Meeting the global demands of epidemiologic transition - the indispensable role of cancer prevention

The number of new cancer cases each year is projected to rise worldwide by about 70% by 2030 due to demographic changes alone, with the largest increases in the lower-income countries. Wider adoption of specific aspects of westernized lifestyles would translate to still greater increases in certain cancer types. In many countries the burden of cancer and other non-communicable diseases will add to communicable diseases and malnutrition to impose a "double burden" on the poorest. These trends represent major challenges to health, poverty, sustainable development and equality. Prevention is, however, possible based on implementing existing knowledge about risk factors and the natural history of the disease. Both primary and secondary cancer prevention offer therefore many opportunities to combat the projected increases. Tobacco control, reductions in obesity and physical inactivity, reduced consumption of alcohol, vaccination against hepatitis B and human papilloma viruses, safe sex, avoidance of environmental and occupational carcinogens and excessive sun exposure as well as the early detection and screening for breast, cervix and colorectal cancers would all make significant contributions. At the same time, for a number of major cancers (e.g., colon, prostate, kidney, pancreas, brain, lympho-haematological malignancies) research is needed to identify as yet unknown risk factors whilst for existing prevention strategies additional work is needed on their implementation into health services. Finally, there is a remarkable opportunity for advances in understanding the molecular basis of carcinogenesis to provide new tools and insights into aetiology and prevention. It is only by complementing efforts to improve treatment with those aimed at prevention that the impending epidemic of this disease can be addressed.