Cancer prevention: epidemiology and perspectives
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
References (75)
- et al.
Declining cancer mortality in European Union
Lancet
(1997) Tobacco and cancer, the European perspective
Ann. Oncol.
(1995)- et al.
Smoking and cancer with emphasis on Europe
Eur. J. Cancer
(1991) - et al.
Epidemiology and prevention of oral cancer
Oral Oncol.
(1997) - et al.
Variations in mortality by weight among 750,000 men and women
J. Chron. Dis.
(1979) Screening for cancerfuture potential
Eur. J. Cancer
(1999)- et al.
Screening of cancer, 1995an update
Ann. Oncol.
(1995) - et al.
Prevention of breast cancer with tamoxifenpreliminary findings from the Italian randomized trial among hysterectomized women
Lancet
(1998) - et al.
Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial
Lancet
(1998) - et al.
Declining cancer mortality in the United States
Cancer
(1996)
Smoking and drinking in relation to cancer of the oral cavity, pharynx, larynx, and esophagus in Northern Italy
Cancer Res.
Cancer incidence and mortality in Europe, 1988–92
J. Epidemiol. Biostat.
Lung cancer and passive smoking
Int. J. Cancer
The past, present, and future of the prevention of lung cancer
Cancer Epidemiol., Biomarkers Prev.
Lung carcinoma trends by histologic type in Vaud and Neuchâtel, Switzerland
Cancer
Global burden of cancer
Lancet
Trends in cancer mortality in central European countries
Eur. J. Publ. Health
Mortality from smoking in developed countries 1950–2000. Indirect Estimates from National Vital Statistics
Trends in smoking in Europe
Eur. J. Cancer Prev.
Tobacco or Healtha Global Status Report
Alcoholic beverages and cancer of the digestive tract and larynx
Cancer of the oral cavity and pharynx in nonsmokers who drink alcohol and in nondrinkers who smoke tobacco
J. Nat.l Cancer Inst.
Type of alcohol beverage and cancer of the oral cavity, pharynx and oesophagus in an Italian area with high wine consumption
Int. J. Cancer
Alcohol and breast cancer. Where are we now and where do we go from here?
Cancer
Cancer incidence and mortality in Europe, 1983–87
Soz Ptaeventivmed
Worldwide patterns of cancer mortality, 1985–1989
Eur. J. Cancer Prev.
Health transformations in Poland after 1988
J. Epidemiol. Biostat.
The causes of cancerquantitative estimates of avoidable risks of cancer in the United States today
J. Natl. Cancer Inst.
Harvard report on cancer prevention
Cancer Causes Control
Nutrition and cancer
Cancer Causes Control
Fruit and vegetables, and human cancer
Eur. J. Cancer Prev.
Whole grain food intake and cancer risk
Int. J. Cancer
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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