Prevention is life- and cost-saving

Abstract

The importance of prevention to safeguard human health is indisputably illustrated by the consequences of its failure. The global unfolding of the coronavirus disease 2019 (COVID-19) epidemic is certainly a most striking example. The disruptive effects of a pandemic have been repeatedly anticipated and illustrated since the emergence of the severe acute respiratory syndrome (SARS) epidemic in 2003 (Osterholm, 2017). Nevertheless, most national and supra-national institutions have failed to take the necessary measures and actions to prepare for a predictable contagion on a global scale.

Prevention can be life- and cost-saving in all domains of disease control - and while the consequences of failed prevention are spectacular in the case of rapidly-evolving epidemic infectious diseases, a lack of appropriate prevention is equally catastrophic for endemic, communicable and non-communicable diseases. For instance, globally, one in five men and one in six women will develop cancer in their lifetime; moreover, one man in eight and one woman in 11 will die of cancer. Furthermore, the global burden of cancer is expected to rise from 18.1 million new cancer cases and 9.6 million cancer deaths in 2018, to 29.4 million cases and 16.3 million deaths in 2040 (Bray et al., 2018). If evenly adopted across the world, actions based on our current knowledge of risk factors could prevent 40% of all cancers worldwide (Weiderpass, 2019). It is noteworthy that, currently, health inequalities are increasing worldwide, and that much of the global effort in preventing cancer has been suspended. There will be a heavy toll later in terms of cancers that could not be averted because of the need to redirect precious healthcare resources to tackling the COVID-19 pandemic. The adverse impact of all the Pap tests, mammograms, colonoscopies, and cancer diagnostic procedures deferred or cancelled, worldwide, is certain, although not yet precisely calculated.

The development of new technologies could substantially increase the number of cancers prevented. For example, an effective vaccine against Helicobacter pylori could lead to the prevention of up to 812,000 gastric cancers worldwide every year (de Martel et al., 2020). However, political commitment, funding, and internationally coordinated research efforts are essential in order to implement available global solutions and to develop new life-saving knowledge and technologies. High-quality data are also crucial to monitor progress in implementation, to assess the impact of ongoing preventive actions, and to project the effectiveness and costs of future interventions. Global initiatives for the development of cancer registries, for monitoring the outcome of prevention and early detection measures, and for lending support to widespread access to cancer treatment should also be encouraged.

Successful prevention is the result of medium/long-term strategic planning and international coordination. Multilateral agencies, such as the International Agency for Research on Cancer, play a pivotal role in shaping an impactful research agenda and framing high-profile collaborations. Global cancer control can only be effective if supported with adequate human, logistic, and financial resources, as well as with undeterred political commitment.