DEVELOPMENT AND INNOVATION IN CANCER MEDICINE - Innovation in the Biopharmaceutical Industry - page 51

Prevention and Screening
In the early years of the 21st century, 10 million people each year develop cancer
worldwide (Blackledge, 2003). The causes of these cancers are known in roughly
75% of cases: 3 million are tobacco-related; 3 million are a result of diet; and 1.5
million are caused by infection. In the UK, 120,000 people die from cancer each
year, even though many of these cancers are preventable — with one-third related
to smoking. Still, only 2% of the total funding on cancer care and research is spent
on cancer prevention. Anti-smoking initiatives are considered successful — even
though it has been 50 years since the association between smoking and cancer was
first identified. In the 1960s, 80% of the population smoked. In 2005, that average
was less than 30%. These figures mask real health inequality. The percentage of
smokers among higher socio-economic classes is low (in single figures), while the
percentage among lower socio-economic classes is around 50% in some parts of
the country. Although the risks are known, it remains true that if friends and family
smoke and there is no social pressure to stop, there is no incentive. A ban on smoking
in public places leads to a further drop of around 4%. Tax increases have been a
powerful incentive to stop smoking, but the price of a packet of cigarettes became
so high that smokers turned to the black market: as many as one in five cigarettes
smoked is smuggled into the country. Lung cancer is now a rare disease in higher
socio-economic groups; it is primarily a disease of poverty.
Lessons taken from anti-smoking initiatives will be instructive for future pre-
vention. Although the association of poor diet, obesity and lack of exercise with
cancer has not yet been confirmed, there is sufficient circumstantial evidence to
suggest that associations will be found. A ban will be put on television advertising
for crisps, sweets and soft drinks, a health tax will be put on these products, and
there will be a ban on sponsorship of public events by manufacturers of these prod-
ucts. By 2010, obesity among the middle classes will be socially unacceptable, but
among the economically disadvantaged it will not change. A major challenge that
lies ahead is the creation of meaningful, imaginative incentives for people to adopt
healthy lifestyles.
The future prevention picture will be coloured by post-genomic research. In
2005, it is accepted among the medical community that about 100 genes are asso-
ciated with the development of a wide range of cancers. The detection of polymor-
phisms in low penetrance cancer-related genes (or a combination of changed genes)
will identify people who run an increased risk. Within the next 20 years, most peo-
ple will be genetically mapped. The information gained from a simple blood test
will easily be stored on a smart-card. Legislation will be required to prevent this
information from being used to determine an individual's future health status for
mortgage, insurance and employment purposes. However, the mapping process will