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Public Health Briefings

Proposed Goals for Cancer Prevention

John P. Fulton, PhD

Published in: Medicine and Health/Rhode Island, 1998;81(05) 189-190

John P. Fulton, PhD, is Acting Associate Director, Division of Disease Prevention and Control, Rhode Island Department of Health, and Clinical Associate Professor, Brown U. School of Medicine.

Objective

The Rhode Island Department of Health assembled an Expert Panel on Cancer Prevention to advise the Department on revising the State’s current cancer control plan, published in 1989. (1) After reviewing the current approaches to cancer prevention recommended by national organizations and the most recent pertinent literature, the Panel proposed goals for cancer prevention to be incorporated in a revised cancer control plan for the State.

Methods

• Review current approaches to cancer prevention recommended by national organizations.

• Review the most recent literature pertinent to cancer prevention.

• Discuss.

• Propose goals for cancer prevention.

• Write a simple rationale for the proposed goals.

• Invite comments on the proposed goals and rationale.

Proposed goals

Avoid tobacco.

• Prevent the use of tobacco by children.

• Create disincentives for tobacco use.

• Help tobacco users quit.

Avoid environmental tobacco smoke.

• Promote state, local, and organizational policies which restrict or ban indoor smoking.

• Promote the avoidance of environmental tobacco smoke.

Avoid excessive sun exposure.

• Promote the avoidance of excessive sun exposure and the use of protective clothing whenever excessive exposure to sunlight is anticipated.

• Promote the use of sunscreen (at least SPF 15) for children, individuals who cannot avoid excessive sun exposure, and individuals who are at substantially increased risk for skin cancer.

• Promote the avoidance of artificial tanning devices, including commercial tanning booths and sun lamps used in the home.

Eat a balanced diet.

• Promote a diet for persons over age 2 in which fats (especially saturated fat) and cholesterol are limited, caloric balance is maintained, and fiber-containing foods (fruits, vegetables, grain products) are emphasized.

• Promote moderation in the use of alcohol among persons who use alcohol.

Get regular physical activity.

• Promote 30 minutes of regular physical activity daily for all persons.

Avoid exposure to cancer-causing substances in the workplace.

• Promote the substitution of safe materials for unsafe materials.

• Promote measures to avoid exposure to unsafe materials, e.g., isolation or enclosure of unsafe materials, local exhaust ventilation, personal protective equipment, air monitoring, and medical monitoring of those employees with potential exposure to unsafe materials.

• Promote the training of employees in proper techniques to avoid exposure to unsafe materials.

• Promote state, local, and organizational policies which restrict or ban indoor smoking in the workplace.

Avoid exposure to cancer-causing substances in the home and leisure settings.

• Promote home inspections for radon and asbestos.

• Promote the safe use, storage, and disposal of pesticides, gasoline, and other unsafe materials.

• Promote state, local, and organizational policies which restrict or ban indoor smoking in public places.

• Promote the avoidance of environmental tobacco smoke.

Rationale for proposed goals

The proposed goals for cancer prevention were selected to reduce exposure to known determinants or correlates of cancer which are common and avoidable.

Tobacco use is the single most important cause of cancer in the United States. (2) Between 20 and 25 percent of adults use tobacco. Tobacco use is entirely avoidable. Children get seduced into using tobacco products by unscrupulous marketing practices, become strongly addicted to nicotine, and may take many years to quit. Preventing tobacco use by children is an extremely effective means of reducing tobacco use overall, because it is a habit rarely initiated by adults. Creating disincentives for tobacco use and helping tobacco users quit have been shown to be useful in reducing tobacco use, as well.

Exposure to environmental tobacco smoke (ETS) is a significant cause of lung cancers in people who themselves do not use tobacco. Between 3000 and 6000 lung cancer deaths per year in the United States are caused by exposure to ETS. (2) A substantial proportion (perhaps a majority) of the population in the United States have some exposure to ETS in the home, at work, or in public settings such as restaurants. Those who live with smokers, and those who work in smoky environments, such as bars or restaurants that permit smoking, may have dangerous exposures to ETS. Recent experience has shown that exposure to ETS may be reduced by the development of state, local, and organizational policies which restrict or ban indoor smoking, and by educating the public to avoid ETS.

Excessive sun exposure is the most important cause of skin cancer, including melanoma of the skin, in the United States. (2) Exposure to the artificial ultraviolet light emitted by commercial tanning booths, sun lamps, and other sources, may also cause skin cancer. Basal and squamous carcinoma of the skin, especially of the face, scalp, and neck, are very common in the United States. Melanoma of the skin is a very serious disease with a high case fatality rate, and is on the rise in the United States. Almost all individuals are exposed to sunlight, but in almost all cases, excessive exposure may be avoided by wearing protective clothing. In those cases where protective clothing cannot be worn, or may not be worn reliably, as with children, the use of sunscreen is prudent, even though the effectiveness of sunscreens in preventing skin cancers has not been proven.

A diet high in fat and low in fiber is believed to be the primary exogenous cause of colo-rectal cancer, and is related to other common cancers, as well. (2) In the developing world, where diets are largely based on grains, vegetables, and fruits, and have a low fat content, colo-rectal cancer is far less common than in the developed world, where meat, whole milk, eggs, oils, and spreads based on fats or oils represent significant sources of calories. Although diets are difficult to change, the typical American diet has changed over the past decades in response to information and promotional campaigns. As a result, for example, the consumption of sodium is down, and the proportional consumption of reduced-fat meat and dairy products is up.

Heavy consumption of alcohol is associated with cancers of the mouth, pharynx, larynx, esophagus, liver, and breast. Heavy alcohol consumption and smoking have long been known to have a synergistic effect on cancers of the mouth, pharynx, larynx, and esophagus. (2) Between five and ten percent of the adult population in the United States consume alcohol at levels that clearly put them at increased risk of cancer, and a higher proportion consume alcohol at levels that may put them at some increased risk. (3) Problem drinking may be prevented by education and counseling and treated effectively by counseling and medical intervention. (3)

A sedentary lifestyle is associated with colo-rectal cancer. (2) Between 50 and 60 percent of the adult population in the United States do not engage in regular physical exercise, putting them at increased risk of colo-rectal cancer, as well as other significant diseases and conditions. (3) Regular, moderate physical activity such as walking for about 30 minutes a day may decrease the risk of cancer and other chronic illnesses significantly. Such exercise is readily accessible to the population at large, and modest health promotion efforts have been demonstrated to increase physical activity.

Certain industrial processes have been strongly linked to cancers of the lung, bladder, nasal cavity and sinuses, larynx, pharynx, lymphatic and hematopoietic system, skin, and liver, and to mesothelioma. (2) The proportion of the population at risk of exposure to cancer-causing materials in the workplace changes over time, as new industrial processes are invented, and old industrial processes become outmoded. Nontheless, industrial processes are believed to cause at least five percent of all cancers, and some estimates of this proportion are considerably higher. Because industrial processes occur in well-understood, organized, and well-monitored environments, subject to federal and state laws regarding the protection of workers and the safe handling of unsafe materials, almost all dangerous exposures to cancer-causing substances may be minimized or avoided altogether by properly designing the work environment, by carefully selecting the materials for use in that environment, by providing workers with protective clothing and gear, by educating workers about the safe handling of unsafe materials, and by monitoring the entire system of protection thus implemented.

Significant exposure to radon (lung cancer) and asbestos (mesothelioma) may occur in the home setting. Homes, especially newer homes, have been built to retain heat, and thus restrict air exchange between inside and outside environments. Therefore, once in a home environment, cancer-causing substances tend to be retained. Unacceptable levels of environmental radon and asbestos may be detected in homes using simple tests and inspections, and the cost of removing or controlling either substance in most affected homes is usually not prohibitive. The control of these substances in the home is amenable to public education, regulation regarding the sale of homes, and subsidies for removal or control. Other cancer-causing substances such as pesticides and gasoline may be used improperly in the home or leisure settings, causing significant, unsafe exposures. The control of these substances in the home is simple, inexpensive, and amenable to public education.

References

1. Rhode Island Department of Health. Cancer control Rhode Island. Plan for 1990-1992. Providence, RI: Rhode Island Department of Health, 1989.

2. Edwards BK, Blot WJ, Gloeckler Ries LA. Cancer rates and risks. NIH Publication No. 96-691. Bethesda, Maryland: National Cancer Institute, 1996.

3. U.S. Preventive Services Task Force. Guide to clinical preventive services, 2nd ed. Baltimore: Williams & Wilkins, 1996.