Prevention key to curbing looming cancer surge: WHO

The Guardian, LONDON

Wed, Feb 05, 2014 - Page 7

The WHO on Monday called for a concerted global effort to tackle the causes of cancer linked to lifestyle, such as alcohol abuse, sugar and obesity, as it predicted that the number of new cases is set to soar by 70 percent to nearly 25 million a year over the next two decades.

Half of these cases are preventable because they are linked to lifestyle, the UN’s public health arm said in its World Cancer Report. The authors say it is implausible for people to think they can treat their way out of the disease and argue that the focus must now be on preventing new cases.

Even the richest countries will struggle to cope with the spiraling costs of treatment and care for cancer patients, while the lower-income countries — where the number of cases are expected to be highest — are ill-equipped to bear such a burden.

The global incidence of cancer has risen from 12.7 million in 2008 to 14.1 million new cases in 2012, when there were 8.2 million deaths from the illness. By 2032, the 14.1 million figure is to increase by 70 percent to almost 25 million a year.

The biggest burden will be in low and middle-income countries, where the population is increasing and living longer. They are hit by two types of cancers: First are those triggered by infections, such as cervical cancers, which are still very prevalent in poorer countries that do not have screening, let alone the HPV vaccine.

Second, there are increasingly more cancers associated with the lifestyles of more affluent countries “with increasing use of tobacco, consumption of alcohol and highly processed foods and lack of physical activity,” WHO Director-General Margaret Chan wrote in an introduction to the report.

Christopher Wild, director of the International Agency for Research on Cancer (IARC) and coauthor of the report, said that when people learn what he does for a living, they ask whether a cure has been found, but few think about preventing the disease.

“Despite exciting advances, the report shows that we cannot treat our way out of the cancer problem. More commitment to prevention and early detection is desperately needed in order to complement improved treatments and address the alarming rise in the cancer burden globally,” Wild said.

Fellow coauthor Bernard Stewart from the University of New South Wales talked of “the crucial role of prevention in combating the tidal wave of cancer” and called for discussion on how to encourage people to change their lifestyles, including by taxing sugared drinks, which could be one possible brake on cancers caused by overweight and obesity and lack of physical exercise.

The world has moved on from what Stewart called a “naive approach” to smoking, which causes lung and other cancers, and once was limited to handing out leaflets and haranguing people to give up. He cited the global tobacco control treaty from the WHO, which incentivizes governments to pass laws banning smoking in public places.

The World Cancer Report, an 800-page volume on the state of cancer knowledge that is the first to be released in five years, must open up the debate, Stewart said.

“In relation to alcohol, for instance, we are all aware of the effects of being intoxicated, but there is a burden of disease not talked about because it is not recognized,” he said.

The report shows that alcohol-attributable cancers were responsible for 337,400 deaths worldwide in 2010, mostly among men. The majority were liver cancer deaths, but drinking alcohol is also a risk for cancers of the mouth, esophagus, bowel, stomach, pancreas, breast and others.

“Labeling and availability and the price of alcohol should all be on the agenda,” Stewart said, adding that so should taxation of sugar-sweetened drinks.

The report calls for efforts to reduce the amount of cola, lemonade and other drinks containing substantial amounts of added sugar to become “a high priority.”

Stewart said that obesity is a greater risk for diabetes than cancer, but awareness of cancer is so great in communities that the cancer risk is likely to put more pressure on politicians to act.

For example, about half of Britons do not recognize the importance of diet in protecting them against cancer, according to a poll carried out by the World Cancer Research Fund. Eating a lot of red meat — especially processed prodcuts — increases the risk of bowel cancer.

Eating fruit and vegetables may protect against some forms of cancer, although the report said it “does not appear to be as strongly protective against cancer as initially believed.”

However, IARC said it is definitely protective against diabetes and heart disease.

The survey also found that 59 percent of people did not know that putting on weight increased cancer risk.

Lung cancer is the most commonly diagnosed form of cancer among men (16.7 percent of cases) and the biggest killer (23.6 percent of deaths), the IARC report said.

Breast cancer is the most common diagnosis in women at 25.2 percent and caused 14.7 percent of deaths, which is a drop in the ocean and now only just exceeds lung cancer deaths in women, which account for 13.8 percent of deaths. Bowel, prostate and stomach cancer are the other most common diagnoses among women.