Taking Steps to Address Cancer: Prevention

Last year, MD Anderson President John Mendelsohn, M.D., proposed 10 steps that can be taken to ensure cancer deaths decrease more rapidly, the ranks of survivors swell, and an even greater number of cancers are prevented in the first place.

This is the third in a series of posts on key actions outlined by Mendelsohn:

3. Prevent more cancers.
In an ideal world, cancer "care" would begin with risk assessment and counseling of a person when no malignant disease is present. Risk factors include both inherited or acquired genetic abnormalities and other factors that are related to behavior, lifestyle and the environment. The largest risk factor for cancer is tobacco smoking, which accounts for nearly one-third of all cancer deaths. Tobacco is also a major contributor to cardiovascular and pulmonary diseases. Tobacco use should be discouraged with cost disincentives, and government and private sector payors should reimburse medical management of discontinuing tobacco use.

A second major risk factor is obesity, which has become a major public health concern in the United States. An estimated 30% of our population is obese and this is associated with increased risk of cardiovascular disease, cancer and diabetes.

Since these diseases account for more than half of health care expenses, there is a tremendous opportunity to improve health and reduce the expenditures for health care. Modification of diet is the top priority. In addition to the types and quantities of foods that we eat, exercise fits into this equation by burning off calories. Addressing these important components of behavior and lifestyle will have a major impact on the mortality from cancer.

Information is available on a small number of inherited genetic risk factors that result in a major risk of cancer. More research is needed to identify and quantify environmental risk factors related to molecules we introduce into the air we breathe and the food we eat.

Cancer risk assessment should be followed by appropriate interventions (either behavioral or medical) at a pre-malignant stage, before a person develops cancer. Diagnosis and treatment of a confirmed cancer would occur only when these preventive measures fail.

A full understanding of cancer in our diverse society requires research to identify more completely the genetic, environmental, lifestyle and social factors that contribute to the varying types and rates of cancer in different groups in this country and around the world.

A common cancer in Japan or India, for example, often is not a common cancer in the United States. When prostate cancer occurs in African-Americans it is more severe than in Caucasians. A better understanding of the factors that influence differences in cancer incidence and deaths will provide important clues to preventing cancer in diverse populations world-wide.

Next: 4. Address the needs of cancer survivors.