Joe Arringtion Cancer Center

JACC
4101 22nd Place
Lubbock, Texas 79410

phone: 806-725-8000
fax: 806-723-6412

General Information:
info@joearrington.org

Preventative Oncology

Cancer Prevention: The Role of a Lifetime
By David Close, M.D., MPH

Hope for successful personal cancer prevention efforts demands lifelong personal initiative. Success also requires initiative at the professional, school, workplace, organizational, community and higher societal levels to foster the initiatives of the people they serve. Success will be achieved through primary and secondary prevention strategies and multidisciplinary research strategies involving all levels of society. In particular, success will be achieved through effective health education and communication strategies to inform our initiatives, to foster understanding and encourage adoption and implementation of our best efforts in the difficult task of lifelong planning for good health.

Primary and secondary prevention strategies are designed to reduce cancer incidence and mortality and to promote healthful behaviors through use of growing knowledge about the causes of cancer, improved screening and diagnostic techniques and more effective preventive treatment. Primary prevention strategies aim to reduce the likelihood that a healthy person will develop cancer. Examples of interventions include smoking cessation, dietary modification of fat, fruit and vegetables, increase of physical activity, increased use of sun screen, genetic counseling, and chemoprevention provided to individuals whose risk factors for cancer are estimated to equate with very high likelihood of developing cancer. Secondary prevention is accomplished by screening asymptomatic people in order to diagnose cancers at an early stage when treatment can be given with the best likelihood of cure. Examples of interventions include mammography, Pap testing, and colonoscopy. Newer screening methods are constantly under development. It is estimated that up to 50% of all cancer could be prevented if individuals would follow recommendations related to smoking, diet, alcohol, known occupational exposures, sun exposure and cancer screening. Reduction of cancer incidence by preventive and curative interventions is estimated to result in an average gain in individual life expectancy of ten to fifteen years. Additionally, there are millions of cancer survivors in the United States who could benefit from interventions to reduce their risks of cancer recurrence.

Research in preventive oncology is a multidisciplinary endeavor frequently involving disciplines as nutritional science, behavioral science, epidemiology, biostatistics, health education and health psychology, as well as clinical medicine, nursing and other areas. Research settings include medical practices, screening clinics, workplaces, schools, organizations, communities, or even the nation itself. Research outcomes are translated into medical practice and community action through an iterative process of theory and evidence-based research design, application, evaluation, and further research. The testing and validation of cancer prevention interventions begins with formulation of a research question and development of a research design. The interventions to be evaluated may be concerned with health education, health communication, health behavior, screening and early detection, chemoprevention, or with other prevention issues. A second phase involves testing the research question via a protocol with respect to feasibility of the intervention, acceptability, reliability, accuracy, and potential adverse effects. The intervention’s effect on health-related quality of life is commonly measured. After validation of the experimental methodology and measurement instruments, efficacy of the preventive intervention is evaluated based on controlled observational or experimental (randomized controlled trial) research designs that are structured in selected or targeted populations. Subsequent phases of cancer prevention research are designed to have an impact on the entire population and effective generalizable outcomes are ultimately adopted as organizational, community or public health programs.

The best primary and secondary preventive methods and the best research outcomes will not diffuse into general society and will not be adopted, implemented or become durable practice strategies without effective health education and health communication in making the most of these prime opportunities. As a prevention strategy, health education and health communication can help increase awareness of a health issue, problem or solution, affect attitudes to create support for individual or collective action or change, and address health beliefs, culture, self-efficacy and skills important to adopting behaviors for health promotion and prevention of disease. Effective health education and health communication will lead to an individual’s greater knowledge and adherence to cancer preventing behaviors.

Preventive oncology is an evolving, eclectic science, involving many disciplines inside as well as outside the traditional biomedical model. Its strategic framework enhances planning for health from the level of the individual to the world at large. The goals of preventive oncology include health promotion as well as disease prevention. Preventive oncology posits many challenges for traditional health care structure, process, equity and access, for non-traditional health care such as complimentary and alternative medicine, for individual and societal ethics, for resource allocation, for organizational and community planning and action, and for governmental health policy. To achieve success in cancer prevention, we must take the initiative, personally and collectively.