5th International Cancer Control Congress
Cancer and NCD prevention from a global perspective
Dr Graham Colditz - Institute for Public health, St. Louis, USA
This morning I got to present an overview of the burden of cancer and other non-communicable diseases from a global perspective, highlighting the increasing number of cases of cancer being diagnosed each year and emphasising that the majority of those cancer cases occur in low and middle income countries. We can contrast that with the research focus which is very much in high income countries and really the research is looking for new drugs, new ways to treat cancer, and the world really has a challenge of prevention that we’re not putting the same energy into. I worked through some of the examples, like breast cancer where with rapidly changing reproductive patterns, so fertility has come down in countries throughout the world with better access to contraception, shifting from six or seven pregnancies per woman down to somewhere between one and two, we’ve shifted that to an older age and with that breast cancer rates go up. We can look at Korea as a highlight where rates in their registry, particularly among premenopausal women, have increased to be comparable to the United States. When we look at the fertility patterns around the world and particularly low and middle income countries, with the rapid decline in childbearing there’s, over the next thirty years or more, an explosion of breast cancer.
We all know about smoking and lung cancer and how that pattern emerges so from that we quickly ran through the leading causes of cancer that we could be acting on today: smoking, obesity, lack of physical activity, poor diet and of course also vaccines. The vaccines for HPV and hepatitis vaccine really again highlight the contrast between high income countries and low/middle income countries where they’re being used quite aggressively in higher income countries and we still haven’t got full use in low income countries and yet the burden of cervical cancer and liver cancer is far higher in our low income countries. So, again, getting the known strategies for prevention to the populations that need them really has to be our highest priority.
I also emphasised the need to think of our prevention strategies as involving healthcare providers as well as the regulations that will reinforce healthy behaviours, whether that’s tobacco tax or our policies on alcohol, our policies on access to safe places to exercise, neighbourhood safety and so forth. Then the third layer of that onion is really the community in which we live, our schools and other components of that. But emphasise that that community is located in a broader social mix that’s exposed to marketing, whether it’s tobacco, alcohol, diet, factors that ultimately impact our obesity, our cancer risk etc. So wanting the participants here, from providers through to public health and policy people, to remember that we need to be working at all these levels. We need providers reminding patients of the importance of prevention; we need government working to make our neighbourhoods safe and our environment safe and then we need programmes in our communities, our schools and so forth that promote a healthy lifestyle.
The last point in all this is that the healthy lifestyle we’re talking about doesn’t just benefit from lowering risk of cancer but it’s the same lifestyle that benefits heart disease and diabetes risk. So there are many benefits if we can move to reduce smoking, more physical activity, avoiding weight gain, healthy diet and limiting alcohol intake.