This Article Full Text Full Text (PDF) All Versions of this Article: theoncologist.2008-0157v1 13/12/1306    most recent eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Frieden, T. R. Articles by Farley, T. A. Search for Related Content PubMed PubMed Citation Articles by Frieden, T. R. Articles by Farley, T. A.

Prevention

A Public Health Approach to Winning the War Against Cancer

^aNew York City Department of Health and Mental Hygiene, New York, New York, USA; ^bTulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA

Correspondence: Thomas R. Frieden, M.D., M.P.H., New York City Department of Health and Mental Hygiene, 125 Worth Street, CN28, Room 331, New York, New York 10013 USA. Telephone: 212-788-5250; Fax: 212-964-0472; e-mail: tfrieden{at}health.nyc.gov

Received July 23, 2008; accepted for publication November 18, 2008; first published online in THE ONCOLOGIST Express on December 17, 2008.

Disclosure: The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers.

The "war on cancer" in the United States has been viewed primarily as an effort to develop and disseminate cancer cures, but cancer is far more easily prevented than cured. There are three major approaches to cancer prevention: Primary prevention, through reduction in risk factors and changes to the environment that reduce human exposure to widely-consumed cancer-promoting agents. The most important actions for primary prevention of cancer are those that reduce tobacco use through taxation, smoke-free environment policies, advertising restrictions, counteradvertising, and cessation programs. The World Health Organization's MPOWER package outlines these actions, each of which covered less than 5% of people in the world in 2007. Similarly, cancer can be prevented by reducing alcohol consumption through policies such as alcohol taxes and limits on alcohol sales, and restoring caloric balance through policies such as creating healthier food environments and engineering the built environment to increase opportunities for physical activity. Vaccination is an effective approach to preventing specific virus-associated cancers, such as using human papillomavirus vaccine to prevent cervical cancer and hepatitis B virus vaccine to prevent hepatocellular cancer. Secondary prevention reduces cancer mortality through screening and early treatment; this approach has been used successfully for breast and cervical cancer but is still underused against colon cancer. Progress can be made in all three approaches to cancer prevention, but will require a greater emphasis on public health programs and public policy. Winning the war on cancer will require a much larger investment in prevention to complement efforts to improve treatment.