Cancer Prevention, Screening, and the Reality of Cancer

Dr.Nafees Ahmad Siddiqui

Consultant Medical Oncologist & Director

Nabeel Cancer Care Centre, Lucknow, UP, India

First-class scientific group further highlighting the substantial relevance of the underlying organ-specific rate of stem cell division to the risk for the development of malignant disease resulted in a negativeresponse from certain quarters of the oncology community.Why?

The stated concern is that accepting the argument that cancer occurs due to “bad luck” and is not under the direct control of either the individual (eg, smoking cessation, weight control) or society (eg, environmental exposure) may lead to the highly inappropriate and remarkably oversimplified belief that unhealthy “lifestyle decisions” do not influence cancer risk. Similarly, one might mistakenly suggest that government actions to meaningfully reduce exposure to recognized carcinogens are of limited or no value.

There is absolutely nothing in these scientific reports to support such an irrational conclusion. However, it must also be remembered that the age-standardized prevalence of routine daily use of “cancer sticks” (cigarettes) worldwide is approximately 25% among males and 5.5% among females. And the widespread use of this product, which possesses precisely zero health-related value, is estimated to be responsible for all global deaths is 9.6 million  in 2018.Therefore, it is understandable why many in the oncology community would fear that rational thinking does not necessarily trump what are unfortunately far more persuasive factors (ie, nicotine addiction, peer pressure, immensely powerful media messages, and so forth).

So, although these investigative efforts were intended to emphasize the critically relevant relative impact of human biology in the process of cancer development rather than to suggest that prevention or early detection strategies are of minimal or no value, the analysis does once again emphasize the limits of our understanding of this remarkably complicated area.

In addition, efforts by the cancer establishment try to increase the public’s understanding of the etiology of malignant disease by attempting to overly simplify the profound unknowns are fraught with great danger, and such efforts may produce confusion and even distrust of the research community.Consider, for example, the ongoing intense debate about the clinical utility of prostate cancer screening. As noted in a recent commentary, there remains a rather remarkable level of open disagreement between major cancer organizations and expert panels about the value of this strategy despite extensive trial efforts undertaken over several decades.Which specific individuals will benefit from prostate cancer screening, that is, will have a malignancy destined to spread and cause death unless the process is discovered early enough in its natural history that curative therapy is possible? And how can these more aggressive cancers be distinguished from essentially identical-appearing conditions that are destined to never progress in this manner, or for which successful therapy (if necessary for that individual) can be started after characteristic symptoms develop? It is critical to acknowledge that, today, in the absence of a valid biomarker, such distinctions are extremely difficult at the individual patient level.

Yes, while it may be “bad luck” plus the influence of the genetic background and some to-be-defined environmental exposure that resulted in the development of a cancer, what is important to emphasize is that it is our research mission to more fully understand the relevant etiologic factors and to continue to develop more effective approaches to favorably influence disease-related morbidity and mortality—even if cancer prevention is not a current or future reality.