It is not possible to predict the future, but the following are possible outcomes, assuming healthcare systems and policy makers build on what we already know through research. Additional research to identify additional modifiable cancer causes and/or to effective interventions to reduce risks could increase positive outcomes. In 5 years:
The availability of new communication technologies will foster the development of innovative cancer prevention interventions; for example, personal data assistants will allow real-time assessment of outcomes and delivery of information and other intervention components. In the developing world, new technologies have the potential to allow regions to 'leap frog' over inadequately developed and outmoded infrastructures (although as Howard has shown, this is by no means assured);
Obesity will be the focus of comprehensive coordinated prevention programs, modeled after tobacco control programs. Such programs will involve interventions at multiple levels and will probably need to include economic and regulatory mandates. For example, transfats have been banned in New York City (NY, USA) food and food preparation, and there are current discussions about imposing high taxes on sugared beverages. Broad and sustained initiatives that go across sectors and include, for example, legislation and policy, participation by the private sector (e.g., multinational food companies), and pubic education both to prevent obesity and to promote weight loss, are likely to be most successful;
Tobacco use in the developing world will show positive indicators of change as efforts by the WHO and other organizations gain traction. It may be unrealistic to expect changes in tobacco use rates in a 5-year period, since such cancer control strategies take time to be implemented and produce results. One useful interim indicator of progress would be an increase in the number of countries that adopt the WHO strategies, and in the number of strategies each takes up; the results of ongoing cohort studies will identify new cancer risk factors, particularly combinations of factors, and will identify gene–environment interactions that define at-risk populations for targeted interventions. In some cases, these studies will be congruent with chemoprevention research that measures both behaviors and genetic polymorphisms. These results will give rise to research on interventions that are tailored to the characteristics of specific settings and individuals;
The aging of the population worldwide will result in many more cancers, individuals in declining health, and resultant tremendous economic pressures for healthcare systems. The importance of prevention for cancer and other chronic diseases will receive increased priority. Prevention will be integrated into the health system much more closely than it is today;
Greater attention to social determinants of cancer will result in more research and resources provided to populations in need, with the result that gaps in cancer-related outcomes are reduced. This will be true both within countries and regions, and across the world. Reductions in disparities in 5 years may not be achieved, but positive progress is anticipated;
Research will increasingly reflect the environmental and social characteristics of the target population to ensure that intervention strategies applied in the developing and developed worlds, and in different subgroups, reflect their distinct needs and assets. This may result in, for example, new cohort studies being implemented in Africa, the Middle East and South America. Despite the impressive breadth of current cohort activities, these regions are not well represented;
Cancer rates will decrease, owing to widespread application and dissemination of effective interventions to increase healthy lifestyles. While this goal may seem unrealistic, it is perhaps the most likely of the bullets in this 'five-year view' to be achieved. The reductions in smoking that have occurred in many regions of the world over the past few decades, thanks to the comprehensive tobacco control programs implemented, will continue to provide benefits in the form of lower rates of tobacco-related cancers. These rates are already declining and should continue to do so, over the next 5 years and into the future, thus providing an indication of whether risk reduction can result in cancer prevention. Learning how to control other cancer risk behaviors and exposures, and eliminating the gaps in outcomes across the world will be challenges for the next 5 years and well beyond.
Thanks to Nicci Bartley for assistance in manuscript preparation and to two anonymous reviewers for their helpful comments. Thanks also to the Canadian Cancer Society – British Columbia Yukon Division for their support.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
Expert Rev Pharmacoeconomics Outcomes Res. 2010;10(2):143-154. © 2010 Expert Reviews Ltd.
Cite this: Cancer Prevention: Major Initiatives and Looking into the Future - Medscape - Apr 01, 2010.