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More attention needs to be paid to prevention in the fight against cancer

On 11 November Professor of Gastroenterology and Hepatology, Monique van Leerdam will deliver her inaugural lecture entitled, ‘Aiming for Prevention’. Van Leerdam, who specialises in hereditary tumours, was appointed professor in July 2020. In her inaugural lecture she will discuss the importance of cancer prevention and why it is worthwhile. She will call for a greater focus on and more research funding for prevention.

In her inaugural lecture Van Leerdam will discuss three types of prevention: prevention for hereditary cancer syndromes, prevention through bowel cancer screening programmes and prevention for the whole Dutch population through a healthier lifestyle.

Prevention for hereditary cancer syndromes

‘If we know who is genetically predisposed, we can offer prevention in the form of periodical testing. We want to detect the precursors of cancer and remove them so these people won’t develop cancer. Or we want to discover the cancer at an early stage because the prognosis is much better once you treat it. For the inherited cancers it is really important to know who is genetically predisposed.’

Detection is essential

Different detection methods are needed per cancer syndrome. Van Leerdam works a lot with people with Lynch Syndrome, one of the most common hereditary cancer syndromes, which occurs in one in 280 births. According to Van Leerdam, detecting this syndrome is simple.

‘You look at the molecular profile of all patients with bowel cancer. If this is abnormal, you can confirm from the blood whether Lynch syndrome is indeed present. As soon as you know this person has a hereditary cancer syndrome, you can start testing and informing them and their relatives. Then you can offer preventive testing. For people with Lynch Syndrome, we offer preventive colonoscopies where we can remove polyps so they don’t develop bowel cancer.’

Prevention in average-risk groups

The second form of prevention that Van Leerdam will touch on in her inaugural lecture is screening for the general population: the bowel cancer screening programme.

‘We started this in the Netherlands in 2014 and have just received the results of the first five years. These data clearly show that the number of people with bowel cancer is already decreasing. There’s also a decrease in advanced-stage bowel cancers, which clearly shows the importance of prevention. If we look at the countries around us, we can conclude that we have a very good, well-run system in the Netherlands. Lots of people take part in the screening. And if you reach lots of people, your programme also becomes more effective. In addition, we can monitor and evaluate the screening programme because we have built a database that brings everything together. By using these structures, we can start adjusting the programme, which is important.’

Prevention is cost-saving

Van Leerdam says that there is still not enough time and money to evaluate various aspects of the screening programme. ‘We shouldn’t forget that bowel cancer screening actually results in huge cost savings.’ Van Leerdam therefore thinks it is really important for funding to be made available to monitor, evaluate and optimise the programme. This has not yet been properly facilitated.

Prevention in the general population

Then it’s on to the third point in Van Leerdam’s inaugural lecture: prevention of cancer in the general population through a healthier lifestyle. ‘We’ve noticed that the population’s health is deteriorating because many more people are overweight: about 50% of the population is overweight and 13% is obese even. This trend is set to continue in the coming years. Moreover, we know that our western lifestyle really does cause more cancers. For people with hereditary cancer syndrome, known risk factors such as smoking, obesity and alcohol consumption have also been shown to increase cancer risk. The risk factors are the same for both high-risk groups and the general population.

‘Although attention is being paid to this issue, you notice – especially with all the crises now – that changing our lifestyle is not easy. And it won’t get any better in the near future. So we also have to work together to achieve a social situation in which there is enough room for health and lifestyle changes.’

Monique van Leerdam’s inaugural lecture can be watched live from 16:00 on Friday 11 November

Photo: Unsplash / Louis Reed

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