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Book Review

Cancer Prevention and Control

N Engl J Med 1995; 333:673September 7, 1995

Article

Cancer Prevention and Control
(Basic and Clinical Oncology.) Edited by Peter Greenwald, Barnett S. Kramer, and Douglas L. Weed. 803 pp. New York, Marcel Dekker, 1995. $195. ISBN: 0-8247-9258-0

The field of cancer prevention and control includes a broad range of related ideas, methods, and activities; its practitioners, researchers, and teachers come from many disciplines. Its scientific basis is being advanced by increasingly sophisticated analytic techniques. Much greater understanding exists now than ever before of the nature of carcinogenesis and the respective contributions of inherited and environmental factors. As preventive interventions are tested, validated, and introduced into routine clinical practice, psychosocial, ethical, and economic issues are being studied.

Historically, the passage of the National Cancer Act in 1971, the creation of the Division of Cancer Control and Rehabilitation in 1974, and the establishment in 1983 of the Division of Cancer Prevention and Control were critical events in the evolution of cancer prevention in the United States. Dr. Greenwald defines cancer control in his introduction as “the reduction of cancer incidence, morbidity and mortality through an orderly sequence from research on interventions and their impact in defined populations to the broad, systematic application of the research results.” The application on a broad scale of these concepts, as well as a rigorous application of the scientific method in cancer-prevention research, has had substantial and far-reaching effects not only in the United States but also abroad.

It is perhaps most fitting that the editors of this book are senior scientists at the National Cancer Institute. This comprehensive, multiauthored book has six sections. Part I, “The Burden of Cancer,” describes the magnitude of cancer in the United States and internationally. This section gives a detailed analysis of the economic aspects of cancer. Part II, “Basic Concepts in the Biology of Cancer,” describes carcinogenesis, risk assessment, biomarkers, and genetic–environmental interactions. Part III, “The Methodologies of Cancer Prevention Research,” emphasizes research strategies and trial design. In part IV, “The Practice of Cancer Prevention and Control,” dietary prevention, chemoprevention, control of tobacco use, and legal and ethical aspects are described and evaluated. Part V, “Prevention and Control for Organ-Specific Tumors,” presents practical information on specific approaches to the prevention of cancers of individual organs, such as breast, lung, skin, head and neck, and large-bowel cancers. In part VI, “The Future of Cancer Research and Control,” contributors discuss future developments in cancer prevention, including the use of models and training in cancer prevention. The appendixes contain useful information such as state-of-the-art statements on cancer screening from the National Cancer Institute. My only substantive criticism concerns the absence of a chapter describing the methodologic aspects and accomplishments of behavioral-science research as applied to primary prevention, screening, early detection, and quality-of-life assessment. One hopes that this lack will be remedied in subsequent editions.

The chapters, written by acknowledged experts from the United States, Canada, and Australia, are authoritative and well referenced with current (1994) bibliographic citations. The editors have successfully achieved considerable consistency of style in the construction of the chapters. Although emphases may shift as new concepts emerge, the book establishes a new standard of excellence for this emerging field. It is rendered even more useful by virtue of a detailed index.

Bernard Levin, M.D.
University of Texas M.D. Anderson Cancer Center, Houston, TX 77030

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