Cancer prevention: epidemiology and perspectives

https://doi.org/10.1016/S0959-8049(99)00094-5Get rights and content

Abstract

Following increases up until the late 1980s, some decline in cancer mortality has been observed in North America and in Western Europe. Approximately half the decline can be attributed to the levelling off in lung and other tobacco-related cancer epidemics and the rest to several factors, including reduced exposure to occupational carcinogens, prevention and early diagnosis, and improved treatment. Between 25 and 30% of all cancer deaths in Europe are due to tobacco smoking. In this review the effect of tobacco smoking on cancer incidence and mortality is examined, together with other important aetiological factors including alcohol, diet and environmental and occupational carcinogens. The effect of new treatments and the potential for prevention of cancer are also discussed.

Section snippets

Introduction and descriptive epidemiology

Cancer incidence and mortality have been steadily rising throughout this century in most areas of the world. However, over the last few years, in North America and in Western Europe, some decline in cancer mortality has been observed. Thus, age-standardised cancer mortality rates for all neoplasms in the U.S.A. declined by 3.1% in both sexes combined between 1990 and 1995 [1]. Approximately half the decline was attributed to the levelling off in lung and other tobacco-related cancer epidemics,

Tobacco

In Europe, as well as in Japan and North America, between 80 and 90% of lung cancers in men, and between 55 and 80% of lung cancers in women, are attributable to cigarette smoking. Between 75 and 90% of cancers arising in the oesophagus, larynx and oral cavity are related to the effect of tobacco, both acting singly and jointly with alcohol consumption. Cancers of the bladder, pancreas, kidney and cervix are causally related to tobacco smoking, and there have been suggestions of an association

Screening and early diagnosis

Screening for cancer was reviewed by Jack Cuzick in an earlier Millennium Review [60], and only some main quantitative aspects will be mentioned here.

A more rational approach to cervical screening (Pap test) could further reduce the risk of this neoplasm and avoid up to 1% of cancer mortality in some areas of Europe.

It is also likely that rational indication of mammography can reduce breast cancer mortality by 20–30% in women aged 50–70 years. Early diagnosis and surveillance have been shown to

Potential impact of newer therapies on the prevention of cancer deaths

It is difficult to understand and quantify the potential impact of newer treatment on cancer survival. For several of these neoplasms, there is little basis to suggest any material improvement, but even in the case of breast cancer, where a 10% improvement in survival may have been achieved 63, 64, this can easily be missed within the changes of incidence.

There are, however, a few selected neoplasms or groups of neoplasms for which the progress in therapy over the last few decades has been

Acknowledgements

I thank Dr Peter Boyle for providing material on the smoking section, Dr Carlo La Vecchia for other parts of the manuscript, and Mrs France Lucchini for technical assistance. This work was partly supported by the Swiss Cancer Research Foundation (grants KFS 497-8-1997 and KFS 700-8-1998).

Since 1993, Fabio Levi, MD, has been Chief of the Cancer Epidemiology Unit, Director of the Cancer Registries of the Swiss Cantons of Vaud and Neuchâtel at the Institute of Social and Preventive Medicine of the University of Lausanne and Associate Professor of Epidemiology at the Medical Faculty of the University of Lausanne, Switzerland. His main areas of interest are descriptive epidemiology of cancer and other chronic diseases, and analytical epidemiology, with a particular interest on the

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    Since 1993, Fabio Levi, MD, has been Chief of the Cancer Epidemiology Unit, Director of the Cancer Registries of the Swiss Cantons of Vaud and Neuchâtel at the Institute of Social and Preventive Medicine of the University of Lausanne and Associate Professor of Epidemiology at the Medical Faculty of the University of Lausanne, Switzerland. His main areas of interest are descriptive epidemiology of cancer and other chronic diseases, and analytical epidemiology, with a particular interest on the effects of smoking and diet. He has contributed to the assessment of the risk of cancer following a number of benign conditions, defined the histotype specific risk of lung cancer following the changing type of cigarette smoking and provided comprehensive figures of trends in cancer incidence and mortality in Europe

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