Cancer Causes and ControlAuthor(s): Brian MacMahonSource: Cancer Causes & Control, Vol. 1, No. 1 (Jul., 1990), pp. 3-4Published by: SpringerStable URL: http://www.jstor.org/stable/3553446 .

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Cancer Causes and Control , 3 - 4

EDITORIAL

Cancer Causes and Control

The title of our new journal offers a broad mandate. There is little pertaining to cancer that would not be relevant. But there is something to be said for not biting off more than can be chewed. Our subtitle, which identifies us with cancer in

populations, denotes the bite that we have chosen; one that we believe no other journal has as its focus, albeit it is represented in many.

The study of cancer in human populations has contributed most obviously to knowledge of cancer causes. A few substances were first identified as carcinogens in experimental animals and subsequently have been shown to be active in

humans-vinyl chloride and chloromethyl methyl ether are examples. They are responsible for no more than a tiny fraction of human cancer. Many other substances identified as cancer initiators or promoters in other species have not yet been shown to increase cancer risk in humans, despite substantial exposure of some groups of people-2,3,7,8-TCDD ('dioxin') is a notable instance. Cross-species concordance for

carcinogenicity, while it no doubt exists to some extent, has not been a major contributor to

knowledge of cancer causes in humans. On the other hand, the study of cancer in human populations has made tremendous contributions-to knowledge not

only of causes but to knowledge of causes that can be controlled. Pre-eminent, of course, is the recogni- tion of the role of the cigarette in the pandemic of

lung cancer which now covers most of the world. Although some developed countries have made pro- gress towards the control of this disease (Sweden and Great Britain are exemplars in this regard) it is a

pandemic which will be with most of the world for at least the next 50 years. For each year that the

population studies of the 1950s-and political action based on their findings-could have been advanced, many millions of premature and ugly deaths could have been avoided.

Perhaps we should explain briefly that we use the word 'population' in a broad sense. 'Population studies' in our usage are studies of disease in groups of individuals, whether the groups be political entities (e.g. nations), formal associations (e.g. trade unions), or simply groups assembled ad hoc (e.g. the patients seen by a particular physician). Such studies take advantage of what Willcox called "the uniformity and predictability of many important biologic phenomena taken in the mass,"'I some of us hold that this predictability exists for all biologic phenomena-not only the important ones but it is not worth the time to argue about that; let us pro- ceed by taking advantage of the instances where it has been demonstrated. In the context of causes of cancer, population studies have detected, and at least partially quantitated, the roles played in human cancer of tobacco, asbestos, infection with hepatitis- B virus, sunlight, ionizing radiation, benzene and a few other chemicals. If exposure to these agents were eliminated (or in the case of sunlight and ionizing radiation, attenuated) human cancer rates would probably be 30 to 40% lower than they are today. There is still a long way to go. Although much is known of risk factors associated with major cancers, such as those of the breast and of the gastro- intestinal tract, no practical means of prevention yet has been identified. For cancer of the liver, probably the most frequent fatal cancer world-wide, although at least one major cause has been identified the efficacy of vaccination against hepatitis-B virus as a preventive remains to be demonstrated. A major focus of Cancer Causes and Control will be on studies aimed at correcting these deficiencies.

But there are values to the study of cancer in

populations beyond those having to do with knowledge of cancer causes. The lion's share of the resources that society devotes to the fight against cancer are directed towards the treatment of persons

? 1990 Rapid Communications of Oxford Ltd 3

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Editorial

who already have the disease. Dramatic cures are obtained, and in recent decades carefully conducted randomized trials have demonstrated that persons who get medical care do live a little longer, on average, as well as feel substantially better. But we will not know the average costs and benefits of clinical efforts to individual patients until we have studied these costs and benefits in populations. Cancer Causes and Control does not seek reports of

clinically-oriented therapeutic trials, randomized or not, but is interested in reports of trials or studies which evaluate measures which have the potential to influence disease rates in the population.

Finally, population studies help determine not

only how resources should be allocated to achieve a particular objective (in this case the prevention or cure of cancer) but also what proportion of societal resources should be directed to that specific purpose rather than to any or all of the many other

responsibilities that modern society assumes. One

has reason to be skeptical about the extent to which facts influence policy decisions and must recognize that policy decisions in regard to health are not immune from the value judgments, prejudices, and even personal ambitions, that we expect in policy decisions in other areas. Nevertheless, to the extent that facts influence policy-and we think they do- professionals have a responsibility to see that the facts used are accurate and timely. We anticipate that the reports published in Cancer Causes and Control will help in this regard.

Brian MacMahon Boston, MA, USA

Reference

1. Willcox WF. Introduction. In: Graunt J. Natural and Political Observations made upon the Bills of Mortality (London, 1662). Baltimore: The Johns Hopkins Press, reprinted 1939.

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