harm head-on through:
- mandatory health warnings highlighting cancer risk
- minimum unit pricing
- marketing restrictions
to reduce consumption, lower cancer risk, and protect lives.
Read the full letter below
The Rt Hon Keir Starmer MP
Prime Minister
10 Downing Street
London SW1A 2AA
CC: The Rt Hon Wes Streeting MP, Secretary of State for Health and Social Care
Ashley Dalton MP, Parliamentary Under-Secretary of State for Public Health and Prevention
25 June 2025
The UK government must act on alcohol now to prevent cancer
Dear Prime Minister,
On behalf of more than 20 organisations and public health leaders, we are writing to share our deep concern about the continued lack of action to reduce alcohol consumption across the United Kingdom. In particular, the absence of a National Alcohol Strategy for England stands in stark contrast to the scale of harm caused by alcohol, with alcohol-specific deaths having increased by 42% in England between 2019 and 2023 alone.
This week marks Cancer Prevention Action Week (CPAW) – a national campaign led by World Cancer Research Fund (WCRF) – which seeks to empower the public and inspire change to prevent cancer. This year, CPAW is shining a spotlight on the link between alcohol and cancer, and the urgent need for government action.
In the UK, alcohol causes around 17,000 cases of cancer every year – equivalent to 46 people receiving a diagnosis every single day. And as our population ages and grows, these numbers are projected to rise. Worryingly, the pandemic has also driven an increase in high-risk drinking. Modelling by the Institute of Alcohol Studies and Health Lumen suggests that if this trend persists, we could see an additional 18,785 cancer cases by 2035.
Public awareness remains alarmingly low that alcohol is a Group 1 carcinogen, the same category as tobacco and asbestos, and a cause of seven types of cancer, including two of the most common breast and bowel as well as mouth and throat, oesophageal, liver and stomach cancer. These risks are present even at low levels of consumption. New polling commissioned by WCRF reveals that when asked unprompted only 1 in 14 UK adults are aware that alcohol increases cancer risk and 25% believe there is no health risk attached to drinking alcohol.
We are not alone in our concern – thousands of members of the public including more than 20 organisations have signed our petition calling for greater government action. They agree that no one should have to suffer the devastating trauma of alcohol-related cancer.
The human toll is compounded by the economic burden. In 2016, Cancer Research UK estimated that alcohol-attributed cancers cost the NHS alone an estimated £100 million annually. With the health service under immense strain, it is imperative to act now and realise the government’s priority of prevention.
Despite alcohol being the sixth leading cause of preventable cancer in the UK, current policy does not reflect this reality. We urge the government to fulfil its responsibility to protect public health by introducing a National Alcohol Strategy for England without delay, which must include:
- Mandatory alcohol product labelling with health warnings, including information on cancer risks and calorie content.
- Marketing restrictions on alcohol by classifying it as an ‘unhealthy product’ under high fat, salt and sugar marketing restrictions.
- Implementing and evaluating minimum unit pricing at 65p in England with rates adjusted in line with inflation, to bring England into line with Scotland, Wales and Northern Ireland who all either have MUP already or have stated their intention to implement.
It is vital that this strategy aligns with the forthcoming National Cancer Plan for England, ensuring that alcohol is comprehensively addressed as a modifiable risk factor for cancer. We also urge the UK government to work in close collaboration with the devolved administrations, particularly to enable action to improve approaches to labelling and advertising. All policy development processes must be protected from industry influence and vested interests to ensure public health is placed above profit.
Such action would not only help to reduce cancer risks but reduce other alcohol-related harms. It would also support the government’s own ambitions to shift from sickness to prevention, as set out in the Health Mission, and contribute to economic growth by reducing illness-related inactivity.
We stand ready to support this effort and urge you to act now. Together we can tackle the devastating impact of both alcohol harm and cancer.
Yours sincerely,
Rachael Gormley, Chief Executive, World Cancer Research Fund
Dr Richard Piper, CEO, Alcohol Change UK
Alison Douglas, Chief Executive, Alcohol Focus Scotland
Professor Sir Ian Gilmore, Chair, Alcohol Health Alliance
Greg Fell, President, Association of Directors of Public Health
Dr Heather Grimbaldeston, Chair, BMA Public Health Medicine Committee, British Medical Association
Professor David Strain, Chair, BMA Board of Science, British Medical Association
Thalie Martini, Chief Executive Officer, Breast Cancer UK
Eddie Crouch, Chair, British Dental Association
Pamela Healy OBE, Chief Executive, British Liver Trust
Jill Clark, Chair, CancerWatch
Alison Wise, Communications Manager, on behalf of Fight Bladder Cancer
Ailsa Rutter OBE, Director, Fresh and Balance
Kostas Tsilidis, Associate Professor of Cancer Epidemiology and Prevention, Imperial College London
Dr Katherine Severi, Chief Executive, Institute of Alcohol Studies
Dr Dominique Florin, Medical Director, Medical Council on Alcohol
Daniela Binnington Nessman, Founder, Menopause and Cancer
Gopika Chandratheva, Nutritionist, NHS
Tamara Khan, CEO, Oracle Head & Neck Cancer UK
Jon Coleman-Reed, Head of Operations, Prevent Breast Cancer
Dr Claire Shannon, President, Royal College of Anaesthetists
Robert Steele, Chair, Board Directors, Scottish Cancer Foundation
Dr Alastair MacGilchrist, Chair, Scottish Health Action on Alcohol Problems
Chris Curtis, Chief Executive Officer, Swallows Head & Neck Cancer Support Charity
Amandine Garde, Professor of Law & Non-Communicable Diseases Research Unit, University of Liverpool
Richard Cooke, Professor of Health Psychology, University of Staffordshire
Dr Kathryn Scott, Chief Executive, Yorkshire Cancer Research
More CPAW news and blogs
‘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.