Strategies for cancer control on an organ-site basis

A great deal of research information has been generated regarding cancer incidence rates and underlying risk factors. Since incidence:mortality ratios are generally less than 2:1 and often approach equivalence there clearly is a need for particular emphasis on preventive measures and early detection. Whether the latter should be through screening or education for improved awareness will depend on the socioeconomic conditions and the organ site. The location within the body, physiological factors and the cell type, whether essentially glandular or squamous, and the particular risk and protective factors operating in the particular social context will all impact on what measures can be recommended. Here the focus is on primary and secondary prevention of cancers in the various regions of Asia, taking into account similarities and differences in etiology for organs/tissues of the gastrointestinal tract, the respiratory tract, the urinary system, the reproductive system, the nervous system, the thyroid and non-Hogkins lymphomas and leukemias. Globocan 2002 data on incidence and mortality and all of the findings reviewed in the Regional Reviews were taken into account in compiling this overview. The chief recommendations are education in the developing world, to overcome the problem of late presentation at hospital (reflected by high mortality/incidence ratios), betel and tobacco control for the oral cavity and pharynx, reduce salt intake and targeting of Helicobacter pylori for the stomach, reduction in food intake, improvement in the diet and more exercise for the colorectum, kidney, prostate, breast, ovary and endometrium, reduction in smoking and exposure to other fumes for the lung, increase in water intake, particularly for the urinary bladder, and avoidance of parasites for the special cases of the urinary bladder and intrahepatic bile ducts. The cancer registry could be a major resource for development of further research capacity, with selection of suitable partners in areas with contrasting cancer rates and lifestyles for detailed comparisons applying the same protocols. This should facilitate future exploration and hopefully elucidation of any anomalies, so that cancer control programs can be optimized in accordance.