'We Know What to Do' -- Cancer Prevention Must Be Implemented

Fran Lowry

March 08, 2017

The US cancer burden could be reduced right now if known cancer prevention strategies were implemented, public health experts say.

"The main point we want to get across is that we know how to prevent many cancers," says Graham A. Colditz, MD, PhD, Niess-Gain Professor of Surgery and deputy director of the Institute for Public Health at Washington University, St. Louis, Missouri.

"We know what to do, we just need the will to do it," he told Medscape Medical News.

"We have the knowledge, we've done the research, we know what works. Now is the time to use these resources to educate and engage the community to make healthy lifestyle changes and choices," he added.

Dr Graham A. Colditz

Dr Colditz is coauthor of a "Sounding Board" article on the subject that appears in the March 9 issue of the New England Journal of Medicine. Coauthor is Karen M. Emmons, PhD, from Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

"In the past two decades, we and others have estimated that more than half of cancers could have been prevented by applying knowledge that we already have," the authors write.

"We need to get our return on all the money we've already spent on research to understand prevention. We've made the investment over the last 50 years, and now we're not getting our full payback because we're not using all the preventive strategies that have been shown to be so effective," Dr Colditz told Medscape Medical News.

The main point we want to get across is that we know how to prevent many cancers. Dr Graham A. Colditz

That lack of implementation of effective cancer prevention strategies means that people are getting cancer that could be prevented and are dying of cancer that could be prevented, he emphasized.

"So, what we need to do now is to understand what are the features that are actually leading to less than complete use of these effective prevention strategies, and why are there such differences in access to prevention across the US. We need increased research into how best to break down barriers that keep well known prevention strategies from being adopted," Dr Colditz said.

For example, smoking cessation is a well-established lung cancer prevention strategy. But, to be successful, smokers need to be supported in their efforts to quit and maintain that, he said.

"We've got such variation between states, despite the fact that the Surgeon General has been saying for 50 years that smoking is the leading cause of cancer that is preventable. We need to give everyone, regardless of where they live in the US, access to programs that support their efforts to stop smoking," Dr Colditz said.

Smoking cessation programs actually save money for the healthcare system, he noted.

"For example, for every dollar the Massachusetts Medicaid program spent to provide smoking cessation programs, they saved more than $2.00 in health care costs. Instead of just saying 'Smoking is bad for you,' they actually put a system in place to help people in their efforts to stop smoking," Dr Colditz said.

Most people know about screening for colon, breast, and cervical cancer, yet not everyone has access to such screening. If there were universal access to screening, "we probably wouldn't have some of the problems we do have," he said.

In the United States and many European countries, women have regular Papanicolaou (Pap) smears to screen for cancer of the cervix. But in Australia, this test is soon to become a thing of the past because of a successful nationwide vaccination program against human papillomavirus (HPV), Dr Colditz said.

"The federal government pays for the vaccine so all children going into middle school get vaccinated. Their rates of vaccination are high enough and they have shifted to having an HPV blood test every 5 years rather than Pap smears. Show me a woman who wouldn't like to be living in Australia with that as an option. They've done the math. Vaccination saves costs, reduces cases of cervical cancer, reduces procedures for preinvasive cervical lesions, and reduces mortality," he said.

Dissemination of information and implementation research that is focused on strategies needed to enhance population-level cancer prevention may be very productive, Dr Colditz said.

"Environmental and policy initiatives can reach a large number of people efficiently. I would like to see more programs to help people quit smoking, maintain a healthy weight, increase their physical activity, eat more fresh fruits and vegetables, and get appropriate cancer screenings and vaccinations," he said.

Dr Colditz is supported in part by the Alvin J. Siteman Cancer Center. Dr Emmons was employed by Kaiser Permanente during the period in which the manuscript was written.

N Engl J Med. 2017;376:986-990. Abstract

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