Fulfilling the Potential of Cancer Prevention and Early Detection (2003) / Chapter Skim
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2. Potential to Reduce the Cancer Burden Through Cancer Prevention and Early Detection
2. Potential to Reduce the Cancer Burden Through Cancer Prevention and Early Detection
Pages 30-40
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From page 30... ...
The four analyses described in this chapter apply different methods and underlying assumptions in making their projections but arrive at a similar conclusion: that major reductions in the cancer burden are achievable by sharply reducing rates of tobacco use, increasing levels of physical activity, decreasing the prevalence of obesity, improving dietary practices, keeping alcohol consumption at low to moderate levels, and getting screened for cancer at recommended intervals. How rapidly such changes can occur will largely depend upon social investments and political will.
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From page 31... ...
Rather, Doll and Peto estimated the reduction theoretically possible by comparing the rates in the United States with those in other countries. Their choice of method stemmed from the observation that the cancer incidence rate among migrants tends to be that found in the country to which they migrated, indicating that differential cancer incidence rates are due in part to environmental factors such as diet, exercise, occupational exposures, and smoking habits, and that cancer does not arise exclusively because of genetic factors.
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From page 32... ...
To provide information on behavior-specific reductions in the rate of mortality from cancer, the investigators considered data for unique populations in the United States such as those from the Adventist Health Study, which indicated the magnitude of change possible within the context of the current U.S. culture.
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From page 33... ...
. Although ~ c~ modeled the ettects ot reductions in various risk factors with a sophisticated computer program (called Can stroll, to arrive at their goal of a 50 percent reduction in total cancer mortality rates, they underestimated the latencies of the social and political changes that would be needed to bring about large changes in the behavior of the population.
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From page 34... ...
and Prevention, and information on cancer treatment from the American College of Surgeons' National Cancer Database. Byers and colleagues made projections for cancer incidence and mortality rates for each cancer site separately and for all cancers combined, con
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From page 35... ...
Prevalence of low levels of fruit and vegetable consumption reduced to 47-58% by 2010; Prevalence of high fat intake reduced to 9-15% by 2010 Prevalence of frequent alcohol intake reduced among women to 12-14% by 2010; Prevalence of frequent and heavy alcohol intake reduced to 1-4 % by 2010 Prevalence of nonuse reduced to 23-35% by 2010 Prevalence of failure to get sigmoidoscopy every 5 years reduced to 45-55% by 2010; Prevalence of failure to get mammography every 2 years reduced to 10-15% by 2010; Prevalence of failure to get PSA test every 2 years reduced to 20-30% by 2010 Prevalence of failure to get best therapy reduced to 14-16% by 2010 15 years 10 years not explicitly stated 5 years 5 years 5 years not explicitly stated 5 years not explicitly stated 5 years sidering major cancer risk factors that had been changing over time (see Table 2.1~. They assumed a 10-year latency for the effects of tobacco and a S-year latency for the effects of other factors.
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From page 36... ...
Byers and colleagues found that past and future reductions in rates of tobacco use were the single largest contributor to the projected future declines in overall cancer incidence and mortality rates. Other risk factors for which declines in prevalence were projected to be important contributors to declines in cancer incidence and mortality rates were poor dietary practices (low levels of consumption of fruits and vegetables)
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From page 37... ...
This debate is especially active for prostate cancer, for which the certainty of screening benefit is less, but which has shown a sharp mortality decline since 1990. Despite the lack of scientific consensus on the explanations for cancer mortality declines, it seems reasonable to state that the detectable favorable changes in incidence or mortality rates that occur as a result of population-wide shifts in risk factors usually take at least several years to become manifest.
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From page 38... ...
changes in risk behaviors that resulted in setting an unrealistic national goal to halve the total cancer mortality rate between 1980 and 2000 (in fact, the mortality rate was reduced by only 7 percent for 1980 to 1997~. In the last analysis reviewed, Byers and colleagues estimated that by 2015 there would be a 13 percent total reduction in the cancer incidence rate and a 21 percent reduction in the cancer mortality rate if the prevalence of the major modifiable risk factors continued to decline at the 1990 rate; but if there were accelerated declines in these risk factors, they estimated that the cancer incidence rate could decline by 19 percent and that the cancer mortality rate could decline by 29 percent Using very different methods, the estimates of Willett et al.
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From page 39... ...
. To date, scientific estimates of the proportion of the cancer burden that can be eliminated if the population distributions of major risk factors were to be shifted in a positive direction have focused on the important but relatively narrow issues of strength of risk factor-disease associations and biological latency.
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From page 40... ...
A person who stops smoking today or who is prevented from starting smoking instantaneously reduces his or her risk of respiratory and cardiovascular problems, although the effect on the lung cancer risk may not be seen for many years (US DHHS, 1990~. Similarly, a person who adopts a healthier diet and a more active lifestyle will reduce his or her risk of heart disease, stroke, diabetes (Knowler et al., 2002)
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