In the Journals

More than half of cancers may be preventable using existing resources

More than half of cancers in the United States may be preventable, according to researchers at Washington University in St. Louis.

Graham A. Colditz, MD, DrPH, the Niess-Gain Professor in the School of Medicine and associate director of prevention and control at the Siteman Cancer Center, and colleagues recently published a paper in Science Translational Medicine in which they said a combination of behavioral interventions and public health efforts could dramatically reduce cancer incidence and mortality.

These “research-proven” strategies can prevent both initial cancers and recurrences, the researchers wrote.

“We actually have an enormous amount of data about the causes and preventability of cancer,” Colditz said in a press release. “It’s time we made an investment in implementing what we know.”

Colditz and colleagues outlined eight obstacles to implementing what they consider known and available prevention strategies:

  • Skepticism that cancer can be prevented.
  • The short-term focus of cancer research.
  • Interventions deployed too late in life.
  • Research focus on treatment, not prevention.
  • Debates among scientists.
  • Societal factors that affect health outcomes.
  • Lack of transdisciplinary approaches.
  • The complexity of successful implementation.

Colditz cited CDC data that indicates the smoking-related mortality rate is nearly 75% lower in Utah than in Kentucky. Smoking rates in Kentucky are more than double those in Utah.

“We conservatively estimate that 75% or more of lung cancer could be prevented through elimination of cigarette smoking in the United States,” Colditz and colleagues wrote.

The researchers suggested studies with extended follow-up were linked to more conclusive results and yielded more concrete prevention strategies, although achieving such results is considerably more difficult with research funding that lasts 5 years or less, the usual span allotted.

The success of vaccinations (such as hepatitis or HPV), sun protection measures, and even teen alcohol and breast cancer awareness programs offer documented evidence that early life interventions can have a significant effect on cancer rates, the researchers wrote.

“Our now clear understanding of the years- to decades-long time frame of tumor development, which often starts early in life, should propel us to think anew about how we can organize and commit resources to markedly reduce the burden of cancer on individuals and society,” they wrote.

Carol Fabian, MD, chairwoman of ASCO’s Prevention Committee and director of the Breast Cancer Prevention Center at the University of Kansas Medical Center, said she agreed “in general” with the point Colditz and colleagues made regarding the focus of most research.

“I do not think he means to imply that we should stop research into treating cancer patients, but that in an era of decreasing research dollars, we should be putting a greater proportion of those dollars into those things that are likely to have the biggest impact on cancer morbidity and mortality,” Fabian told HemOnc Today. “Spending billions on developing a new drug that may marginally impact survival of an individual for a few months should have a lower priority.”

Colditz and colleagues described conflict in the scientific community as a “source of inertia” that prevents forward movement in cancer research, and they said many debates will never be resolved.

“Each passing year leaves a substantially greater portion of the world population at risk for cancer, despite our current knowledge,” they wrote. “We have a moral responsibility to act now and reduce that burden.”

Although Colditz and colleagues addressed lifestyle factors from a largely policy-based perspective, Fabian brought it to a more personal level.

“The biggest challenges are impacting lifestyle, and not just of socially disadvantaged individuals,” she said. “Most of these patterns are set early in life. Physical education classes need to be back in schools and need to be mandatory for all grades. Nutrition needs to be taught early on along with implementation tactics such as how to shop and cook with fresh foods, at low cost and quickly. Sidewalks need to be mandatory, along with bike and walking trails for all neighborhoods. It needs to be socially unacceptable to lead a sedentary lifestyle or eat high-fat, calorie-dense foods. These foods need to disappear from the school lunch and breakfast programs.”

The lack of transdisciplinary approaches is tied to the difficulties implementing coordinated strategies, Colditz and colleagues said. Researchers often are trained to focus on a specific aspect of the disease rather than maintain a clear view of the problem “from society to the cell,” they wrote.

In the end, it may be an issue of accountability. Clearly defining who is responsible for what aspects of implementing these strategies could be a key to their success, Colditz said.

Disclosure: Drs. Colditz and Fabian report no relevant financial disclosures.

More than half of cancers in the United States may be preventable, according to researchers at Washington University in St. Louis.

Graham A. Colditz, MD, DrPH, the Niess-Gain Professor in the School of Medicine and associate director of prevention and control at the Siteman Cancer Center, and colleagues recently published a paper in Science Translational Medicine in which they said a combination of behavioral interventions and public health efforts could dramatically reduce cancer incidence and mortality.

These “research-proven” strategies can prevent both initial cancers and recurrences, the researchers wrote.

“We actually have an enormous amount of data about the causes and preventability of cancer,” Colditz said in a press release. “It’s time we made an investment in implementing what we know.”

Colditz and colleagues outlined eight obstacles to implementing what they consider known and available prevention strategies:

  • Skepticism that cancer can be prevented.
  • The short-term focus of cancer research.
  • Interventions deployed too late in life.
  • Research focus on treatment, not prevention.
  • Debates among scientists.
  • Societal factors that affect health outcomes.
  • Lack of transdisciplinary approaches.
  • The complexity of successful implementation.

Colditz cited CDC data that indicates the smoking-related mortality rate is nearly 75% lower in Utah than in Kentucky. Smoking rates in Kentucky are more than double those in Utah.

“We conservatively estimate that 75% or more of lung cancer could be prevented through elimination of cigarette smoking in the United States,” Colditz and colleagues wrote.

The researchers suggested studies with extended follow-up were linked to more conclusive results and yielded more concrete prevention strategies, although achieving such results is considerably more difficult with research funding that lasts 5 years or less, the usual span allotted.

The success of vaccinations (such as hepatitis or HPV), sun protection measures, and even teen alcohol and breast cancer awareness programs offer documented evidence that early life interventions can have a significant effect on cancer rates, the researchers wrote.

“Our now clear understanding of the years- to decades-long time frame of tumor development, which often starts early in life, should propel us to think anew about how we can organize and commit resources to markedly reduce the burden of cancer on individuals and society,” they wrote.

Carol Fabian, MD, chairwoman of ASCO’s Prevention Committee and director of the Breast Cancer Prevention Center at the University of Kansas Medical Center, said she agreed “in general” with the point Colditz and colleagues made regarding the focus of most research.

“I do not think he means to imply that we should stop research into treating cancer patients, but that in an era of decreasing research dollars, we should be putting a greater proportion of those dollars into those things that are likely to have the biggest impact on cancer morbidity and mortality,” Fabian told HemOnc Today. “Spending billions on developing a new drug that may marginally impact survival of an individual for a few months should have a lower priority.”

Colditz and colleagues described conflict in the scientific community as a “source of inertia” that prevents forward movement in cancer research, and they said many debates will never be resolved.

“Each passing year leaves a substantially greater portion of the world population at risk for cancer, despite our current knowledge,” they wrote. “We have a moral responsibility to act now and reduce that burden.”

Although Colditz and colleagues addressed lifestyle factors from a largely policy-based perspective, Fabian brought it to a more personal level.

“The biggest challenges are impacting lifestyle, and not just of socially disadvantaged individuals,” she said. “Most of these patterns are set early in life. Physical education classes need to be back in schools and need to be mandatory for all grades. Nutrition needs to be taught early on along with implementation tactics such as how to shop and cook with fresh foods, at low cost and quickly. Sidewalks need to be mandatory, along with bike and walking trails for all neighborhoods. It needs to be socially unacceptable to lead a sedentary lifestyle or eat high-fat, calorie-dense foods. These foods need to disappear from the school lunch and breakfast programs.”

The lack of transdisciplinary approaches is tied to the difficulties implementing coordinated strategies, Colditz and colleagues said. Researchers often are trained to focus on a specific aspect of the disease rather than maintain a clear view of the problem “from society to the cell,” they wrote.

In the end, it may be an issue of accountability. Clearly defining who is responsible for what aspects of implementing these strategies could be a key to their success, Colditz said.

Disclosure: Drs. Colditz and Fabian report no relevant financial disclosures.