Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Cancer prevention strategies: the right decision!
- Zubair Kabir (30 April 2003)
-
Role of weight Reduction in Oesophageal reflux
- Dorasami Raman (3 May 2003)
|
|
|||
|
Zubair Kabir, Research Fellow CResT Directorate, St. James's Hospital, Dublin 8.
Send response to journal:
|
I read with interest Stuart's article (1). I am afraid I have some concerns with regard to supporting the ‘American’ College of Gastroenterology's strategies from a global perspective, especially in developing countries. Stuart has commented upon the huge cost involved in gaining QUALYs from Barrett’s oesophagus using regular endoscopic surveillance. A developing country, such as India, has limited health resources for delivering adequate health care to conditions, which are of huge public health implications, for example, TB, diarrhoeal deaths, malaria, etc. We are still grappling with such infectious disease conditions in developing countries. In addition, both nutrition and epidemiologic transitions have given rise to chronic conditions, which are on the rise. For example, we have to tackle conditions, such as over and under nutrition, as well as diabetes and certain cancers, such as cervical and upper aero-digestive cancers, including oesophagus. There is recent evidence of an increase in oesophageal adenocarcinoma worldwide (2). It is uncertain whether Barrett’s oesophagus is the culprit. However, it may be linked to increasing obesity prevalence. A follow-up study (3)in the United States suggested the absolute reduction of 90,000 deaths from obesity-related cancers, including oesophageal adenocarcinoma, annually if both men and women could maintain normal weight. In addition, an earlier study in the European Union suggested a reduction of 36,000 cancer deaths by halving the prevalence of obesity and overweight annually (4). Unfortunately, such studies in any of the developing countries are yet to draw the attention of the so-called global health agenda initiatives! If the cause-effect relation of obesity and oesophageal adenocarcinoma is true, public-health interventions aimed at anti-obesity campaigns at all levels of the society may have a greater impact on saving lives rather than embarking on an 'indirect' evidence of linking endoscopic surveillance to the apparent survival in Barrett's oesophagus. I strongly recommend that researchers across the globe should not have a tubular vision and rather be more open, as well as committed to a global health agenda to have a wider impact worldwide. Cancer prevention strategies should be one of the priorities over the next two decades (5), but I wonder if screening is the right decision in such a ‘murky’ situation! 1. Spechler SJ. Managing Barrett’s oesophagus. BMJ 2003; 326: 892-4. 2. Corley DA, Buffler PA. Oesophageal and gastric cardia adenocarcinoma: analysis of regional variation using the Cancer Incidence in Five Continents database. Int J Epidemiol 2001; 30: 1415-25. 3. Calle EE, Rodriguez C, Thurmond KW, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 2003; 348: 1625-38. 4. Bergstrom A, Pisani P, Tenet V, Wolk A, Adami H-O. Overweight as an avoidable cause of cancer in Europe. Int J Cancer 2001; 91: 421-30. 5. World Health Organization. World Cancer Report. Lyon: International Agency for Research on Cancer Pres, 2003. Competing interests: ZK is a Research Fellow in Cancer Epidemiology at the University of Dublin (Trinity College). |
|||
|
|
|||
|
Dorasami Raman, Consultant Rheumatologist Our Lady's Hospital, Manorhamilton,Co.Leitrim, Ireland.
Send response to journal:
|
Dr.Spechler's excellent editorial does not mention any preventable factors.Surely sustained weight reduction and abdominal muscle exercises,play a significant and inexpensive role.AstraZeneca,Janssen and Wyeth-Ayerst,understandably,would like to play this down!! Competing interests: None declared |
|||