Cancer Causes and Control

Dear Colleagues,

Cancer is to a large extent avoidable. Many cancers can be prevented. Others can be detected early in their development, treated and cured. Even with late stage cancer, the pain can be reduced, the progression of the cancer slowed, and patients and their families helped to cope.

But because of the wealth of available knowledge, all countries can, at some useful level, implement the four basic components of cancer control: prevention, early detection, diagnosis and treatment, and palliative care, and thus avoid and cure many cancers, as well as palliating the suffering.

Cancer control aims to reduce the incidence, morbidity, and mortality of cancer and to improve the quality of life of cancer patients in a defined population, through the systematic implementation of evidence-based interventions for prevention, early detection, diagnosis, treatment, and palliative care. Comprehensive cancer control addresses the whole population, while seeking to respond to the needs of the different subgroups at risk.

Components of Cancer Control

Prevention of cancer, especially when integrated with the prevention of chronic diseases and other related problems (such as reproductive health, hepatitis B immunization, HIV/AIDS, occupational and environmental health), offers the greatest public health potential and the most cost-effective long-term method of cancer control. We now have sufficient knowledge to prevent around 40% of all cancers. Most cancers are linked to tobacco use, unhealthy diet, or infectious agents.

Early detection detects (or diagnoses) the disease at an early stage, when it has a high potential for cure (e.g., cervical or breast cancer). Interventions are available which permit the early detection and effective treatment of around one third of cases.

There are two strategies for early detection:

• early diagnosis, often involving the patient's awareness of early signs and symptoms, leading to a consultation with a health provider – who then promptly refers the patient for confirmation of diagnosis and treatment;
• national or regional screening of asymptomatic and apparently healthy individuals to detect pre-cancerous lesions or an early stage of cancer, and to arrange referral for diagnosis and treatment.

Treatment aims to cure disease, prolong life, and improve the quality of remaining life after the diagnosis of cancer is confirmed by the appropriate available procedures. The most effective and efficient treatment is linked to early detection programmes and follows evidence-based standards of care. Patients can benefit either by cure or by prolonged life, in cases of cancers that although disseminated are highly responsive to treatment, including acute leukaemia and lymphoma. This component also addresses rehabilitation aimed at improving the quality of life of patients with impairments due to cancer (see Diagnosis and Treatment module).

Palliative care meets the needs of all patients requiring relief from symptoms, and the needs of patients and their families for psychosocial and supportive care. This is particularly true when patients are in advanced stages and have a very low chance of being cured, or when they are facing the terminal phase of the disease. Because of the emotional, spiritual, social and economic consequences of cancer and its management, palliative care services addressing the needs of patients and their families, from the time of diagnosis, can improve quality of life and the ability to cope effectively (see Palliative Care module).

You may choose our Joint Special Issue in International Journal of Environmental Research and Public Health.

Dr. Rafael Marcos-Gragera
Guest Editor

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• cancer burden
• risk factors for cancer
• primary cancer prevention
• secondary cancer prevention
• tertiary cancer prevention
• quality of life for people who have cancer
• population-based cancer registry