Synopsis
Prioritise evidence-based cancer prevention, communicate absolute rather than exaggerated risk, and connect tobacco, alcohol, weight, infection, ultraviolet and occupational interventions to equitable care.
- Tobacco avoidance and cessation remains the highest-impact modifiable cancer-prevention intervention and reduces cardiovascular and respiratory harm at the same time.
- Alcohol risk rises with consumption and affects several cancer sites; practical reduction advice should avoid implying that any drinking level is cancer-protective.
- Maintaining a healthy weight, regular activity and a fibre-rich diet support prevention, but counselling must avoid blame because cancer is multifactorial.
- HPV and hepatitis B vaccination prevent infection-related cancers; vaccine eligibility and catch-up routes follow current national programmes.
- Sun protection combines shade, clothing and correctly used sunscreen; a tan and intermittent intense exposure do not provide safe adaptation.
- Occupational and environmental carcinogen control is primarily a systems responsibility using elimination, engineering and protective measures, not worker education alone.
- Chemoprevention is reserved for defined higher-risk groups after discussion of absolute benefit, bleeding or other harms and competing options.
- Prevention advice complements, but never replaces, symptom assessment and population screening; a healthy lifestyle cannot rule out cancer.
Investigation priorities
Measure current use, dependence, previous quit attempts and readiness.
Management branches
A routine consultation identifies several potentially modifiable exposures.
- Address tobacco first when present, while also identifying alcohol dependence, safeguarding, occupational hazards or symptoms that cannot wait.
- Use shared decision-making to select a feasible action and explain the expected broader health benefit without promising cancer prevention.
- Connect the person to commissioned cessation, alcohol, weight-management, vaccination or occupational services and arrange a review point.
Key medicines
Varenicline for tobacco dependenceStart 1–2 weeks before the quit date: 0.5 mg orally once daily on days 1–3, 0.5 mg twice daily on days 4–7, then 1 mg twice daily from day 8, usually for 12 weeks; reduce for intolerance and follow the SmPC for severe renal impairment.Review renal function, pregnancy, seizure risk and new or worsening neuropsychiatric symptoms; nausea and abnormal dreams are common, and stopping smoking can itself alter concentrations of medicines affected by tobacco smoke.