The need for preventive drugs and vaccines in global cancer

These expensive drugs are not available to most

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these expensive drugs are not available to most infected people in poor countries, and cheaper control measures are either not developed (vac- cines) or often not very effective (e.g., counselling about the use of condoms). During the last 30 years, some undeniable successes in controlling cancer have taken place. Tobacco-associated cancers are in decline ¡ / but only in a few countries. Stomach and cervical cancers are decreasing in several countries. Apart from cervical cancer, this success comes from prevention, which deserves continuing high priority in terms of both research and application. The `war’ on cancer, declared by President Richard M Nixon some 30 years ago, is thus only partially won. After a quarter of a century of rapid advances, cancer research has undoubtedly devel- oped into a logical science, where complexities of the disease, described in the laboratory, clinic, as well as in populations, have become understandable in terms of a handful of underlying principles. We start understanding the intricate workings of the human genome ¡ / ultimately responsible for con- trolling all biological processes in health and disease. The announcement of the sequencing of the human genome in 2001 represents an unprece- dented milestone in the advancement of our knowl- edge on the molecular basis of life itself. This information generated by genomics will, over time, provide major benefits for the prevention, diagnosis and management of diseases such as cancer. Preventive drugs and vaccines in cancer control H Vainio 85
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Already developed gene chips and microarrays detect minute code changes of considerable rele- vance. Novel screening technologies have the po- tential to detect just a few cancer cells in a patient. Chemoprevention and dietary prevention in stomach cancer Stomach cancer is among the most common malignancy worldwide, with some 870 000 new cases every year, and some 650 000 deaths. About 60% of cases occur in developing countries, with the highest incidence coming in eastern Asia, the Andean regions of South America and East Eur- ope. The good news is that stomach cancer is declining worldwide, in some regions almost dra- matically. In some European countries, the mortal- ity fell by 60% within one generation (WHO, 2003). The main reason for this welcome development may be the invention of refrigeration, allowing fish and meat preservation without salting. Additional factors contributing to the trend are the availability in many countries of fresh fruit and vegetables throughout the year, and the downward trend in Helicobacter pylori ( H. pylori ) prevalence in many countries. The infection prevalence is still high in many high cancer-risk populations, such as Japan and Colombia. But several large populations with high infection prevalence display a very low rate of stomach cancer. This so-called `African enigma’ remains unexplained (Holcombe, 1992), but it does point out an important fact: not all H. pylori infections increase the risk of stomach cancer. It is known that a number of risk factors increase the risk of stomach cancer, most prominently irritants such as excessive dietary salt, and some protective
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