Cancer research for cancer prevention: an international view.
Christopher Wild
International Agency for Research on Cancer, Lyon, France
The global burden of cancer is estimated to double in the next 20 years, with a majority of the increase occurring in the low and middle-income countries (LMC), where health services are least able to cope with the challenge. This inequality is highlighted by the markedly lower cancer survival rates in LMC compared to economically richer countries. Much could be achieved in terms of prevention based on implementation of current knowledge but at the same time the aetiology of many cancers remains obscure. This implies research into cancer aetiology must parallel that into cancer prevention; this combination should be the research priority in the coming decades.
Most cancers have an environmental (defined broadly) cause but the precise contribution and interaction with other risk factors is difficult to elucidate. This is at least partially due to limitations in accurately measuring exposure. Recent advances in laboratory sciences (e.g. “omics” technologies) have been paralleled by an increased understanding of mechanisms of carcinogenesis (e.g. epigenetics). This provides a promising avenue for the improvement of environmental exposure assessment and an understanding of its consequences. In addition, this new generation of biomarkers can help establish the biological plausibility of exposure-disease associations, providing also a bridge from epidemiology to experimental data.
Much remains to be accomplished to provide the evidence-base for public health decisions on cancer prevention. Nevertheless, rapid advances in technology, the fresh understanding of carcinogenic mechanisms and the availability of large prospective cohort studies with associated biobanks provide exciting new opportunities. Prevention strategies based on these foundations demand an interdisciplinary approach whereby the term translational cancer research includes translation from the laboratory to the clinic and the population. Such a “two-way translation” holds rich promise in combating the projected increases in global cancer burden.
Click here to view the speaker biography.
