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Alleviating the Burden of Cancer: A Perspective on Advances, Challenges, and Future Directions

Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan

Requests for reprints: David Schottenfeld, Department of Epidemiology, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109-2029. Phone: 734-647-3217; Fax: 734-764-3192. E-mail: daschott{at}umich.edu

The control of the burden of cancer would be achievable by promoting health-maintaining lifestyle behavioral practices in conjunction with facilitated access to affordable and effective periodic screening and early detection examinations combined with comprehensive treatment services. In a global population exceeding six billion in the year 2002, there were 10.9 million new cancer cases, 6.7 million cancer deaths, and 22.4 million persons surviving from cancer diagnosed in the previous 5 years. In 2020, the world's population is projected to increase to 7.5 billion and will experience 15 million new cancer cases and 12 million cancer deaths. This perspective on advances, challenges, and future directions in cancer epidemiology and prevention reviews the conceptual foundation for multistep carcinogenesis, causal mechanisms associated with chronic inflammation and the microenvironment of the cancer cell, and obesity, energy expenditure, and insulin resistance. Strategic priorities in global cancer control initiatives should embrace these fundamental concepts by targeting tobacco and alcohol consumption, the increasing prevalence of obesity and metabolic sequelae, and persistent microbial infections. (Cancer Epidemiol Biomarkers Prev 2006;15(11):2049–55)

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