Leading CRUK’s cancer prevention initiative
Professor Linda Bauld’s research in applied health focuses on two main areas: the evaluation of complex public health interventions, and the use of evidence to inform health policy. She is also Cancer Research UK’s new Cancer Prevention Champion, with a brief to lead our £6 million research initiative focussing on the lifestyle and behavioural changes that can prevent cancer. Currently Professor of Health Policy at the University of Stirling, and Deputy Director of the UK Centre for Tobacco and Alcohol Studies, Professor Bauld is passionate about the importance of integrating behavioural research into all aspects of CRUK’s science portfolio.
It’s becoming clear that rather than using models based on individuals or subgroups, population level intervention is the most effective way to achieve behavioural change. What do you see as the challenges for CRUK in this approach?
The work CRUK has done on tobacco is relatively straightforward — the charity has a policy of non-engagement with the tobacco industry. For tobacco it is clear, but in other areas there needs to be more of a sliding scale where we may need to have dialogue with other industries that sell products which might have a role in causing cancer. There are important distinctions, particularly around the food industry and the retail sector, for example. CRUK has important partnerships, and a policy of non-engagement with a supermarket would be silly — everybody needs to eat. We should say very clearly that we are asking our commercial partners to adopt policies that encourage healthy behaviour — for example, effective food labelling, not having sweets at the till, not marketing unhealthy products to kids — these are the kinds of policies we should be advocating. It’s constructive engagement.
I think alcohol is more tricky than food. The links between alcohol and cancer are clear and it is vital that cancer prevention research is conducted entirely separately from the alcohol industry. Here it is important that CRUK works to improve public understanding of alcohol and cancer risk and also collaborates with other organisations to make the case for better alcohol policies. These include measures on price and also promotion, for example. Alcohol shouldn’t be marketed to children and we need to look very carefully at issues such as alcohol sponsorship of sport, in my opinion.
You’ve encountered a high level of hostility from the tobacco industry. How do you cope?
I’ve been personally threatened in the past. The police have been involved, and although the university has been very supportive, it’s not been easy. But you have to keep going. Smokers are using a highly addictive product that will kill one in two people who continue to smoke. The industry that promotes that product is fundamentally flawed, and part of their technique is to discredit the scientists who speak out against it; they’ve done it for decades. I think you have to do the best quality research that you can, and feel confident about the evidence you’re using when speaking to parliamentarians or the press. I feel very committed to this — I wouldn’t do it otherwise.
Do you see your role as campaigning?
Most of my own research is very traditional — trials and observational studies with smokers who find it difficult to stop smoking and want a way out. In terms of my policy roles, we know that the most important way to change behaviour is to work with government at the population level. Raising the price of unhealthy products reduces consumption, and restricting advertising and marketing changes people’s consumption behaviour. I wouldn’t be doing an effective job if I didn’t get involved in building the evidence base to support those high level actions. So it’s not so much campaigning, it’s about providing evidence to support policy change.
How is your new job as CRUK’s cancer prevention champion going?
It’s an interesting but challenging role. For years, behavioural science hasn’t been a very significant area of focus for CRUK, so it’s about showing the community that their work is relevant to cancer. For example, research into physical activity isn’t seen as cancer research, but it’s a major determinant of chronic disease, so teams working in this field are perfectly justified in coming to CRUK for funding; they just need to show the link with cancer.
Just as for some of the discovery science that CRUK supports — where we may not necessarily be developing a future cancer researcher — we need to recognise the benefit of supporting someone to become a really excellent behavioural scientist or public health researcher who will do research that will be useful to a whole range of problems. That’s a challenge, to get that message across — both to CRUK and to the behavioural science community.
How can behavioural research best integrate with the rest of the cancer research portfolio?
We already collaborate with basic scientists — for example, in tobacco research we rely on basic research on the effects of nicotine, largely in rodent models and preclinical research. We can’t understand how nicotine replacement therapy works without having that research.
There’s a big gap between cancer treatment research and behavioural interventions. We’ve been working on smoking cessation with oncologists who specialise in lung cancer — you’d think that that sort of collaboration would just happen, but it doesn’t. We are setting up a couple of studies where we’re trying to tailor treatment options for people who’ve been diagnosed with lung cancer.
For researchers in other disciplines, I would say if you’re designing a complex study, think seriously about the benefits of involving a behavioural scientist!
How do you rate our progress so far in cancer prevention?
We’ve made huge progress but we still have a long way to go. We know where we’re going — we have a roadmap, and we’re a major player, both in terms of policy and research. What we do will matter. So that keeps me getting up in the morning!