Cancer Prevention in Primary Care

Canadian Medical Association Journal 1995; 153: 788

174 pp.Illust. BMJ Publishing Group, London. 1995. $33.75 (CMA members); $40.50 (nonmembers). Prices include shipping and handling. ISBN 0-7279-0825-1. Available from Canadian Medical Association, Membership Services.

Overall rating: Good
Strengths: Succinct and clearly written; provides a balanced view and practical advice on health promotion and screening in order to detect cancer early.
Weaknesses: Uses British statistics and guidelines for screening for breast and cervical cancer, which differ from those in Canada.
Audience: Family physicians, medical students, nurses, other health care professionals and the public.

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Epidemiologic studies have revealed wide variations in the incidence of cancer between and within countries. Migrants show the cancer incidence patterns prevailing in their country of adoption. These studies have led to the recognition that lifestyle and environmental factors play an important role in causing cancer. Since these factors may be changed, cancer -- in particular lung, breast and colorectal cancer in women and lung, prostate and colorectal cancer in men -- could be prevented. The types of cancer just listed account for more than 50% of all new cases among women and men respectively. Smoking, alcohol consumption, diet and exposure to sunshine (ultraviolet radiation) are the main risk factors that could be modified by behavioural changes. Epithelial cancer develops over many years. Precursor lesions (dysplasia and cancer in situ) precede malignancy (microinvasive, invasive and metastatic cancer). This provides ample opportunity not only to influence patients' behaviour but also to detect premalignant and early cancer that may be curable.

Health promotion involves how to lead a healthy life. In terms of cancer prevention this means avoiding or discontinuing exposure to carcinogens (e.g., tobacco smoking) and complying with medical procedures and recommendations proven to reduce cancer incidence or mortality (e.g., regular Pap smears). On the part of physicians, what is required are knowledge, skills, patience and confidence in what can be achieved.

This book addresses these issues from a family physician's perspective. General practitioners play a major role in cancer prevention by motivating and influencing behavioural changes in their patients and by screening patients. The book consists of two main parts: the first concerns the major risk factors for cancer as determinants of specific tumour sites, and the second involves screening. The chapters are concise, clear and factual, with up-to-date selected references. The essential information and key messages are effectively captured and summarized in boxes.

The book provides a balanced view of the evidence on cancer prevention and screening with practical, realistic and very useful guidelines and advice for family physicians. The reader should be aware that some of the guidelines for screening for breast and cervical cancer are British and differ from those in Canada. However, these differences do not affect the overall importance and usefulness of the book.

Pierre Band, MD, FRCPC
Chair
Division of Epidemiology and Cancer Prevention
British Columbia Cancer Agency
Vancouver, BC

CMAJ September 15, 1995 (vol 153, no 6) / JAMC le 15 septembre 1995 (vol 153, no 6)