From evidence to action: the IARC's role in strengthening cancer prevention and early detection.

Purpose: Under the auspices of the WHO-IAEA Joint Programme on Cancer Control, the International Atomic Energy Agency's (IAEA) Programme of Action for Cancer Therapy (PACT) supports Member States through assessments of national cancer control capacities and needs (imPACT Reviews) related to the cancer continuum. imPACT Reviews are conducted jointly with the World Health Organization (WHO), the International Agency for Research on Cancer (IARC), and other partners as appropriate. To ensure continuity of imPACT Reviews to Member States during the COVID-19 pandemic, in particular to low- and middle- income countries, a hybrid modality with a virtual component has been adopted. Methods: With the hybrid modality, imPACT Reviews are conducted partially virtually through online meetings with stakeholders/international experts (using photos, videos and live walk-throughs of health facilities), and through in-country visits when travel restrictions are lifted to validate findings and engage with national authorities. Results: The case studies of Senegal and Mali initiated in mid-2020 demonstrate the effectiveness of the hybrid modality. Review findings and recommendations have been consolidated into preliminary reports submitted to the respective Ministries of Health in December 2020 and considering the impact of COVID-19 on cancer-related health services. The Reviews featured a cervical and paediatric cancer focus in line with WHO global initiatives and national priorities. Immediate next steps for the countries are the development of costed national cancer control plans and support in mobilizing resources. Conclusion: The coordinated efforts of IAEA, IARC and WHO ensured continuity of evidence-based cancer control assessments and the virtual component may be considered for future imPACT Reviews. Benefits include involving a higher number of institutions and experts, minimizing disruption to their work, visiting more health facilities, and ensuring sustained dialogue over a longer period of time. This contributes to a stronger collaborative network while enhancing government engagement and national ownership. Citation Format: Marianna Nobile, Kendall Siewert, Maria Tena Perpina, Yuliya Lyamzina. Cancer Control Assessments in Low- and Middle-Income Countries during COVID-19: The IAEA-IARC-WHO imPACT Review Hybrid Modality [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 18.

The burden of cancer is increasing worldwide due to ageing, growing populations and increased exposure to major risk factors, including unhealthy diet, sedentary lifestyle and for many populations, tobacco smoking (Global Burden of Disease Cancer Collaboration et al., 2015). This trend is part of a wider phenomenon of increasing burden of non-communicable diseases (NCDs) (World Health Organization, 2011). Deaths from NCDs are projected to increase from 38 million to 52 million between 2012 and 2030 (World Health Organization, 2014). The NCD burden is not evenly distributed, with more than 80% of all premature NCD deaths occurring in low- and middle-income countries (LMIC). The growing burden of cancer in developing countries is due to changes in lifestyle and reproductive factors, which complement a pre-existing high burden caused by infectious diseases (Bray, Jemal, Grey, Ferlay, & Forman, 2012; Kanavos, 2006). Much of the cancer burden in developing countries is preventable through lifestyle modification, tobacco control, screening and vaccination (Kanavos, 2006). As a result of overburdened, poorly developed and fragmented health care systems, the prevailing lack of prevention, early detection and treatment interventions contributes to a disproportionately higher cancer mortality in these countries. Given many competing priorities, governments and donor agencies lack the resources and strategic direction to address the scale of the NCD challenge (Reeler & Mellstedt, 2006). Underfinanced health care facilities are not able to offer complex and expensive cancer treatments (Global Burden of Disease Cancer Collaboration et al., 2015). Another important issue is the lack of appropriate data on cancer incidence, mortality and outcomes of services. These data are necessary to understand the extent of the cancer problem across the population, and to monitor status changes in incidence and mortality, including responses to cancer control initiatives, such as treatment and preventive programmes (Bray, Znaor, et al., 2015; Parkin, 2006). In this commentary, we provide an overview of cancer epidemiology and cancer registration challenges in LMIC, with a special focus on the Pacific Islands. There were an estimated 14.1 million new incident cancer cases and 8.2 million cancer deaths globally in 2012, with 57% of new cases and 65% of the cancer deaths occurring in the less developed countries (Ferlay et al., 2013). Large increase in global cancer burden is projected by 2025 (Bray, 2014). Increases in cancer incidence are projected to be proportionally greatest in LMIC (Bray et al., 2012). According to GLOBOCAN data, the overall age-standardised cancer incidence and cancer mortality rates in less developed regions were 147.7 and 98.4 per 100 000 people in 2012 (Ferlay et al., 2013). The most frequent cancer sites were lung, breast, stomach, liver and colon/rectum. By comparison, the corresponding cancer incidence and mortality rates in more developed regions were 267.2 and 108.5 per 100 000 respectively. The smaller elevation in mortality than incidence in more developed areas reflects both a difference in mix towards less lethal cancer types and better survival. The incidence gap is closing rapidly, however, as developing countries adopt "Western" lifestyle and health behaviours (Bray, 2014). In more developed areas, breast, prostate, lung and colorectal cancers comprise approximately half of all cancers, whereas in less developed areas, stomach, liver and cervical cancers play a more important role (Ferlay et al., 2015). Infectious agents play an important role in the genesis of these cancers highlighting the greater importance of infections as a cancer cause in developing countries. Infections are responsible for an estimated 25% of cancers in developing countries, whereas the corresponding proportion is about 10% in developed countries (Plummer et al., 2016). In recent decades, a cancer transition has taken place, however, with an increasing incidence of breast, colorectal and prostate cancers also taking place in less affluent populations which historically had a lower risk of these cancers (Bray et al., 2012). Changes in reproductive, dietary, metabolic, hormonal and behavioural factors are likely to be responsible for this transition. Pacific Islands countries and territories (PICTs) comprise 20 000–30 000 islands in the Pacific Ocean (World Health Organization Western Pacific Region, 2012). PICTs vary in stage of human development, size, culture and economic resources; however, they all face the triple burden of NCDs, communicable diseases and the impact of climate change (World Health Organization Western Pacific Region, 2012). PICTs have one of the highest NCD incidence rates in the world, comprising the leading cause of mortality. Relatively small populations, large physical areas with long distances, geographic isolation, reliance on overseas assistance and weak economies complicate the provision of the health care services that would be essential to address this increasing public health challenge. The cancer burden is thought to be increasing in the PICTs, although only limited quantitative evidence is available due to a paucity of cancer incidence and mortality data (Moore et al., 2010; Varghese, Carlos, & Shin, 2014). Eight of the 22 PICTs were included in the GLOBOCAN 2012 (Fiji, French Polynesia, Guam, New Caledonia, Papua New Guinea, Samoa, Solomon Islands and Vanuatu) (Ferlay et al., 2013). Most of these PICTs had national incidence data for some diagnostic time periods, but not Papua New Guinea and Solomon Islands, where all cancer rates or rates for neighbouring countries have been used to estimate cancer incidence. Meanwhile, mortality data were missing for Guam, Papua New Guinea, Samoa, Solomon Islands, and Vanuatu, where mortality estimates were derived from estimated national incidence rates and modelled survival. None of the PICTs were reflected in or contributed to the Cancer Incidence in Five Continents Volume X (CI5-X) publication (Forman et al., 2014), indicating their relatively low availability of high quality data. According to GLOBOCAN 2012, cancer incidence was estimated to be highest in New Caledonia (age-standardised rate (ASR) of 330.7 for men and 269.3 for women per 100 000) and in French Polynesia (ASR 287.4 for men and 227.3 for women per 100 000) (Ferlay et al., 2013). Similarly, age-standardised cancer mortality rates were estimated to be highest in French Polynesia (ASR 153.9 for men and 116.3 for women per 100 000) and New Caledonia (ASR 146.0 for men and 112.0 for women per 100 000). In all other countries, cancer incidence estimates were below the World average, with cancer incidence generally higher among women than men. The most common cancers among men were estimated to be prostate, lung, stomach, liver and lip/oral cavity cancers. For women, breast cancer was ranked as the most common cancer in all countries, except in Papua New Guinea where cervical cancer was most common. Notably Papua New Guinea accounts for over a third of the total Pacific population at over 6 million, thereby increasing the contribution of cervical cancer to the cancer burden in the Pacific region. A study examining cancer incidence in four PICTs (Fiji, Tonga, Cook Islands and Niue) reported that age-standardised cancer incidence was lower in these countries than among Pacific people living in New Zealand (Foliaki et al., 2011). Under-recording is likely to have contributed to these differences. Despite relatively low (reported) cancer incidence in many PICTs, cancer is one of the leading causes of death in the region (Carter et al., 2011, 2016; Pacific Regional Central Cancer Registry, 2015). There are distinguishing features of cancer epidemiology in the PICTs, such as very high thyroid cancer incidence in New Caledonia and French Polynesia (Ferlay et al., 2013), a high burden of cervical and uterine cancers, especially in Fiji and the Cook Islands (Foliaki et al., 2011; Law et al., 2013) and a high burden of oral cavity and pharyngeal cancers linked with betel nut chewing (Moore et al., 2010; Pacific Regional Central Cancer Registry, 2015). Nuclear tests conducted by France in French Polynesia and by the US in Marshall Islands have been linked to increased thyroid cancer and leukaemia rates (Bouchardy, Benhamou, de Vathaire, Schaffar, & Rapiti, 2011; Simon, Bouville, Land, & Beck, 2010). Data collected by population-based cancer registries (PBCR) are the gold standard for providing information on cancer incidence across geographic areas and for planning population-wide cancer control programmes (Bray, Znaor, et al., 2015). Full case ascertainment and unbiased information on cancer burden is optimally achieved where there is a well-functioning health care system. Availability as well as quality of cancer incidence and mortality data tends to increase with development and infrastructure levels, with many LMIC still without cancer registration systems in place or hospital- or pathology-based registration systems that are not population-based. In addition to cancer data, population denominator data are also needed in order to provide accurate information on cancer incidence rates. These data commonly come from censuses which may be rarely or irregularly conducted in developing countries (Valsecchi & Steliarova-Foucher, 2008). Population-based cancer registries systematically collect information on all cancers occurring in a defined population using multiple data sources, whereas hospital- and pathology-based registries collect information on cases treated/diagnosed in selected institutions or laboratories (Bray, Znaor, et al., 2015). While useful, such data may not be representative of the overall population experience and may contain important statistical biases from a population perspective. While data collected from hospital- or pathology-based registries may provide a misleading cancer profile for the general population, they still can be useful for hospital administration purposes, for reviewing clinical performance and for providing information about cancer profiles of people who obtain hospital/pathology services (Bray, Znaor, et al., 2015; Valsecchi & Steliarova-Foucher, 2008). There are many challenges with cancer registration in developing countries, including weak or non-existent health care infrastructures, lack of accurate death records and population data, complicating issues related to cultural norms and problems caused by political and economic instability, and mobile populations (Parkin & Sanghvi, 1991; Valsecchi & Steliarova-Foucher, 2008). In order to register all cases of cancer, data need to be collected from multiple sources, including hospitals, laboratories and death certificates (Bray, Znaor, et al., 2015). Lack of health care networks, poorly developed communications between different stakeholders as well as inability to uniquely identify individuals complicate the collection of these data (Valsecchi & Steliarova-Foucher, 2008). Underestimation of both cancer cases and deaths is commonplace where many people lack access to basic health care services and cancers and cancer deaths go unrecorded, as may apply in particular in the rural areas. People may die at home and be buried at home or otherwise locally without reporting to government authorities (Jedy-Agba et al., 2015). Poor transportation networks and phone connections, cultural and religious constraints, preference for traditional healing and taboos and stigmas relating to cancer contribute to an underestimation of numbers of cancer and a lack of follow-up for registered cases (Valsecchi & Steliarova-Foucher, 2008). In addition to these technical challenges, a lack of financial and material resources, trained personnel and support from governments, policymakers and health professionals further complicates cancer registration. As cancer registration involves considerable costs, regional registries collecting data on sub-national samples have been considered good options in some low-resource countries (Bray, Znaor, et al., 2015). When cancer data are collected, there may be issues with quality, such as low proportions of cases confirmed microscopically due to a lack of pathology services (Bray, Ferlay, et al., 2015). Cancer diagnoses may be based on clinical examination only, with greater uncertainty (Parkin & Sanghvi, 1991). Another important indicator of poorer data quality is a high percentage of cases registered from death certificates only (DCOs), reflecting incomplete case identification (Bray, Ferlay, et al., 2015). On the other hand, a total lack of DCOs may indicate failure to use death certificate information or to link death information to the cancer registry (Curado, Voti, & Sortino-Rachou, 2009). Accuracy of diagnostic information derived from death certificates is generally suboptimal. In addition, there may be specific problems in developing countries in relation to the quality of death certification, with information on causes of death often missing/erroneous and with certificates often completed by lay-people instead of medical doctors. In addition to cancer diagnosis and death data, other essential data may be missing or incomplete, including birth date, age and place of residence (Jedy-Agba et al., 2015). Lack of co-operation and difficulties in accessing data from several data sources may be caused by general distrust of government-related activities, lack of a culture of data collection and concerns about confidentiality (Jedy-Agba et al., 2015). Making cancer a registrable disease by government regulations can mitigate challenges in data collection and increase the authority of PBCR, although success is likely to depend on availability of resources and culture and politics of the country. Continuous monitoring and mentoring involving both local and international experts and sustainable funding models are often essential for ongoing, successful registration (Jedy-Agba et al., 2015). Commonly, low cancer data quality stems from overall weakness of health care system and, therefore, wide-ranging system-level improvements would materially improve registry quality. The first cancer registry in the PICTs was established in Papua New Guinea in 1958 (Foliaki et al., 2011). According to information from the World Health Organization, many PICTs have cancer registries nowadays (World Health Organization, 2016). In addition, most PICTs have collected census information in recent years (Secretariat of the Pacific Community, 2016). There are issues, however, with quality, coverage and completeness of cancer data (Dachs et al., 2008; Moore et al., 2010; Shin, Carlos, & Varghese, 2012). Many of the registration challenges mentioned earlier in this commentary are familiar to PICTs. Lack of infrastructure, coordination and funding, poorly developed health care systems, under-recording as well as poor quality of death certificates and diagnostic information complicate the collection of cancer data in many PICTs (Palafox et al., 2004). Along with vast distances between PICTs and degree of remoteness, the high proportions of foreign contract workers in some islands, and conversely the extent to which the birth population has migrated off-island impact the development of sustainable infrastructure. Different development agencies, including funders of new programmes, often request data in formats and using software modules that are not familiar to local data custodians complicating the meaningful collection and utilisation of data at the regional level. Many PICTs have close relationships with 'host' countries (the US, New Zealand and France) and are dependent on external aid, including health development. There is an opportunity to review health development assistance platforms with one of the major initiatives being health information and monitoring. Due to natural conditions, many PICTs are dependent on imported food (World Health Organization Western Pacific Region, 2012). Financial incentives, such as the Nuclear Claims Tribunal in the Marshall Islands, may facilitate the case finding of certain cancer types, but not others. Natural and other disasters have destroyed cancer registry databases in Nauru (Palafox et al., 2004), Niue (Foliaki et al., 2011) and American Samoa (Tsark, Cancer Council of the Pacific Islands, & Braun, 2007). Due to limited treatment options, people diagnosed with cancer may die off-island and, therefore, may not be registered. The Global Monitoring Framework of WHO, subsequent to the United Nations high-level meeting to "launch and all-out attack" on NCDs in 2011, specifically mentions the recording of cancer incidence by type of cancer per 100 000 population as an indicator to monitor 2025 targets; thereby placing an onus on countries to establish PBCR. The International Agency for Research on Cancer (IARC) in collaboration with major international and national partner organisations established the Global Initiative for Cancer Registry Development (GICR) in 2011 (International Agency for Research on Cancer, 2014, 2016). The aim of the GICR is to improve the coverage, quality and networking capacities of PBCR in LMIC. The GICR is organised around Regional Hubs for providing technical support and on-site training, assessing data quality and overall capacity for development, coordinating different activities and monitoring overall progress in the region. One of these is the emerging Pacific Islands Regional Hub which will focus on supporting cancer registries and improving data collection and data utilisation for cancer control in Fiji, New Caledonia, Papua New Guinea, Solomon Islands, Vanuatu, Guam, French Polynesia and Samoa. The Hub will be governed by an Advisory Board comprising regional experts from participating PICTs, along with Australia and New Zealand, and other local experts in the use of registry data to support local service delivery and research. The Pacific Islands Regional Hub will comprise a collaboration of registry experts, local public health practitioners and administrations. The registry experts will provide support and consultancy services for existing registries, such as ongoing training and assistance with registration, quality assurance, statistical analysis and research activities, whereas local PICT public health practitioners and administrators will give direction to the use of these data for local service delivery. There is no question that the Pacific Hub initiative should be tested, along with obligations to establish PBCR. It will be critical to continually monitor progress and reassess implementation in terms of strategic approaches, steps taken, and local involvement to ensure full participation and ownership of the initiative by Pacific countries, as well as sustainability and effectiveness of the Hub activities. The US-associated PICTs (American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Belau) established the Cancer Council of the Pacific Islands and the Pacific Regional Central Cancer Registry in the early 2000s (Pacific Regional Central Cancer Registry, 2015; Tsark, Cancer Council of the Pacific Islands, & Braun, 2007). This collaboration has enabled the development of culturally appropriate cancer control strategies and activities for the US-associated PICTs, with publication of cancer incidence rates for 2007–2012. The key to the success has been culturally appropriate approaches, local capacity building and leadership, and funding support. The Pacific Islands Regional Hub seeks to build on this experience and through collaborative arrangements, provide complementary support services for other PICTs that are attuned to their needs. In order to strengthen cancer registration in the PICTs, improvements in health care systems and infrastructure are needed more generally and in quality of death certificates and diagnostic information systems. The key strategies for achieving these improvements include building governance structures which coordinate the responsibilities and actions of different stakeholders and using culturally appropriate methods in order to ensure strong local engagement and sustainability. The potential of the emerging Pacific Islands Regional Hub to serve a useful role in advancing and coordinating these activities will be tested. None to declare.

Public health and evidence-informed policy-making: The case of a commonly used herbicide.

Diet, nutrition and cancer: public, media and scientific confusion

Over the past 6 decades, the International Agency for Research on Cancer (IARC) has played a pivotal role in global cancer research capacity building. This study presents a comprehensive evaluation of IARC's capacity-building initiatives with a mixed-methods approach. We integrated qualitative and quantitative data from institutional records, outcome surveys, and a career-tracking study of postdoctoral fellows. IARC's capacity-building portfolio includes fellowships, digital-learning platforms, a summer school, and global networks such as the Global Initiative for Cancer Registry development, the Cancer Screening in 5 Continents project, and the Biobank and Cohort Building Network. Since 1966, approximately 30 000 professionals from most countries in the world have benefited from those initiatives, with a majority from low- and middle-income countries. Among tracked IARC postdoctoral fellows, since 1966, 76.5% remained in academia, and 18.7% had a role in public health policy. Qualitative findings highlight the impact of IARC training on individual careers, institutional capacity, and global cancer control strategies. IARC's sustained investment in capacity-building has strengthened the cancer research workforce and institutional infrastructures while reducing inequalities in low- and middle-income countries. These efforts have advanced leadership, equity, and evidence-based cancer prevention. As global health challenges evolve, continued support remains essential to achieving equitable cancer control worldwide.

Moving cancer up the global health agenda

RÉSUMÉ: Cette thèse porte sur une nouvelle technique d'imagerie médicale qui permet de déterminer la distribution de conductivité électrique des tissus d'une région du corps avec une résolution comparable à celle de techniques courantes d'imagerie par ultrasons. Cette nouvelle technique, appelée imagerie par « modulation acoustique de conductivité électrique » (MACE), est basée sur l'interaction entre une onde acoustique et un champ électrique. Dans sa réalisation expérimentale la plus simple, quatre électrodes placées à proximité de la région à imager appliquent un courant électrique de faible amplitude et mesurent la différence de potentiel résultant du passage du courant dans les tissus. Un transducteur ultrasonore focalisé vient insonifier un voxel de la région d'intérêt, modifiant la distribution de conductivité et, ce faisant, l'amplitude du potentiel mesuré par les électrodes. Une image de la distribution de conductivité peut être obtenue en déplaçant l'ensemble capteur-électrodes pour balayer la région d'intérêt ; l'onde acoustique sert alors d'agent de localisation, tandis que la mesure de potentiel quantifie la variation de conductivité dans chaque voxel insonifié. L'imagerie par MACE présente de nombreux avantages mais aussi des défis importants de mise en œuvre. Puisque ces avantages et défis dépendent de l'application visée, notre démarche a été orientée vers un objectif particulier, soit l'application de l'imagerie par MACE au diagnostic du cancer du sein. Ce choix est justifié par le potentiel que présente cette technique pour discriminer une tumeur maligne des autres tissus mammaires. En effet, des études expérimentales sur des tissus excisés réalisées durant près d'un siècle ainsi que l'apport plus récent des techniques de mesure d'impédance confirment qu'il existe une différence significative dans les spectres fréquentiels de conductivité électrique des tissus cancéreux et sains. Le développement de systèmes de tomographie d'impédance électrique (TIE) orientés vers l'imagerie du sein ne semble pas pouvoir réaliser ce potentiel, principalement parce que la résolution spatiale de la TIE est insuffisante pour détecter les tumeurs à un stade précoce. L'imagerie par MACE pourrait contourner cette limite fondamentale de la TIE. Deux modèles sont proposés dans cette thèse pour réaliser l'imagerie par MACE. ABSTRACT: This thesis describes a new medical imaging technique for determining the electrical conductivity distribution of tissues in a body region with a resolution comparable to that of current ultrasound techniques. The new technique, henceforth referred to as "Acousto-Electric Conductivity Modulation" (AECM) imaging, is based on the interaction of a sound wave with an electrical field. In its simplest form, four electrodes located near the region to be imaged apply a low-amplitude electrical current and measure the potential difference arising from current flow in the tissues. A focused ultrasound transducer directs a pressure wave to a voxel of the region of interest, modifying its conductivity distribution and, as a result, the amplitude of the potential measured by the electrodes. An image of the conductivity distribution can thus be constructed point-by-point by moving the electrodes and transducer to scan the object. In this context, the acoustic wave acts as the localization agent while the electrical potential provides a measure of the local conductivity change that occurs in the voxel.AECM imaging presents several advantages but also implies addressing significant difficulties in its deployment. Since the advantages and implementation difficulties depend on the intended application, we have focused on achieving a specific objective: applying AECM imaging to the diagnosis of breast cancer. The rationale for this choice is the potential presented by AECM imaging for discriminating cancerous tumors from healthy breast tissue. Indeed, experimental studies on excised tissues carried out over nearly a century, supported by more recent wideband tissue impedance measurements, have shown that there are significant differences in the electrical conductivity spectra of cancerous and normal tissues. Yet electrical impedance tomography (EIT) systems specifically designed for breast imaging do not seem to be capable of providing the required tissue discrimination characteristics, mainly because the low spatial resolution of EIT prevents detecting tumors at an early stage. AECM imaging could overcome this inherent limitation of EIT.Two models are proposed in this thesis for implementing AECM imaging. Formulations for the forward and inverse problems are provided for both models. The forward problem involves computing the AECM signals given the electrical conductivity distribution of the medium and the data acquisition protocol.

in Lyon, France, we lost a great human being, a staunch advocate for public health, a thorough and delving scientist, and a humanitarian par excellence. Lorenzo Tomatis, MD, above all, was a learned teacher and creative innovator. His accomplishments are legion, and his far-reaching impact on human health, including the well-being of future generations, will be impossible to replace. Tomatis was clearly a true pioneer and admired leader in primary disease prevention. He stands tall among other giants and trailblazers of environmental health science and public health advocacy including Cesare Maltoni, Norton Nelson,

Every year, millions of people climb in various states of undress into warm, glowing tanning beds, where during a typical 2- to 15-minute session they’ll absorb a controlled dose of ultraviolet (UV) radiation at an intensity up to two to three times stronger than the sunlight striking the equator at noon. The tanning industry has grown rapidly since the 1980s,1 rising to an estimated 28 million users in the United States.2 This rise has been accompanied by an increase in diagnoses of skin cancer. The reasons behind the rising skin cancer diagnoses remain open to debate. Some experts attribute the rise to more frequent skin cancer screening, whereas others blame environmental and behavioral risk factors, particularly changes in UV exposure. In this latter context, UV-emitting tanning beds—classified as carcinogenic to humans by the International Agency for Research on Cancer (IARC)3—have come under growing scrutiny. People tan to look healthy, but looks can be deceiving; UV radiation causes all three types of skin cancer. Melanoma, a tumor of the cells that produce the skin pigment melanin, is the rarest but deadliest type, accounting for 75% of skin cancer deaths worldwide.4 According to the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program, melanoma incidence among U.S. whites (who develop the disease more often than other races) rose from 8.7 cases per 100,000 people in 1975 to 28 cases per 100,000 in 2009.5 Most of that increase occurred in older men, who rarely tan indoors. But a closer look at the age-stratified SEER data reveals that melanoma rates among white girls and women aged 15–39 rose by 3.6% per year between 1992 and 2006, compared with a 2% increase per year among boys and men of the same ages.6 Although they’re not tracked by SEER, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC)—the other two types of skin cancer—also appear to be on the rise, according to regional studies from the United States and Europe. A recent study by Anne Marie Skellett, a consulting dermatologist at Norfolk and Norwich University Hospital, reveals that BCC diagnoses among people under age 30 in the United Kingdom jumped 145% between 1981 and 2006.7 Statistics such as these have prompted 33 U.S. states and some municipalities to ban or restrict indoor tanning among children under age 18.8 California’s ban, signed into law in October 2011, was the first,9 followed by Vermont in April 201210 and the city of Chicago the following June.11 Other states have introduced legislation to limit indoor tanning among minors.8 Melanoma in the United States Scanning electron micrograph of a melanoma cell magnified 8,000 times Mary Brady, an associate professor of surgery at Weill Medical College in New York and the author of an editorial on indoor tanning that appeared in the May 2012 issue of the Journal of Clinical Oncology,12 says the bans make sense. “We legislate against smoking in kids less than 18, and that sends a strong message that there’s something wrong with it,” she says. “We need to send the same message on indoor tanning.” But the bans have drawn a backlash from the tanning bed industry, whose representatives say they’ve been unfairly and incorrectly singled out. John Overstreet, executive director at the Indoor Tanning Association in Washington, DC, describes the evidence linking indoor tanning to skin cancer as speculation and advocacy science reported by the media as fact. He points out that UV light triggers skin cells to produce vitamin D, which may have cancer-protective effects. “It’s frustrating,” he says. “There’s no doubt that repeated overexposure to UV or burning can cause skin problems, but you also have to look at the health benefits, and that issue always gets lost.”

Chronic infection and other risk factors of cancer in China and other countries

The World Health Organization (WHO) targets for eliminating HCV by 2030 may be overambitious for many high-income countries. Recent analyses (ie, data from 2017 to 2019) show that only 11 countries are on track for meeting WHO's elimination targets. For a country to be truly on track, it is important that the majority of infected individuals be identified and treated. There is still a need for country and population-specific evaluations within the different HCV screening and treatment strategies available, in order to assess their cost-effectiveness and sustainability and support an evidence-based policy for HCV elimination. Any health policy model is affected by the diversity and quality of the available data and by gaps in data. Given the differences among countries, comparing progress based on fixed global targets will not necessarily be suitable in the same measure for each country. In a recent document, the European Collaborators of Polaris Observatory provide insight into the limitations of the current WHO targets. The absolute targets identified by each country in accordance with the measures set by WHO would be essential in reaching the HCV elimination. All analytic models to assess the progress towards HCV elimination are based on projections to 2030 not including the impact of the COVID-19 pandemic on hepatitis-related services. With specific regard to the achievement of WHO hepatitis elimination goals, all measures that will be put in place during and after COVID-19 pandemic could be transferred in increasing diagnosis and linkage to care of people with hepatitis.

Editorial introductions

Vol. 119, No. 11 CorrespondenceOpen AccessIn Favor of Controlling Proven, but Not Probable, Causes of Cancer: Landrigan et al. Respondis accompanied byGlobal Prevention of Environmental and Occupational CancerIn Favor of Controlling Proven, but Not Probable, Causes of Cancer Philip J. Landrigan, Carolina Espina, and Maria Neira Philip J. Landrigan Search for more papers by this author , Carolina Espina Search for more papers by this author , and Maria Neira Search for more papers by this author Published:1 November 2011https://doi.org/10.1289/ehp.1104201RAboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit We thank Erren et al. for their positive comments about our editorial on environmental and occupational causes of cancer (Landrigan et al. 2011). In particular, we acknowledge their support of our central thesis, expressed in the Declaration of Asturias [World Health Organization (WHO) 2011], that control of the toxic chemical causes of cancer must be a core component of global cancer control programs, equal in importance with efforts to understand and control “lifestyle” carcinogens such as diet, alcohol, and tobacco.Erren et al. assert that programs aimed at control of chemical carcinogens must focus solely on chemicals that have been designated by the International Agency for Research on Cancer (IARC) as proven (class 1) human carcinogens (IARC 2011). Clearly class 1 carcinogens such as asbestos, benzene, benzidine, and dioxin merit very high priority in cancer control. There is no excuse, for example, for the continuing export of any form of asbestos to low- and middle-income countries.We are of the view, however, that programs for control of chemical carcinogens must also encompass certain judiciously chosen class 2A or “probable” human carcinogens, such as diesel exhaust, indoor emissions produced by combustion of biomass fuels, and dimethylnitrosamine, for which there is already strong evidence of carcinogenicity in animal, cellular, or molecular models and limited human data (IARC 2011). In years past it would have been a serious lost opportunity not to have taken actions to control such carcinogens as formaldehyde or 1,3-butadiene during the years in which those compounds were classed by IARC as “probable” human carcinogens before they were upgraded to class 1.For the future, as incidence rates of cancer and cardiovascular disease (CVD) continue to increase worldwide with accelerating global spread of the “Western lifestyle” and concomitant global diffusion of toxic synthetic chemicals, it will be imperative that disease control programs in countries around the world address both lifestyle as well as chemical causes of chronic illness. Strong synergies have been documented between lifestyle and toxic chemical exposures, for example, between cigarette smoking and asbestos in causation of lung cancer (Selikoff et al. 1968) and between diet and urban air pollution in causation of CVD (Brook and Rajagopalan 2010). Approaches to disease causation therefore need to address both lifestyle and toxic chemicals as causes of illness if they are to be fully effective in improving health and saving lives.The authors declare they have no actual or potential competing financial interests.ReferencesBrook RD, Rajagopalan S. 2010. Particulate matter air pollution and atherosclerosis.Curr Atheroscler Rep 12(5):291-30020617466. Crossref, Medline, Google ScholarIARC (International Agency for Research on Cancer). 2011. Agents Classified by the IARC Monographs, Volumes 1–102.Available: http://monographs.iarc.fr/ENG/Classification/index.php [accessed 18 July 2011]. Google ScholarLandrigan PJ, Espina C, Neira M. 2011. Global prevention of environmental and occupational cancer. [Editorial]Environ Health Perspect 119:A280-A28121719377. Link, Google ScholarSelikoff IJ, Hammond EC, Churg J. 1968. Asbestos exposure, smoking, and neoplasia.JAMA 204(2):106-1125694532. Crossref, Medline, Google ScholarWHO (World Health Organization). 2011. International Conference on Environmental and Occupational Determinants of Cancer: Interventions for Primary Prevention. Asturias Declaration: A Call to Action.Available: http://www.who.int/phe/news/events/international_conference/Call_for_action_en.pdf [accessed 18 July 2011]. Google ScholarFiguresReferencesRelatedDetailsRelated articlesGlobal Prevention of Environmental and Occupational Cancer1 July 2011Environmental Health PerspectivesIn Favor of Controlling Proven, but Not Probable, Causes of Cancer1 November 2011Environmental Health Perspectives Vol. 119, No. 11 November 2011Metrics About Article Metrics Publication History Originally published1 November 2011Published in print1 November 2011 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. 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The American Cancer Society released the 2nd edition of The Cancer Atlas at the World Cancer Congress, which took place in Melbourne, Victoria, Australia between December 3 and 6, 2014.1 Issued for the first time as both a book and an interactive Web site (canceratlas.cancer.org), the report highlights the complex nature of the global cancer problem as well as strategies for governments to reduce their cancer burden. With the number of cancer cases expected to increase by more than 50% by 2030, researchers from around the world collaborated to cull through numerous data sources to create this resource. The Cancer Atlas was produced in partnership with the International Agency for Research on Cancer (IARC) within the World Health Organization and the Union for International Cancer Control. The report consolidates data from 184 countries and the best sources available, including the IARC GLOBOCAN database. The Web site includes an interactive map and tables, and provides highlights of country-by-country strengths and weaknesses worldwide, enabling an assessment of the differences in risk, burden, and prevention. Ahmedin Jemal, DVM, PhD, lead author of the project, notes that as nations become more industrialized, their cancer risk factors (including tobacco use, diet, and physical activity) increase, along with life expectancy. He adds that although these countries tend to be associated with a higher cancer risk, they also have experienced declines in cancer mortality because of advances in early detection and treatment. The United States, for example, has avoided 1.3 million cancer deaths within the past 20 years. Economically developing countries now account for nearly one-half of the world's new cancer cases and deaths. Inequality in access to interventions that can prevent and treat cancer is another important factor highlighted in The Cancer Atlas, according to Christopher Wild, PhD, director of the IARC. Bringing those interventions to individuals in lowincome and middle-income countries is a major priority, he says.

Perspectives on recent reviews of aspartame cancer epidemiology