Primary Prevention of Cancer

Primary Prevention of Cancer Your stories on cancer present well-rounded perspectives on cancer treatment.1,2 However, for targeting cancer incidence and mortalities, increased attention must be directed toward primary prevention of cancer, rather than most resources being centered on molecular and mechanistic biology, diagnoses, and treatment regimens. These issues are vitally important, but primary prevention has been too long proportionately neglected. Except for tobacco, and even there global public health attention to this disaster is woeful, there are few concerted efforts toward primary prevention of cancer and related diseases. We endorse eating fruits and vegetables, exercise, physical activity, maintaining healthy body weights, eating suitable diets, avoiding sun exposures/artificial tanning, using screening diagnostic aids judiciously (PSA, mammograms, pap smears), and limiting consumption of alcohol/tobacco. Clearly, more must be done in other aspects of primary prevention: avoiding known/suspected environmental causes of cancers, and identifying additional causes. Too much attention and resources are geared toward molecular carcinogenesis and treatment regimens. Witness the premier American Association for Cancer Research meeting on cancer prevention research scheduled for October in Boston. Not a single session or presentation centers on primary prevention of cancer. Image: Anthony Canamucio After long disregard, substantially more effort must be given to preventing cancer from having the opportunity to be initiated. We must reorient our public and private health programs to include and highlight this vitally important discipline. For example, the National Cancer Institute and the American Cancer Society do proportionately and comparatively little in primary prevention of cancer; it's a very small percentage of their overall budgets. These and other organizations devoted to cancer efforts should give increased attention to primary prevention. More outreach efforts are essential to better inform lawmakers and regulatory agencies and the public on scientific aspects and dire unmet needs of primary cancer prevention. Unfortunately, most organizations are not focused toward these important primary preventative strategies. One reason primary prevention receives scant attention and little verve centers on the difficulty of measuring prevention success. That is, because chemical/environmental/lifestyle causes of cancer (estimated as 80-90% of cancers) often take 20-40 years to develop, difficulties exist in determining the actual numbers of cancers prevented or delayed. Historically, we know that reducing/ eliminating workers' exposures to chemical carcinogens or exposure circumstances reduces occupational cancers. These easily initiated or strengthened primary prevention strategies will reduce cancer incidences and hence cancer morbidities and mortalities: Reduce/eliminate tobacco usage, subsidies, exportation, and advertising. Stop asbestos use worldwide. Reduce/eliminate workplace exposures to carcinogens (benzene, beryllium, butadiene, chromium, pesticides, and many other known/suspected human carcinogens) and hazardous exposure circumstances (asphalt fumes, coke oven emissions, furniture/cabinet making, painting, rubber/tire manufacturing). Reduce/eliminate farm worker and consumer exposures to pesticides/herbicides, especially on lawns and around homes. Reduce/eliminate chlorination byproducts exposures from drinking water, explore less hazardous methods. Reduce/eliminate air pollution (coal/power plants, chemical industries, gasoline/diesel vehicles). Reduce/eliminate consumer exposures to chemicals, especially suspected/known carcinogens. Reduce/eliminate known and suspected carcinogens in/on foods (pesticides and food additives) and in consumer products, including cosmetics. Design noncarcinogenic drugs for cancer chemotherapy. Clean up/eliminate hazardous waste sites and reduce/prevent current industry pollution practices. Increased efforts for primary prevention of cancer also include: Increasing public awareness and education of known causes of cancers (nearly 100 identified chemicals/industries cause cancer in humans). Increasing worker knowledge of exposures and safety precautions. Increasing efforts to identify environmental causes of cancer. Increasing regulatory efforts to reduce/eliminate exposures to occupational/environmental carcinogens. Increasing public awareness regarding lifestyle/personal habits and cancer increases (obesity, tobacco use, diet, alcohol). Initiating a "health tax" on tobacco/alcohol products for clinical treatments and hospital costs for use-victims. Increasing right-to-know information on avoidable causes of cancer. Increasing regulatory standards and enforcements for environment and workplaces. Increasing reliance on experimental means of identifying carcinogens. These straightforward and simple efforts, with diagnostic techniques and treatment regimes, will reduce mortality from cancer. However, only greater efforts in primary prevention strategies will reduce the continuing increasing cancer incidences, and will also reduce cancer morbidity/mortality. Thus a nation devoting billions of dollars on the "war on cancer" needs to mount renewed and increased efforts toward primary prevention of cancer and other diseases. To do otherwise is wrong. James Huff, PhD National Institute of Environmental Health Sciences Research Triangle Park, NC Barry Castleman, DSc Environmental Consultant Baltimore Joseph LaDou, MD International Center for Occupational Medicine University of California School of Medicine San Francisco Samuel S. Epstein, MD Professor Emeritus, Environmental and Occupational Medicine University of Illinois at Chicago School of Public Health ** Chairman, Cancer Prevention Coalition Chicago Arthur L. Frank, MD, PhD Professor of Public Health Drexel University of Public Health Philadelphia Morris Greenberg, MB, FRCP London Kim Hooper, PhD Environmental Health Sciences Berkeley, Calif. Peter Infante, PhD Consultant in Occupational Health Washington, DC Ronald Melnick, PhD National Institute of Environmental Health Sciences Research Triangle Park, NC Jennifer Beth Sass, PhD Senior Scientist, Natural Resource Defense Council Washington, DC Daniel Teitelbaum, MD Professor of Environmental Sciences and Engineering Colorado School of Mines Denver Lorenzo Tomatis, MD Cave25/R, 34011 Aurisina, Trieste, Italy References 1. D. Steinberg, "Closing in on multiple cancer targets," The Scientist, 16[7]:29-31, April 1, 2002. 2. C. Bahls, M. Fogarty, "Reining in a killer disease," The Scientist, 16[11]:16-18, May 27, 2002.

Primary Prevention of Cancer

Primary Prevention of Cancer

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