Cancer is a complex set of diseases with many different causes and risk factors, and the reasons why it affects some people and not others are still not fully understood. Age and gender, and for some cancers, genetics, are the most important fixed risk factors. Cancer incidence and mortality increase with age, more males aged 70-84 die from cancer than any other group. One in ten of the Wessex population is aged 75 years and over and we have an older population when compared with the rest of England. Almost all cancers are more prevalent, with higher mortality in areas of highest deprivation.

Modifiable risk factors such as smoking, being overweight, poor diet (insufficient fibre and too much processed meat combined), UV radiation exposure (including use of sunbeds), drinking alcohol and low levels of activity may increase a person’s chances of developing cancer. In addition to being a healthy behaviour, breastfeeding is a protective factor for women and may lower the risk of developing breast cancer.

It is estimated that 38% of cancers are preventable.

Our ambition is to prevent more people in Wessex from developing cancers. Regardless of who they are or where they live, we will try to ensure that everyone can benefit from knowledge about how to prevent cancer where possible.

To do this, we will:

1. Embed Very Brief Advice (VBA) on healthy life choices into our clinical pathways.
2. Support people to actively improve their health and wellbeing, to reduce risk of developing diseases, including cancer, in the future.
3. Target the areas with the highest smoking rates in Wessex to increase awareness of, and access to local stop smoking services.
4. Reduce the risk of cervical cancer by meeting the target to increase Human Papillomavirus (HPV) vaccination uptake.
5. Consider the impact of air quality on system-wide resource allocation and planning.
6. Continue to embed genetic testing in our clinical pathways to ensure those at higher risk of a future cancer are identified and supported to make choices to reduce that risk.

Aim: We will embed Very Brief Advice on healthy life choices into our clinical pathways to make best use of every opportunity to help our population understand their own potential to reduce risk of cancer in the future.

Objective: Very Brief Advice is demonstrably embedded into 90% of clinical pathways.

In order to achieve this:

• Clinicians in cancer pathways will be trained to ensure they can have competent, sensitive, culturally appropriate, and confident ‘brief advice’ conversations about alcohol, smoking, weight, and physical activity and improved awareness of local offers and referral pathways.
• We will develop pathways and tools to support risk factor screening, VBA, and onward referral when appropriate.
• All clinicians involved in cancer pathways will be trained in VBA every three years.

Aim: Support people to actively improve their health and wellbeing, to reduce risk of developing diseases, including cancer, in the future.

Objective: Local public, private and third sector organisations will have access to tools and training to support the people they come into contact with to understand how they can reduce their risk of developing cancer in the future.

 In order to achieve this we will:

• Offer training tools and advice in partnership with industry, communities, and local organisations to improve health literacy across our population.
• Seek to test and share technology that will empower people to manage their own health and wellbeing.
• Use digital technology and data to identify those at greatest risk of developing cancer and allocate resources to support them to reduce that risk.
• Ensure multidisciplinary teams (for example public health nurses, community health workers, primary care staff) are engaged in cancer-related prevention including promoting screening.
• Support the reduction of skin cancer by increasing public understanding of the risks of UV exposure as a cause of skin cancer through social marketing and targeted education.
• Identify people with an increased risk of cancer and offer them surveillance as eligible in line with NICE guidance. We will embed call and recall of patients identified as having increased risk of cancer, including but not limited to: people with liver cirrhosis, Barrett’s
  Oesophagus, lung nodules, familial breast cancer risk, Lynch syndrome.

Objective: Promote benefits of healthy weight, reduced alcohol consumption and physical exercise in reducing the risk of cancer.

Healthy weight

• We will pursue an ambition for anyone on a suspected cancer pathway with a BMI over 30 to be offered access to support to reduce their weight.
• We will work to raise awareness of the link between obesity and cancer among health professionals and the public.
• We will seek to open access to existing prediabetes and community liver health check programmes for weight loss and prevention via cancer clinical pathways (including anti-obesity drugs and comprehensive support). This will widen opportunity for more people to be supported to achieve and maintain a healthy weight for example, the NHS Digital Weight Management tool.
• With Local Authorities we will focus on food insecurity and access to healthy foods, promoting a healthy, balanced diet as well as healthy weight.

Reducing alcohol consumption

• We will work to raise awareness of the link between alcohol and cancer among health professionals and the public, including how to talk to people about their alcohol use.
• Providers of hepatocellular cancer surveillance programmes will ensure they have strong links to local alcohol and drug services.
• All people entering the hepatocellular cancer surveillance programme will be screened for drug and alcohol use, with a supported handover to local drug and alcohol services if appropriate.
• Anyone on a suspected cancer pathway will be asked about levels of alcohol use with subsequent sensitive and targeted conversations about support available to reduce alcohol use as appropriate to the individual’s circumstances.
• Our general practice cancer leads will support prevention of harm from alcohol and drug use through promoting staff training, development of links to drug and alcohol services, proactive identification of people using drugs and alcohol, with conversations and referral to drug and alcohol services as appropriate and quality improvement projects/audit to support the work. 

Physical activity
Regular physical activity has been shown not only to reduce the risk of cancer and other non-communicable diseases but also to significantly reduce the risk of recurrence following a cancer diagnosis.

• We will provide information to patient facing staff on the benefits of physical activity on health and wellbeing, including evidence of impact on cancer risk and treatment outcomes.
• We will work with providers of cancer support services to embed physical activity as part of their wellbeing offer.

Aim: We will target the areas with the highest smoking rates in Wessex to increase awareness of, and access to local Stop Smoking services. We will particularly focus on areas of greatest deprivation.

People born today in England’s most affluent areas are expected to live on average, up to ten years longer than people in the least affluent. ​ ^{((ONS)., 2023)}​ Smoking is the single biggest driver of this inequality. ​^{(Marmot M, 2010)}​

Objective – We will achieve the National ambition to reduce smoking rates to 5% by 2030. 

In order to achieve this:

• All people who are referred into cancer pathways will be asked whether they smoke and, if appropriate, will be advised on stopping smoking and referred to the local tobacco control offer such as the NHS smoking cessation services (including as part of the pre-operative pathway).
• Lung Cancer Screening will, where possible, be co-located with smoking cessation services.
• Our general practice cancer leads will support the smoking cessation programme through working with Primary Care Networks (PCNs) to promote the implementation of Very Brief Advice (VBA) training, the development of links to smokefree services in the PCN area and ways to proactively identify smokers, with actions to help them stop.

Aim: Reduce the risk of cervical cancer by meeting the target to increase Human Papillomavirus (HPV) vaccination uptake.

Objective: To achieve 90% uptake in all school age children across Wessex by end of year 9 and ensure everyone eligible up to the age of 25 is provided with the opportunity to access the HPV vaccine.

Working in collaboration with Public Health Commissioning Teams, providers and ICBs, we will:

• Use social marketing techniques and community engagement to raise awareness of HPV and HPV vaccination to highlight the role of immunisations (including Hepatitis B) in cancer prevention.
• Empower local advocates, training local champions in immunisation promotion to address mistrust and cultural barriers.
• Continue to target Special Educational Needs & Disabilities (SEND) schools and home educated children as well as overall uptake.
• Develop tailored messaging targeting underrepresented communities to raise awareness of cancer and highlight the importance of screening programmes, starting with HPV vaccination.

Aim: Consider the impact of air quality on system-wide resource allocation and planning.

Objective: Contribute to the reduction of air pollution by working with local providers to ensure they have a sustainability plan that includes improving air quality.

Outdoor air pollution causes 8% of all lung cancer cases in the UK.​^{(DEFRA, 2022)}​ Parts of Wessex experience some of the worst air pollution in England. We commit to working in partnership across Local Authorities and industry to reduce harmful levels of fine particulate matter (suspended particulate matter 2.5 to 10 micrograms per cubic metre) by 2030.

We will work with providers to minimise the negative impact of cancer services on air quality, as part of sustainability plans, including through reducing staff travel requirements, streamlining the patient journey to reduce the need for separate appointments, and supporting sustainable and active travel options, including virtual access to services.

Aim: Continue to embed genetic testing in our clinical pathways to ensure those at higher risk of a future cancer are identified and supported to make choices with respect to that risk.

Objective: We will ensure equitable access to services from predictive testing, risk reducing treatments, and appropriate and timely screening.

Genomic medicine has demonstrated a significant opportunity to prevent some cancers from developing. Cancer is not usually inherited, but the risk of some types – including common cancers such as breast, ovarian, colorectal, and prostate cancer – can be strongly influenced by genes and can run in families.

Predictive genetic testing can indicate an increased risk of developing specific cancers, and as testing insight and research develops, more tests will be routinely embedded into care pathways. Identifying carriers of known genes that increase an individual’s risk of cancer, ensures that discussions on cascade testing to family members can take place; with a clear risk reduction of future cancers.

BRCA and Lynch syndrome tests are already established in some cancer pathways and are offered to patients and family members where appropriate. The result of these offers has allowed affected people to access targeted cancer screening, lifestyle advice and, if appropriate, risk reducing surgery or other treatment.

Working alongside colleagues within genetics (Central and South Genomic Medicine Service Alliance), neighbouring cancer alliances and ICBs will ensure joined up working, minimise duplication of work and provide everyone with equitable access to services from predictive testing, risk reducing treatments, appropriate and timely screening alongside improving clinicians’ awareness to investigate and offer the most appropriate and up to date treatment.