Inspire2Live, an international organization that supports efforts to get cancer under control and the initiator of large-scale charity events like Alpe d’HuZes, organized a conference in Amsterdam on January 17 and 18, 2013 on the prevention of cancer. The main conclusion: we know very well what to do to reduce the number of cancer patients. Tobacco use alone accounts for some 30% of all cancers. There is also much to gain from cutting down alcohol intake, reducing obesity and encouraging exercise and healthier food. Epidemiological and tumor biological research has shown that the reduction of cancer incidence should first and foremost be kick-started through improved prevention. Higher quality education with a specific focus on health at an early age is essential. But there is also an increasingly clear scientific basis for closer attention to prevention geared to citizens’ and patients’ risk profiles.

Prevention reduces cancer incidence by 40%

By now it is well established that people have much to gain from cutting down smoking and enjoying a healthier diet. A working group led by Prof. Martijn Katan listed a number of recommendations for sound food choices with a view to preventing cancer. The group’s main question was how people can be encouraged to make healthier choices. Upbringing, knowledge and education are essential in that context.

Prof. Gerd Gigerenzer, keynote speaker at the conference, made this remarkable statement:

The effect of screening on cancer mortality has been shown to be nil for many cancers, and small for a few. The effect of cancer drugs, for most solid cancers, is in the order of a few weeks or months of life prolonged, with heavy loss in quality of life.

An estimated 50% of all cancers are due to behavior, cigarette smoking (20-30% of all cancers), obesity, fast food, sugary drinks, and physical inactivity (10-20%), and alcohol abuse (10% in men, 3% in women). Thus, the best potential for reducing the burden of cancer is prevention, that is, health literacy.

To be successful, prevention programs has to start early in life. To tell a 15-year-old to stop smoking is too late. Eating habits are formed in childhood. The planned Groningen health literacy project starts in first grade, and continues through puberty. It will be taught by the regular teachers, e.g. embedded in sports and biology, and its goal is to make young people risk competent. The goal is not to tell them what not to do, but to help them to make their own, informed decisions.

Prevention: the main recommendations

The attendant experts in fields including cancer, nutrition, behavioral sciences and molecular biology provided the following guidelines that will help to significantly reduce the risk of cancer.

• General: Prevent overweight and obesity (risk factor) by means of a healthy diet and exercise.
• Tobacco: Quit smoking (smoking accounts for some 30% of all cancers).
• Alcohol: Alcohol consumption increases the risk of cancer and does not make for a healthy lifestyle.
• Nutrition: Eating red meat (beef and pork) poses a risk, but this does not apply to poultry or seafood.
• Fats and sugars are not carcinogenic in and of themselves but they are more likely to cause overweight.
• As to many other nutrients, including coffee, artificial sweeteners like aspartame and a wide range of additives that were once considered carcinogenic, there is little (or too little) evidence.
• Exercising sensibly and more often has a preventive effect on healthy people and (former) cancer patients alike.

There is also insufficient evidence on a number of other foodstuffs that were believed to protect against cancer, including fibers, vegetables, fruit and antioxidants. However, fruit and vegetables and high-fiber food are indeed part of a healthy diet. Alcohol is not, even in small quantities. A comprehensive summary of the recommendations will be posted on the Inspire2Live website (www.Inspire2Live.nl) soon.

Research on prevention in children

“Knowledge about health – health literacy – is essential to help people live healthier lives and halt diseases like cancer,” according to Gerd Gigerenzer, Director at the Max Planck Institute for Human Development in Berlin. This message was ardently supported by Bob Weinberg in his presentation that exposed in particular the myth that science will eventually find a cure for all cancers. Prevention is better than cure and gives more certainty. In order words, children should be shown the ropes in making healthy lifestyle choices at a very tender age. Many children from socially underprivileged families miss out on that knowledge and competence. This has prompted Inspire2Live to join forces with several universities at home and abroad to set up a project in Oost-Groningen aimed at familiarizing young children with the importance of healthy choices. The conference speakers and attendants were unanimous in their opinion that many improvements can be initiated top-down, involving parties like Inspire2Live, the Royal Netherlands Academy of Arts and Sciences [KNAW] and the Dutch Cancer Society [KWF], and that the community is supported regionally and locally in the development of a healthy lifestyle.

Patients are at the center

The conference was unique in that it was attended not only by physicians, scientific researchers and fund-raisers but also by a large number of patients. For two days they joined the exchange of ideas and discussions about how to better combat cancer and improve preventive action. In the months ahead, these Inspire2Live “patient advocates” as they are referred to will also be taking the lead in generating increased awareness of and dedication to prevention. All those involved considered the interaction between patients, doctors and researchers highly worthwhile and necessary to promote further action.

Bob Weinberg expressed the importance of cooperation as follows:

‘You Patient Advocates are by far more convincing when it comes to prevention then a scientist can ever be’.

The interaction and in particular the collaboration bears repeating.

Conclusion

Perhaps the unique collaboration between researchers, clinicians and patients highlights the conference’s main conclusion. Although clinicians, researchers and patients share a profound interest in cancer and its many aspects, they often lack a common language. The existence of a growing group of people with high health literacy makes for better choices – with citizens and patients and for the benefit of society.