NEWS

Prevention Methods Underused, Report Concludes

Charles Marwick

The United States is failing to take advantage of proven methods of preventing cancer, and if sustained efforts were made to help people change their behavior, such as ceasing smoking, and systems were in place to enable them to take advantage of cancer detection procedures, 60,000 cancer deaths and about 100,000 new cancer cases annually could be prevented by 2015. This is the principle message carried by a new report, "Fulfilling the Potential of Cancer Prevention and Early Detection," from the Institute of Medicine.

The report calls for a national strategy to be developed and coordinated by the Department of Health and Human Services that would make concerted efforts by physicians, health plans, insurers, employers, policy makers, and researchers to encourage lifestyle changes in the population.

According to the report, behavior modifications that will save the most lives from cancer include helping people to stop smoking, to maintain a healthy diet, to keep their weight under control, to stimulate physical activity, and to moderate their alcohol consumption. Health insurers, both public and private, should include coverage for evidence-based interventions of cancer prevention and early detection in their policies, the report concluded.

The authors of the report admitted that the call for behavioral change and coverage for prevention is not new, but they maintained that "what is new is the growing body of evidence of the effectiveness of interventions to help people improve their health-related behaviors."

Controlling tobacco offers the greatest opportunity to reduce the incidence, morbidity, and mortality of cancer, and the single most effective method of reducing smoking is to raise tobacco taxes, the report stated.

More controversial and more difficult to implement is a call to the Congress to increase support for programs that provide primary care for the uninsured and low-income groups. Lack of health insurance means poor access to health care, so proven screening procedures for cancer detection remain unused, the report stated.

There are programs already in place such as the community and migrant health centers and family planning programs that have been shown to increase the use of cancer prevention and early detection procedures. Likewise, the Centers for Disease Control and Prevention has a breast and cervical cancer early detection program. Colorectal cancer screening should be added to this, the report stated, and all these programs should get more support.

A major part of the report is an assessment of the value of screening for colorectal, breast, prostate, cervix, and lung cancers. Present methods of screening for breast, colon, and cervical cancer "significantly lowers mortality," the report noted, but the benefit of screening for the others is described as "less direct." Although much of the report is concerned with the underuse of tests for cancer, it also warns of their overuse. Tests that are not recommended or are used too frequently expose patients to harm and consume resources needed for more effective health care, the report stated.

Although there is need for more research, there is a failure to make use of what is already known. "The [United States] is at a crossroads in cancer prevention research," the report noted. Basic science and epidemiology are advancing knowledge of the relationship between cancer and modifiable behavioral risk factors and the molecular pathways that mediate them. Applied research is illustrating how the available evidence can be used to reduce cancer rates. But there is no guarantee that this results in appropriate action. "Only with public awareness and policy support can the potential to reduce cancer be realized," the report concluded.



             
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