Global cancer control: an interdisciplinary approach to prevention

Christopher Wild (IARC) 2 retalladaThe director of the International Agency for Research on Cancer (IARC), Christopher Wild, celebrated his birthday in style this year. On that special day, February 21, he gave a talk to a full auditorium at the PRBB, in what was the 3rd Global Health session co-organised by ISGlobal, CRESIB and CREAL. This was his second visit to the park, the first one being six years ago, when the building was pretty much empty. “It’s great to see how now everything is thriving!”, he said.

Wild started pointing out the three aims of the IARC, the cancer agency of the World Health Organization (WHO): describing occurrence of cancers, evaluating prevention strategies, and supporting implementation in clinical settings. He highlighted particularly the low-income countries where cancer cases are increasing exponentially, with 60% of cancers worldwide now being in developing countries.

The role IARC is crucial if we take into account that 30% of non-transmissible diseases in 30-70 years-old are due to cancer. And especially so if we look at the predictions based on demographics: according to the agency’s director, by 2030 there might be 21.7 million cases of cancer, when in 2012 there were 14 million.

“Cancer patterns are not static; as countries develop, so they do. We need to think forward”

As Wild pointed out, we cannot treat our way out of cancer, so what we need is prevention. Half of the cancers could be prevented by the knowledge we currently have. And taking into account that most cancers have environmental or life style causes, the potential to act is even greater. We have known for years that tobacco, infections, alcohol, lack of physical activity and obesity are factors that can increase your risk of cancer. And we know prevention works, as proven by the decrease of lung cancer cases in countries such as Finland of the UK after tobacco bans were introduced. But it takes a long time. Take the example of cervix cancer: screening and vaccinations against the papilloma virus can decrease its incidence, but at least 20 to 30 years have to pass before we can see an effect on the population! So, as Wild stressed, political vision and leadership is essential in order for prevention to work.

But if prevention is proving difficult, there’s an area which is even more neglected: implementation. The speaker explained some successful cases. One involved aflatoxin, a known carcinogen produced by a fungus that grows on peanuts and corn. In 2005, intervention in some 20 villages in Africa, where simple resources were given to reduce exposure to the fungus (by using mats to reduce humidity, etc.), lead to 60% reduction in exposure. In turn, this lead to only 2% of the villagers having the toxin in blood, as opposed to 20% of people in villages in which intervention hadn’t taken place.

But despite the success of this proof of concept, eight years later nothing has been implemented at a general level.

It is clear that there is a lot of work to do in this area. When asked how far the IARC should go in terms of pushing for this kind of actions, the director was cautious. “Once you become an advocate, your science is under suspicion”, he declared. Sadly, this is the reality faced by some scientists working in the health sector, whose research result can be seen as the outcome of hidden interests if they are too active in pursuing policy changes. Should scientists then just publish their results, perhaps act as advisors in some committees, and then sit back patiently and wait until politicians decide is time to take action? Hearing some of Chris Wild’s arguments and examples, I personally think not. But his point about the dangers of advocacy was a good one. The debate is open….

A report by Maruxa Martinez, Scientific Editor at the PRBB

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