Carcinogenesis, Vol 18, 97-105, Copyright © 1997 by Oxford University Press
L Tomatis, J Huff, I Hertz-Picciotto, DP Sandler, J Bucher, P Boffetta, O Axelson, A Blair, J Taylor, L Stayner and JC Barrett
Despite the considerable efforts and funds devoted to cancer research over
several decades, cancer still remains a mainly lethal disease. Cancer
incidence and mortality have not declined at the same rate as other major
causes of death, indicating that primary prevention remains a most valuable
approach to decrease mortality. There is general agreement that
environmental exposures are variously involved in the causation of the
majority of cancer cases and that at least half of all cancers could be
avoided by applying existing etiologic knowledge. There is disagreement,
however, regarding the proportion of cancer risks attributable to specific
etiological factors, including diet, occupation and pollution. Estimates of
attributable risks are largely based today on unverified assumptions and
the calculation of attributable risks involves taking very unequal evidence
of various types of factors and treating them equally. Effective primary
prevention resulting in a reduction of cancer risk can be obtained by: (i)
a reduction in the number of carcinogens to which humans are exposed; or
(ii) a reduction of the exposure levels to carcinogens. Exposure levels
that could be seen as sufficiently low when based on single agents, may
actually not be safe in the context of the many other concomitant
carcinogenic and mutagenic exposures. The list of human carcinogens and of
their target organs might be quite different if: (i) epidemiological data
were available for a larger proportion of human exposures for which there
is experimental evidence of carcinogenicity; (ii) more attention was paid
to epidemiological evidence that is suggestive of an exposure-cancer
association, but is less than sufficient, particularly in identifying
target organs; and (iii) experimental evidence of carcinogenicity,
supported by mechanistic considerations, were more fully accepted as
predictions of human risk.
REVIEWS
Avoided and avoidable risks of cancer
National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709-2233, USA.
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