Some described themselves as “unconvinced” of a connection between lifestyle, adenoma and bowel cancer, and needed persuading of a potential causal link between their own behaviour and the condition before they would consider making lifestyle changes (Fig. 3). Some suspected that the adenoma treatment process might be used simply to promulgate ‘correct’ lifestyle advice to a captive group “just because it is the done thing” (Group 4), rather than because adenoma patients were specifically in need of lifestyle change. This scepticism was expressed against PCI-32765 cell line a backdrop of wider ambivalence about lifestyle change. A few were dismissive, regarding lifestyle advice as inconsistent and arbitrary

— “if you read the newspapers you realise that whatever you do is bad for you!” (Group 1). Others felt that the possibility of change was unrealistic “at our age” (Group 1), particularly in relation to weight loss which was perceived to be more difficult as one became older and the “pace of life” slowed (Group 3). More positively, some welcomed the possibility of help to address aspects of lifestyle, once they grasped the notion that lifestyle factors could have contributed to their adenoma.

One suggested that “the JNK signaling pathway inhibitor relief of the all clear” (Group 2) combined with a health professional warning them “you could maybe have a wee bit of help with losing weight to make sure this doesn’t happen again” (Group 2) could spur someone to consider making lifestyle changes (Fig. 3). A few said they “would be very open to suggestions about lifestyle changes” (Group 1) and receptive to being offered active support. Some commented that the timing of any lifestyle change messages was important – that information and support would need to be offered soon

after adenoma treatment, whilst recollections of the procedures were still “hot” (Group 3) (Fig. 3). With surveillance colonoscopy (offered to all patients with adenomas), subsequent adenomas can be identified and removed before they progress to CRC. However, colonoscopy may still miss lesions, and there have been reports of interval cancers diagnosed between examinations (Leung et al., 2010 and Robertson et al., 2005). Weight gain is associated almost with the development of adenomas and recurrence, whilst weight loss is associated with reduced adenoma prevalence and recurrence rates (Sedjo et al., 2007 and Yamaji et al., 2008). Therefore, it would seem prudent to recommend weight loss to overweight adults who have experienced an adenoma in order to minimise risk of colorectal cancers as well as related co-morbidities (Avenell et al., 2004). This small qualitative study added to our understanding of the potential and challenges of adenoma diagnosis and treatment as a prevention opportunity and yielded insight into how patients might respond to an invitation to participate in the BeWEL RCT.