Cancer prevention programmes should be tailored to individual countries: A Japanese perspective
As the existing comprehensive recommendations for cancer control policies are mostly derived from Western countries, non-Western nations should strive to tailor their own policies based on their local lifestyle, burden of cancer and characteristics of the local healthcare system.
Speaking at the World Cancer Congress, held in Kuala Lumpur recently, Manami Inoue, Division Chief at the Center for Public Health, National Cancer Center, Japan, said each nation was unique and Asians in particular are a heterogenous population. Manami was speaking about her experience in helping to formulate an evidence-based Japanese cancer prevention recommendation programme. “It is well-known that cancer is the result of preventable risk factors or lifestyles. Against this fact is the reality that there is a substantial difference in the pattern of cancer by geographical region,” said Manami. She noted that up to 2 decades ago, cancer control policies tended to be derived from Western populations.
To illustrate differences between Japanese and Western populations, Manami alluded to the body mass index (BMI) patterns. In Japan, the population with BMI over 30 is only two percent while in countries like Australia, Canada and US, it can range from 10 to 20 percent. Additionally, the BMI trends in Japanese are also unique—across the years surveyed (from 1975 to 2015), the BMI in Japanese women have been going down in all age groups.
It was the realization of the difference in population characteristics between Japanese and Western populations that led to the formation of the Research Group for the Development and Evaluation of Cancer Prevention Strategies in Japan in 2003, of which Manami is part of. The final goals of the group is to suggest lifestyle modifications that have a definite effect on decreasing the incidence of cancer in Japanese; and developing specific, easily implemented prevention methods aimed at modifying the behaviour of individuals.
“This kind of research is what we call translational research—to bridge basic research results to public health or prevention applications,” said Manami. In this case, the effort required collaboration from all frontline scientists and epidemiologists in the research group. Manami and colleagues then compiled evidence from epidemiological studies among the Japanese population and streamlined them according to qualitative evaluation (comprised of literature search and systematic review), and quantitative analysis (meta-analysis or pooled analysis). It was during this time that the Japan Cohort Consortium was founded.By incorporating the results of the risk assessment with risks of non-cancer diseases and total mortality, as well as social concerns were necessary, the team arrived at the official cancer prevention recommendation for Japanese. The recommendations are updated periodically according to new evidence and can be found at http://epi.ncc.go.jp/en/can_prev/index.html. The recommendations encompass six main points which include avoidance of cigarette smoking, drinking of alcohol in moderation; consumption of a nutritionally balanced diet; leading an active lifestyle; maintenance of appropriate weight in adulthood; and getting tested for presence of hepatitis and Helicobacter pylori infection, and if infected, get treated accordingly.