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CPES: Opportunities for cancer prevention discussed

The need to take into account exposures to mixtures of chemicals in cancer prevention was highlighted in The Lancet Oncology in June thanks to a response from Jamie Page, Paul Whaley, Richard Clapp and Andrew Watterson. It says: “Our best understanding is that several carcinogenic exposures accumulate and the overall effect is what causes cancer in individuals and populations.” The response was co-ordinated by Paul Whaley of the Cancer Prevention and Education Society (CPES). He is also editor of “Health and Environment” online, which recently discussed whether focusing on existing knowledge advances or hampers our efforts to reduce cancer incidence.

Read the full article and other challenging discussions here: http://healthandenvironmentonline.com/2012/04/30/opportunities-for-cancer-prevention/

A commentary on CPES’s cancer prevention work was also recently published in the Lancet Oncology called ’Priorities for cancer prevention’ which can be read below.

The Lancet Oncology, Volume 13, Issue 6, Page e230, June 2012

Priorities for cancer prevention
Jamie Page a, Paul Whaley a, Andrew Watterson b, Richard Clapp c

Bernard Stewart’s Personal View [1] in favour of lifestyle choices to prevent cancer seems to be based on the questionable premise that pollutants should be investigated individually for their ability to cause disease. This approach might work for tobacco smoke and other easily isolated causes with obvious effects that lend themselves well to epidemiological study. However, it is not suitable for variable inadvertent exposures to complex mixtures of substances for long periods. Our best understanding is that several carcinogenic exposures accumulate and the overall effect is what causes cancer in individuals and populations.

Stewart repeats some of the arguments of Colditz [2] and Thun [3] after the release of the President’s Cancer Panel report¬ie, that people will be diverted from addressing their risky lifestyles by too much public concern about environmental and occupational exposures. This view implies that people cannot hold two thoughts in their heads at the same time and we cannot as a society try to prevent cancer with several causes. Stewart further cites the President’s Cancer Panel’s steps that individuals can take to reduce exposure to carcinogens, [4] but ignores the Panel’s overarching call for a new prevention-oriented chemicals policy.

John Snow is celebrated because he advocated for change in London in the 1850s on the basis of what his research had led him to believe. He is sometimes called the father of epidemiology, [5] and he was an early advocate of the precautionary principle¬ie, action on the basis of reasonably convincing, although not fully developed evidence. Public health would be well served by the use of this kind of science to obtain solutions. Dozens of known of probable human carcinogens are in use that could be controlled more strictly than they are now or phased out. We do not need to wait for more definitive proof that environmental or occupational exposures have contributed to a specific proportion of the overall cancer burden.

We declare that we have no conflicts of interest.

References
[1] Stewart BW. Priorities for cancer prevention: lifestyle choices versus unavoidable exposures. Lancet Oncol 2012; 13: e126-e133. Summary | Full Text | PDF(93KB) | CrossRef | PubMed
[2] Fox M. Cancer report energizes activists, not policy. www.reuters.com/article/2010/05/09/us-cancer-usa-idUSTRE64827I20100509. (accessed April 3, 2012)
[3] Sampson D. Cancer and the environment. http://acspressroom.wordpress.com/2010/05/06/cancer-and-the-environment. (accessed April 3, 2012)
[4] The President’s Cancer Panel. Reducing environmental cancer risk: what we can do now. http://deainfo.nci.nih.gov/advisory/pcp/annualReports/pcp08-09rpt/PCP_Report_08-09_508.pdf. (accessed April 3, 2012)
[5] Vachon D. Doctor John Snow blames water pollution for cholera epidemic. www.ph.ucla.edu/epi/snow/fatherofepidemiology.html. (accessed April 3, 2012)
a Cancer Prevention and Education Society, Axminster, UK
b University of Stirling, Stirling, UK
c University of Massachusetts, Lowell, MA, USA

Originally posted on 20 June 2012

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