Tim Byers, MD, MPH, and APHA member Shiriki Kumanyika, PhD, MPH, RD, are members of the international expert panel that authored the 2007 report, "Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective." The report, published by the American Institute for Cancer Research and the World Cancer Research Fund, weighed the collected scientific evidence linking various aspects of diet, weight and physical activity to cancer risk.
In February 2009, the two organizations published a follow-up report, "Policy and Action for Cancer Prevention." The report, authored by an expanded expert panel, including Byers and Kumanyika, placed the 2007 report’s conclusions in a global policy context and called on all sectors of society to make "public health, and cancer prevention in particular, a higher priority."
With nearly 11 million people worldwide diagnosed with cancer every year and 8 million losing their lives to the disease, a new report is calling on policy-makers to make prevention a top priority.
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Indian cancer survivors participate in World Cancer Day activities in February in Ahmedabad, India. A recent report is calling on world leaders to tackle the risk factors tied to cancer. Photo by Sam Panthaky, courtesy Getty Images |
Among the many recommendations included in the 2009 policy report, "Policy and Action for Cancer Prevention," which notes that about one-third of the most common cancers could be prevented in the United States alone, is for health professionals to take the lead in educating the public about cancer prevention. And because cancer risk is tied to diet and exercise, the policy report also called on government, industry, schools and other stakeholders to do their part to encourage and support physical activity and healthy eating. For a copy of the report, visit www.aicr.org/policy. A Q&A with two of the report’s panelists follows.
According to the report, the worldwide cancer burden is expected to increase, despite many cancers being preventable. Are we failing in our efforts to confront cancer?
Byers: Progress in cancer is varied, both across specific cancer sites and across countries. In the United States, we are now making good progress, with death rates declining about 2 percent per year for the past 18 years for those cancers we have learned how to prevent, diagnose early or treat, such as lung, colorectal, breast and prostate cancers. For other cancers, progress has been slower.
In most other countries, particularly in the developing nations, cancer trends are not favorable because of the unbridled tobacco epidemic, coupled with insufficient resources to detect cancers early or to provide state-of-the-art treatments. We could do much better both in the United States and in all other countries if we were to get more serious about tobacco control, reduce obesity, increase physical activity and improve diet quality.
Many developing nations are struggling against serious disease threats ranging from malaria to HIV to childhood diarrhea. What priority should cancer prevention take in such a context?
Byers: Cancer is increasing its rank of importance in developing nations, as many recent World Health Organization reports have concluded. Developing nations are now facing the double burdens of infectious and chronic diseases, and will clearly need to address both. The challenge is the scarcity of resources. The high financial cost of cancer screening and treatment necessitates that a high priority be placed on cancer prevention as the principal strategy for developing countries. Effective tobacco control is clearly the most important need.
In addition, however, as we point out in this report, reducing the adverse trends in obesity and poor diet quality in developing nations will reduce risk of not only cancer but also other chronic diseases.
As cancer is often related to individual behaviors, such as exercise and eating habits, how important is it that healthy behaviors begin in early childhood?
Kumanyika: The main message of this new report is that policies and other actions across multiple sectors are needed to reshape environments to make more healthful choices available for people of all ages. We document clearly how individual eating and physical activity behaviors are subject to many different influences in the physical, economic and social environments.
In simple terms, choices that are made are a function of the choices that are available.
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Shiriki Kumanyika and Tim Byers discuss the new cancer report at a Washington, D.C., congressional briefing in February. Photo courtesy AICR |
Cancer risk can be influenced at all stages of life, from before birth to advanced ages. Importantly, all of the recommendations for cancer prevention are compatible with healthy growth and development, so there is no downside to beginning early. The most direct ways to change youth environments are by working in youth-specific settings such as schools and by promoting youth-focused products, activities and media that convey messages related to healthy foods and physical activity.
The report notes that "market economies are not designed to protect public health." However, the notion of the government taking such action makes many nervous. How do you build the case for such actions among the public?
Kumanyika: Some people might think that market forces of supply and demand are a safer bet for determining peoples’ choices than is letting governments have a say. That view holds that people can "speak" to markets through their actions as consumers without having governments impose marketplace regulations. As we have been reminded recently, there are many opportunities for market forces to lead us astray and to thereby fail to address critical societal and human needs.
Those of us in public health can and should have a major role in providing evidence about the types of government interventions that will improve consumer choices. It is important to remember that there are already government interventions underway in areas that relate to food and physical activity. Prime examples are in the federal farm bill and the transportation bill, both of which substantially affect people’s choices regarding food selection and means of transportation.
We need to take a close look at subsidies and regulations that influence food production, prices, trade and marketing as well as policies that affect the choices we have regarding transportation in our communities.
Public health workers have reaped sizable cancer prevention successes, especially in regard to tobacco use, and yet public health isn’t as closely linked to cancer prevention in the public’s eye as traditional medical care. How can public health workers go about changing this perception?
Byers and Kumanyika: First, we need to do a better job describing the role prevention has already played in the remarkable progress in death rates from cancer over the past 18 years. Declining death rates from lung cancer are completely due to the public health successes in tobacco use.
As we look to the future, there are many reasons to believe prevention will have an even bigger role, as we focus our efforts to reverse the obesity epidemic, increase physical activity and improve diet quality. To achieve this, we need to better convince public health workers themselves about the role of eating and activity in cancer prevention so that we can make the case for others. We then need to train the public health work force in strategies for affecting policy and environmental change.
The 2007 World Cancer Research Fund evidence report together with the preventability estimates in the 2009 policy report make a powerful case that many cancers never have to occur. We need to now broadly review and advance the public health science of how we have achieved environmental and policy solutions to other public health problems and then vigorously apply these lessons to the complex challenges of food and physical activity.
Interview conducted, edited and condensed by Kim Krisberg