Primary prevention of cancer in relation to science, sociocultural trends and economic pressures

Our society has paid scant attention to the outcome of a recent meeting of a group of well-known scientists, economists, and artists for the centennial of the Nobel Prize (1). On that occasion 108 Nobel laureates signed a declaration stating that the most serious danger to world peace does not originate so much from irrational acts committed by single persons or single nations, but from a few large problems that cannot be solved by science and technology alone. These problems are the legitimate demands of the poor, the warming of the planet, and the dissemination of weapons. Poverty, environmental degradation, and the diffusion of weapons are forming a truly explosive mixture. Although poverty is widespread around the planet and there is a desperate need for funding food and public health programs, 2.3 billion US dollars a day, that is about 839 billion a year, were spent in 2001 for military purposes (2), about 2.4 billion US dollars a day in 2003, and most likely much more was spent in 2004. It has been declared that globalization, economic growth, and the improvement in health are strictly correlated (3). A general consensus may exist that the spread of information and of education are fundamental to the improvement of living conditions and that globalization is, to a large extent, already a reality. It is not, however, clear that the massive, unopposed penetration and domination of powerful corporate interests throughout the entire planet will alleviate the economic and social unevenness between rich countries and those that are called developing countries. The distance that separates the richest countries from the poorest, and the rich from the poor within many industrialized countries, is increasing, and social and health inequalities are widening. With this situation as background, primary prevention should be given high priority, as one of its main characteristics is its universality, since it protects the rich and the poor, the strong and the weak indiscriminately. By preventing the occurrence of disease it spares pain and sufferance. The primary prevention of infectious diseases has indeed progressed with the help of a general consensus and wide international collaboration as no one has ever contradicted the fact that bacteria, viruses, and parasites were equally pathogenic at all latitudes. If the primary prevention of infectious disease has not been applied with the same care and accuracy throughout the world, it is not because of doubts about the identified etiologic agents of the diseases, but rather as a consequence of a perverse combination of extreme poverty in certain countries, the irreducible selfishness of the rich countries, and the greed of multinational corporations. The primary prevention of cancer, instead, has often stumbled on an obstacle course, primarily in the most industrialized countries. The identification of a chemical or physical agent as carcinogenic has been met with unjustified skepticism or open hostility from powerful groups that perceive such identification as jeopardizing certain, generally large, profits and financial interests. In contrast to what happened with the biological agents of disease, some chemical compounds have been recognized as carcinogenic in certain countries and not in others, and, even where they have been recognized as being carcinogenic, the permitted or accepted concentrations vary considerably, as if their carcinogenicity would disappear or change at certain borders. The identification of an environmental agent as carcinogenic was, therefore, not necessarily followed by