GLOBAL PERSPECTIVE ON CANCER PREVENTION AND EARLY DETECTION

It is well known that in some cases cancer can be prevented and, in others, early detection can reduce mortality.  In U.S. and worldwide our aim as oncology professionals is to reduce cancer morbidity and mortality.  This is best accomplished by cancer prevention and early detection.  Here I will try to describe the six most influential groups of individuals and agents who I believe can and should be involved in this important healthcare process. 

HEALTHY INDIVIDUALS:  Each individual should take charge of his or her health, assume responsibility for preventing cancer that are preventable, and adhere to available screening programs that have proven to be of value.  Healthy behaviors should include avoiding smoking and obesity, regular exercising, maintaining a balanced diet, and avoiding extraneous poisoning and hazardous exposure. 

GOVERNMENT:  The World Health Organization (WHO), the Union for International Cancer Control (UICC), the U.S. Surgeon General, and other officials and organizations have recommended that governments prepare national cancer control programs promoting primary and secondary prevention.  It is the role of the government to secure continuing improvement in the general health of population by imposing legislative, regulatory and environmental measures, as well as by launching screening educational programs for the general public.  Most governments (168 of 192 WHO member states) have signed the WHO framework convention on tobacco control, although not all nations have implemented all of its recommendations.  This evidence-based treaty sets forth worldwide standards on the dangers of tobacco and offers guidelines for limiting its use.  Governments should also be responsible for public health by minimizing occupational cancers and exposures to known carcinogens, (e.g. asbestos and lead) and by preparing national vaccination programs for diseases such as hepatitis B which is widely implemented worldwide and human papilloma virus which is implemented in the western hemisphere.

PRIMARY CARE PHYSICIANS:  Primary care physicians should help ed ucate patients that some cancers can be prevented by behavior modification and that other cancers, if detected early, can be cured.  In addition, these frontline doctors need to raise awareness of the importance of cancer screening and cancer symptoms.  When seeing a patient with symptoms, the primary care clinician should be able to diagnose or rule out cancer.

HEALTH INSURANCE PROVIDERS:  Health insurance programs have essential role in enabling access to and provision of cancer care.  These programs also have a clear role in access to and provision of cancer screening which can improve compliance rates.  Four factors are responsible for the success of cancer screening--Public policy, organizational system, the practice setting, and clinician/patient participation.  Strategies targeted at each of these levels can improve cancer screening.  Using multi-strategies with synergistic efforts can be the most effective approach.

ONCOLOGISTS:  As experts in cancer care, oncologists must be involved in the community based cancer prevention studies and community education, including efforts related to cancer prevention and screening.  The target population here can include but not limited to cancer survivors, families, health groups, high risk groups, general practitioners, health personnel as well as health authorities.  American Society of Clinical Oncology (ASCO) which is the largest and leading oncology organization established cancer prevention committee in 2002 which is committed to supporting oncologists in the risk assessment and prevention. 

CANCER SOCIETIES:  The role of the cancer society includes the following functions--

• To serve as a catalyst in assuring that effective prevention and early detection programs are fully and properly implemented by health authorities.
  
  
• To disseminate reliable information and conduct educational programs for the general population, high risk groups, and patients with cancer.
  
  
• To serve as (watchdog) in efforts to improve treatment modalities and rehabilitation methods for patients, their families and survival.
  
  
• To conduct advocacy and lobbying activities so that the comprehensive oncology network and its targets are placed high on the national health agenda.
  
  

In summary, I believe reduction of cancer morbidity and mortality is achievable via enhanced cooperation and coordination among the six agents described herein.  Everybody, should be responsible and accountable to do the utmost to accomplish the important and novel mission of reducing suffering caused by cancer.  This noble mission is achievable and should be done on the national scale.

Haitham Al-Okk, MD