Document e7jv8qE0OZ3rj3LYZ9Q8RdNqG

Letter to the Editor 'h 'rj 'l /" Preventive Oncology: An Opportunity for Clinical Table 1.--Obstacle* to health promotion Canear Cantar* For the individual: Sir: Life-style factors and cancer incidence have been unquestionably linked by epidemiologic, clinical, and experimental research.1'5 Their relationship is well known among most health professionals and to the general public. Despite this knowledge, there have been "Illusion" of immortality Lack of social and peer support Low self-esteem (sense of powerlewneii) Satisfaction (today) versus benefits (future) Marketing disease-producing products For the health professional: Insufficient financial incentives only isolated instances of broad societal trends toward the adoption of more healthful behavioral patterns. Lack of evident academic reward Lack of support from the medical care and insurance system When such changes have occurred, they have been observed primarily among selected populations. For example, cigarette smoking is clearly associated with cancer. Yet only among white males has there been a lion are provided will cancer prevention programs be sharp reduction of smoking. Among women and black established in our offices and clinical centers. males smoking has actually increased. Rising incidence The opportunities in health promotion, including rates of lung cancer among this group provide tragic those afforded by the establishment of outpatient pre confirmation of'a fact that behavioral scientists have vention clinics in each clinical cancer center, warrant long been aware of: Increased knowledge does not our effort to overcome all obstacles (table 2). Certainly, necessarily lead to changes in behavior. the spiraling disease care costs, the unnecessary pain Other such examples abound. For instance, dietary and suffering, loss of income, and loss of life due to fat is considered an important risk factor in the avoidable illness should provide the more than suffi etiology of a number of cancers, including cancers of cient incentive to adopt a preventive approach. the colon, breast, and prostate gland. Yet, despite this Solutions involve finding strategies whereby pre knowledge, most Americans continue to consume diets ventive services provided within the confines of clinical that are not only high in fat, but also low in fiber, a cancer centers could play an important role. The dietary component putatively correlated with a de establishment of such preventive services in a clinical creased incidence of colon cancer. setting could have dramatic medical and social impact Why then have these habits persisted? And why, not only on hospitalized patients, but also on all who when presented with facts, do most people ignore them come in contact with the hospital. With a minimum ' and resist the opportunity to prevent a devastating and investment, outpatient clinics could establish smoking life-threaiehing illness? The answer, 1 suggest, is posits cessation and nutrition clinics, provide counseling on that health promotion today lacks certain critical in occupational safety, and organize a network for dis i gredients. Perhaps the most important of these is the i enthusiasm of the medical profession as a whole to acknowledge behavior change as a significant factor in seminating cancer detection information. Once in op eration, such services should become economically self- sustaining through cost reimbursement fees, although the prevention of cancer. Cancer prevention through initially they could be staffed from within by those health promotion remains low in the hierarchy of already involved and experienced in disease prevention. medical practice. Of course, the obstacles to health A concentrated health promotion effort across the promotion confronting health providers are both many country with continuing research into the behavioral and well known (table 1). Still, the lack of proper components of health--i.e., how health and illness- involvement in health promotion that we, as health associated habits are established, maintained, and re professionals, have shown almost ensures that these shaped---- could have a broad public health impact, obstacles will remain. Only when academic rewards especially if society follows the other opportunities w and adequate economic remuneration for health promo- listed in table 2 with equal energy. URL 05405 Rmm BS. 0>hn LA. McCoy CD, ft al. Nutrition and its m-Luhni i.. cim.i Ad\ Cancer Res, 1980; 32:2S7-S45, (.siroii RR. Neutral fats and cancer. Cancer Re* 1981: <1 MK.3AIR , hsa pj. RaiMiitvskvD. rds. Workshop on (at and cancer. taian Rrv 19MI; -II (pm 21:3681-3826. Bll \ pathological measure as a predictor in cancer. In: t*ihrii J. Cnllm JW. Maitin LR. eds. Psychosocial aspects ot cancer. RJim Prr, 1982:275-296. ' VV Migrant studies In: Schottrnfeld D. Fraumeni JF ) (am n r|tii|, ntiolog\ and prevention. Philadelphia: Saunders. Table 2.--Opportunities in health promotion For the individual: School health promotion Parental health education Community-wide health education Organized religions For the health professional: Increasing public awareness of benefits of preventive health care * Outpatient preventive care services Organizing work-site programs Influencing insurance policies covering preventive health care services 201 JNQ. VOL. 72, NO. 2. FEBRl'AR^ 194 Jr ,t 202 C L*tt*r to tt> Editor v Who will provide the leadership for this effort? We appeal to the oncological community which knows so well the price of cancer, both in terms of human suffering and economic terms, to examine the oppor tunities afforded by health promotion and to act upon them in their own cancer centers or individual prac tices. It is incumbent upon each of us in the health professions who deals with the complex issues of cancer in our everyday lives to be in the "business" of preventive care. In 1949 the late Dr. Everts Graham in discussing our data on the association between smoking and lung cancer remarked, "We are going to face much opposi tion. In fact, we have only one thing on our side--we happen to be right." The same is true today for preventive oncology. However, it is not enough just to be right. We must act on our belief that there can be no finer treatment than prevention. Ernst L. Wynder. M.D. American Health Foundation New York, New York 10017 JNCt, VOL. 72. SO. 2. FEBRUARY 1984 Oo)