title: Grand challenges in global health and the practical prevention program? Asian focus on cancer prevention in females of the developing world.
abstract: In response to the request for 'Breakthrough Questions' for 'Grand Challenges in Global Health' recently published in Nature, the Asian Pacific Organization for Cancer Prevention should focus its attention on what projects are of the highest priority for integration with its Practical Prevention Program (PPP). The most common female cancers in most of the countries of Asia are carcinoma of the breast, followed by the uterine cervix. While the incidences of breast adenocarcinomas are still generally lower than in the Western world they are rapidly increasing, and squamous cell carcinomas of the cervix are a major problem. Clearly there are many areas which would reward research. One factor which appears of major relevance in the mammary gland case is the diet, and particularly the phytoestrogens included in 'tofu', along with physical exercise. The age at which these could be operating needs to be elucidated, with reference to timing of menarche and menopause, and also breast mammographic density, another predictor of likelihood of neoplasia. In the cervix, the predominant influence is well established to be persistent infection with a high risk 'oncogenic' type of human papilloma virus (HPV). Vaccines therefore hold much promise, but a better understanding of the mechanisms underlying spontaneous clearance of both infection and cervical intraepithelial neoplasia (CIN) of different grades is also essential for optimal intervention. The roles of smoking and antioxidant intake in particular deserve emphasis. In Asia, with the considerable variation evident in both breast and cervical cancer incidence rates, as well as in cultural and other environmental factors, we are in a very favourable position to meet two specific challenges: 1). elucidation of how diet in adolescence determines susceptibility to neoplasia of the mammary glands; and 2). determination of what governs persistence of HPV infection. Realisation of these pivotal research aims, with especial emphasis on the context of the PPP, is our shared goal.
authors.affiliation: apocp2000@yahoo.com
authors.forename: Malcolm A
authors.initials: MA
authors.lastname: Moore
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tajima
authors.forename: Pham Hoang
authors.initials: PH
authors.lastname: Anh
authors.forename: Gulsun
authors.initials: G
authors.lastname: Aydemir
authors.forename: Partha Sarathi
authors.initials: PS
authors.lastname: Basu
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Bhurgri
authors.forename: Kexin
authors.initials: K
authors.lastname: Chen
authors.forename: Vendhan
authors.initials: V
authors.lastname: Gajalakshmi
authors.forename: Kaoru
authors.initials: K
authors.lastname: Hirose
authors.forename: Alireza Mosavi
authors.initials: AM
authors.lastname: Jarrahi
authors.forename: Le Tran
authors.initials: le T
authors.lastname: Ngoan
authors.forename: You Lin
authors.initials: YL
authors.lastname: Qiao
authors.forename: Hai Rim
authors.initials: HR
authors.lastname: Shin
authors.forename: Supannee
authors.initials: S
authors.lastname: Sriamporn
authors.forename: Petcharin
authors.initials: P
authors.lastname: Srivatanakul
authors.forename: Shinkan
authors.initials: S
authors.lastname: Tokudome
authors.forename: Keun Young
authors.initials: KY
authors.lastname: Yoo
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuda
mesh_terms: D001208:Asia; D001943:Breast Neoplasms / Q000209:etiology / Q000517:prevention & control*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007391:International Cooperation; D008019:Life Style; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000209:etiology / Q000517:prevention & control*