LAUSR

The numbers of cancer cases are rising dramatically, and no country is an exception to that trend. The Global Cancer Observatory of the International Agency for Research on Cancer/World Health Organization (IARC/WHO) projects an increase of 55% in the annual number of newly diagnosed cancer patients worldwide over the next 20 years, from 18.1 million in 2020 to 28.0 million in 2040, for all cancer sites combined, excluding nonmelanoma skin cancer [1,2]. This corresponds to a total of more than 450 million new cancer patients over the next 20 years. The projected relative increase is largest (89%) in Africa, the continent with the lowest Human Development Index levels. However, the smaller relative increase of 19% in Europe still means that Europe will remain the continent with the highest number of cancer patients per population size, that is 4.8 million new cases in a population of approximately 730 million projected for 2040 [1]. Globally, mortality from cancer is also rising and is projected to reach 16.2 million in 2040. In 2020, about 27 000 cancer deaths were recorded worldwide every single day [1]. As many have stated before, these massive numbers of cancer patients not only will overburden the healthcare systems of less affluent countries, but also lead to the conclusion that ‘no country can afford to treat its way out of the cancer problem’ [3]. There are also other saddening observations. First, although cancer risk increases steeply with age, cancer affects people of all ages. In 2020, almost one third of the new cancer patients, that is 9.1 million of the 28.0 million, were younger than 65 years when diagnosed with cancer [1]. Second, there are significant social disparities, both within and between countries, in whether a cancer diagnosis is a death sentence. For example, as recently reported for breast cancer, which is the most common cancer type in women, survival of at least 3 years was > 90% in high-income countries compared with < 40– 50% in many sub-Saharan African countries, and within Namibia, for instance, was 90% in White women compared with < 60% in Black women [4]. Third, and perhaps most saddening, is the fact that all this happens although there is convincing scientific evidence that a large proportion of these cancer cases and deaths are preventable. For instance, the preventable fraction is estimated to be about 40% in high-income countries [5], including those in Europe [6]. This underlines the need for more rigorous primary prevention of cancer. A long time is needed for cancer prevention interventions to reverse the increasing trends, because of the slow development of the disease. Therefore, the eleventh hour to implement known effective prevention measures is now. However, the preventive potential differs greatly by cancer type. A disheartening example seems to be lung cancer, which is by far the leading cause of cancer death (about 18% of the total cancer deaths in 2020). The major cause of lung cancer, tobacco smoking, has been known for more than seven decades. Despite this, the epidemic of smoking-related lung cancer is not under control. Instead, the annual number of new lung cancer cases is projected to increase by 59% over the next 20 years [1]. This relative increase is no different from that of cancer overall or from that of many cancer types for which the causes have not been identified. Nevertheless, there are sparks of hope for a turning point, as shown in more detail in this Special Issue: Peruga et al. [7] describe some initial successes of the WHO Framework Convention on Tobacco Control and call for bolder action in, for instance, tobacco taxes and banning certain ingredients in tobacco products. Lung cancer is also the most common occupationally related cancer. In this Special Issue, Olsson and Kromhout outline the preventive potential of rigorously implemented worker protection and reduction of workplace exposures [8]. Yet, another significant risk factor for lung cancer is air pollution. In this Special Issue, Vineis et al. [9] describe how cancer prevention could go hand in hand with climate change mitigation on tobacco control, food production and transportation exhaust, creating an effective win–win for people and the environment. Another preventable cancer type, cervical cancer, was responsible for about 600 000 new cancer cases and about 340 000 cancer deaths in 2020 [1]. Cervical cancer can be prevented by a combination of human papillomavirus vaccination and screening, and there is much optimism about the WHO global strategy to eliminate cervical cancer as a public health problem [10]. In this Special Issue, Bigaard and Franceschi [11] describe that even when