Accelerating the pace of cancer prevention – right now
This paper argues that there is sufficient evidence to convince us that more than 50% of cancers can be prevented by applying knowledge we have previously gained to reduce tobacco use, inactivity and obesity. However the authors suggest that evidence based prevention strategies are inconsistently applied across the US and we could probably argue the UK is no different. Furthermore there is some evidence that failure to implement prevention programmes widens health inequalities as it is the cancers which are most impacted by lifestyle choices that have the greatest differences in mortality rates between the more and less deprived. What can be done to accelerate the implementation of cancer prevention?
This paper presents data on prevention strategies for five cancers – lung, colorectal, breast, cervical and liver which include medical, behavioural, social and policy level interventions. An estimate of the magnitude of preventative benefit is also presented. Research into the implementation of cancer prevention strategies is rarely funded but is critical if we are to systemically adopt these strategies. Implementation science may be a useful tool in this arena as it offers “innovative approaches to identify, understand and develop solutions to barriers to the adoption, adaptation, integration, scale up and sustainability of interventions, tools, policies and guidelines.” Brownson et al. categorises critical steps, learnt from other chronic diseases that could be applied to cancer prevention, as:
1. Start with environmental and policy interventions
2. Think across multiple levels of influence
3. Make better use of existing implementation tools
4. Understand local context
5. Build new and non-traditional partnerships
6. Conduct more and better policy research
We can see from the successes of tobacco control that when the prevention agenda is implemented well and systematically, over time there is a significant population gain. We can achieve reductions in cancer burden right now by implementing what we already know.