February 4th is World Cancer Day – a day to reflect, plan and act on visions for cancer control. The initiative is lead by the Union for International Cancer Control (UICC) who have invited organisations, institutions, communities and people who care about cancer in every part of the world to spread the word and raise the profile of cancer in people’s minds.
In my mind are two big arenas of cancer control that we need to get everyone thinking and acting on.
Not just high-resource countries
The first issue is the predicted rise in incidence of cancer in every nation around the world. In 2013 the global cancer burden was estimated to be at least 14.1 million new cases and 8.2 million cancer deaths. More than half of all cancers and cancer deaths in 2012 occurred in less developed regions of the world, and these proportions will increase further by 2025. In times of diminishing resources for health budgets the expensive drugs and technologies which we may have access to in developed countries will be beyond the reach of many millions of people globally.
Focus on prevention
Everyone dreams of better treatments, less side effects and better survivorship and these are the very worthiest of hopes. But do we focus too much on treatment and too little on cancer prevention? Is there anyone who has been diagnosed with cancer who would not have preferred the disease to be prevented? Dr Christopher Wild, Director of the International Agency for Research on Cancer said: “We cannot treat our way out of the cancer problem. A balanced approach to prevention, early detection and treatment is required.”
But we certainly do not have a balanced approach when it comes to prevention. For example, in Scotland, breast cancer incidence is predicted to rise by 27% between 2008–12 and 2023–27. These rates echo those increases that have been seen for decades in Scotland and throughout the world. Most learned texts say increased incidence is due to more diagnosis, ageing, change in reproductive history and (in passing) a shift in lifestyle.
The last offers little opportunities for our expert laboratory colleagues to gain research funding or drug company investment but does offer the chance for many women to reduce their risk of the disease. One look at our national spend on research on prevention shows how unbalanced our prevention spend really is and notably in the area of “lifestyle shift”.
We have a national breast cancer screening programme in the UK (and in many countries worldwide) but there are no national screening and prevention programmes. In the UK, women are denied the opportunity to hear about how lifestyle can help to reduce breast cancer risk although there is evidence that the setting of a screening programme is an acceptable one for hearing about effective and supportive interventions. It is interesting that women say they have heard about different aspects of lifestyle in relation to heart disease and diabetes but not breast cancer.
This information is still news to far too many women including those with a family history of the disease. Estimates for the importance of lifestyle and breast cancer prevention vary between 27% and 38% of the disease that can be prevented by decreases in body weight, alcohol and inactivity. If any drug offered such a significant drop in risk (with no side effects) we would all be talking about it – headline news indeed!
Promote changes in lifestyle
The second issue is about how we can move beyond the statistics into action to promote changes in lifestyle. These changes should embrace education and motivational approaches and support visions for a healthier environment where the price, availability and marketing of food and drinks match the health needs of our population.
It is too late to argue whether taxes or limiting portion sizes or reducing marketing of unhealthy food are the right way to go. The evidence on lifestyle and cancer risk is too strong to ignore. It is now time to say how can we put these actions into place in an equitable manner so that all of society can reduce the risks of one our biggest fears.
Last month saw a publication (Diet and Nutrition Proposals for setting the direction for the Scottish diet) from Food Standards Scotland of a vision on how we can help to achieve dietary change in Scotland. I can support these plans wholeheartedly because there needs to be strong voices for supporting diet and lifestyle change for cancer prevention. I think we can all work together to support governments who take effective actions to make the healthy diet and physical activity options the preferred options.
Watch World Cancer Research Fund International’s 1 minute video featuring all 10 Cancer Prevention Recommendations. For the latest news from the organisation, please follow twitter.com/wcrfint.