Press releases Monday 25 October to Friday 29 October 2010

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's website (http://www.bmj.com).

(1) Following lifestyle tips could prevent almost a quarter of bowel cancer cases

(Research: Association of adherence to lifestyle recommendations and risk of colorectal cancer: a prospective Danish cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.c5504
(Research: A decision aid to support informed choices about bowel cancer screening among adults with low education: randomised controlled trial)
http://www.bmj.com/cgi/doi/10.1136/bmj.c5370
(Editorial: Decision aids and uptake of screening)
http://www.bmj.com/cgi/doi/10.1136/bmj.c5407

Almost a quarter of colorectal (bowel) cancer cases could be prevented if people followed healthy lifestyle advice in five areas including diet and exercise, says a new study published on bmj.com today.

Researchers from Denmark found that following recommendations on physical activity, waist circumference, smoking, alcohol and diet could reduce the risk of developing bowel cancer considerably - by 23 per cent.

Bowel cancer is the third most common cancer in the UK where more than 38,600 people are diagnosed with the condition every year. It is the second most common cause of cancer death in the UK, killing more than 16,250 people each year.

There is much evidence that implicates modifiable lifestyle factors such as smoking, physical activity, body composition, alcohol and diet.

The Danish researchers wanted to study the link between following healthy lifestyle advice and risk of bowel cancer in middle-aged people. They also wanted to find out the proportion of bowel cancer cases that might be linked to lack of adherence to the advice.

They studied data on 55,487 men and women aged 50-64 (bowel cancer is rare amongst people under 40) not previously diagnosed with cancer. The people were studied over almost 10 years up to 2006.

All participants filled in a lifestyle questionnaire including questions about social factors, health status, reproductive factors and lifestyle habits as well as a food frequency questionnaire developed to assess average intake over 12 months.

The researchers created a healthy lifestyle index using internationally accepted public health recommendations from the World Health Organization, World Cancer Research Fund and the Nordic Nutrition Recommendations.

These included being physically active for at least 30 minutes a day, having no more than seven drinks a week for women and 14 drinks a week for men, being non-smoker, having a waist circumference below 88 cm for women and 102 cm for men and consuming a healthy diet.

During the follow-up period, 678 people were diagnosed with bowel cancer.

After looking at how the participants managed to keep to each of the five lifestyle recommendations, the researchers calculated that if all participants (except the healthiest) had followed even one additional recommendation, it was possible that 13% of the bowel cancer cases could have been prevented.

If all participants had followed all five recommendations, then 23% of the bowel cancer cases could have been avoided.

The researchers conclude: "Our study reveals the useful public health message that even modest differences in lifestyle might have a substantial impact on colorectal cancer risk and emphasises the importance of continuing vigorous efforts to convince people to follow the lifestyle recommendations."

A second study also published today shows that adults with low education who used a decision aid when considering whether to have a bowel cancer screening test were more informed, but were less likely to have the test. Despite the lower uptake, the authors state that the decision aid improved informed choice in people with low education. They recommend that such aids should be made available for people who want to make an informed choice about screening and could be integrated within primary care.

However, an accompanying editorial says that before information interventions are adopted in practice, evidence is needed that they inform patients and meet the service need.

Contacts:
Study 1: Anne Tjønneland, Head of department, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
Email: annet@cancer.dk
Study 2: Sian Smith, Postdoctoral Research Fellow, Screening and Test Evaluation Program, Centre for Medical Psychology and Evidence-Based Decision-Making, Sydney School of Public Health, University of Sydney, NSW, Australia
Email: sian.smith@sydney.edu.au
Editorial: Hilary Bekker, Senior Lecturer in Behavioural Sciences, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, UK
Email: h.l.bekker@leeds.ac.uk

(2) Year-long opiate substitution for drug misusers has 85% chance of cutting deaths
(Research: Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK general practice research database)
http://www.bmj.com/cgi/doi/10.1136/bmj.c5475

Giving people opiate substitution treatment to help with their drug addiction can lead to a 85% plus chance of reducing mortality, according to a new study published on bmj.com today.

Researchers from Bristol and London found that the length of time people had opiate substitution treatment (OST) for had a large impact on its success and the likelihood of death.

Opiate users have a high risk of death, often from overdose.

OST, mostly methadone and buprenorphine, is central to prevention of drug related mortality and often delivered in primary care settings. Over the past 10 years, opiate prescription has more than doubled while the number of deaths involving methadone has fallen. However, the overall number of opiate deaths has not decreased and targets to reduce overdose deaths in England and Wales have not been met.

Previous research has shown that there may be an elevated risk of death during OST initiation (first 28 days) and in the first few weeks after OST has been stopped.

So the researchers studied data from the General Practice Research Database (GPRD), a database containing anonymised patient records from more than 460 general practices in the UK.

They analysed data on 5,577 patients who had a substance abuse diagnosis and received 267,003 OST prescriptions during 1990-2005. These patients were followed up until one year after the expiry of their last OST prescription, or the date of death before this time has passed, or the date of transfer away from the practice.

The researchers looked at mortality rates comparing periods in and out of treatment compared with the general population.

A total of 178 (3%) patients died either on treatment or within a year of their last prescription. The rate of death amongst people off treatment was almost double that of people taking treatment.

In the first two weeks of OST, the mortality rate was 1.7 per 100 person years - more than three times higher than the mortality rate during the rest of time on treatment.

The mortality rate was also raised substantially in the period immediately after treatment and people were eight to nine times more likely to die in the month immediately after stopping OST.

The researchers calculated that OST had an 85% and higher chance of reducing overall mortality in opiate users if they were taking the treatment for 12 months or longer.

They conclude: "Clinicians and patients should be aware of the increased mortality risk at the start of opiate substitution treatment and immediately after stopping treatment. Further research is needed to investigate the effect of average duration of opiate substitution treatment on drug related mortality."

Contact:
Matt Hickman, Professor in Public Health and Epidemiology, Department of Social Medicine, University of Bristol, UK
Email: matthew.hickman@bristol.ac.uk

(3) Not putting the clocks back this weekend will improve health, says expert
(Personal View: More daylight, better health: why we should not be putting the clocks back this weekend)
http://www.bmj.com/cgi/doi/10.1136/bmj.c5964

Not putting the clocks back this weekend but still putting them forward in the spring would be a simple and effective way to vastly improve our health and well-being, says an expert in this week's BMJ .

Mayer Hillman, Senior Fellow Emeritus at the Policy Studies Institute, argues that the effect of doing so would be to increase the number of 'accessible' daylight hours and thus encourage more outdoor activity throughout the year.

A major public health problem contributing to the incidence of chronic illnesses in the UK is caused by lack of exercise, writes Hillman. Adults are recommended to engage in at least 30 minutes of moderate or vigorous activity daily and children at least one hour. However, surveys have revealed a trend towards declining fitness and it has been predicted that over half the population will be clinically obese by 2050.

Although most people are aware of the benefits of taking up more physical activity - a lowered risk of coronary heart disease, obesity, diabetes, hypertension and some cancers - this routine features in few people's everyday lives, and the school curriculum allocates insufficient time for this, he adds.

Research shows that people feel happier, more energetic and have lower sickness rates in the longer and brighter days of summer, whereas their mood tends to decline during the shorter and duller days of winter. Two studies published by the Policy Studies Institute also point to a wide range of advantages of the clock change proposal.

It is surprising therefore that there has been a consistent oversight of the role that increasing the number of 'accessible' daylight hours in this way could play in the promotion of physical health and well-being, he says. Taking account of the typical daily patterns of adults and children, the clock change "would considerably increase opportunities for outdoor leisure activities - about 300 additional hours of daylight for adults each year and 200 more for children."

According to Hillman, there is strong public support for the clock change – "about 4 to 1 in England and Wales and fairly evenly divided in Scotland."

Adopting the clock change proposal "is an effective, practical and remarkably easily managed way of achieving a better alignment of our waking hours with the available daylight during the year," he argues. "It must be rare to find a means of vastly improving the health and well-being of nearly everyone in the population – and at no cost. Here we have it. All it requires is a majority of MPs walking through the 'Ayes' lobby in the House of Commons," he concludes.

Contact:
Mayer Hillman, Senior Fellow Emeritus, Policy Studies Institute, London, UK
Email: mayer.hillman@blueyonder.co.uk

Photographs and logos are available on request

FOR ACCREDITED JOURNALISTS

For more information please contact:

Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bma.org.uk

Press Office telephone : 020 7383 6254 (Weekdays : 0900hrs - 1800hrs)
British Medical Association
BMA House, Tavistock Square, London WC1H 9JP

and from:

the EurekAlert website, run by the American Association for the Advancement of Science (http://www.eurekalert.org)
http://intranet.bmj.com/departments/dept-bmj/bmj-team-resources/web-team-resources/General_blogging_principles.doc