Cancer prevention, detection and survival--how hopeful is the outlook?

Recent overall appraisals of cancer occurrence, detection, treatment and survival have noted: rising incidences; relatively steady mortality rates; and disappointingly small improvements in survival time (the magnitudes of which are controversial). In this review attempts have been made to answer questions on countermeasures--principally, what could be done, and what is likely to be done. It is concluded, broadly, that in Western populations the only ameliorative changes likely are reductions in frequency and intensity of cigarette smoking, and improvements in early detection of certain cancers by screening procedures. Accordingly, the outlook is very unpromising. Claims of halving cancer mortality by the year 2000 would seem to be hyperbole. As to developing populations, frequencies of certain cancers (oesophageal, liver and cervix) are likely to fall, but they will be replaced by increases in cancers characteristic of Western populations. Yet rises in incidence of diet-related cancers (breast, colorectal, and possibly prostate) may be retarded by slow rises in socio-economic state.