Types Of Cancer Prevention And Cohort Studies In South West Of Iran

There is an old American saying (by Benjamin Franklin) an ounce of prevention is worth a pound ofcure that is true in our contemporary community about cancer. If we could detect risk factors ofcancer as possible as, so we can prevent malignancies by eliminating them. Therefore, it is muchmore cost effective than paying a billion dollars for diagnosis, treatment and rehabilitation of thesepatients. Prevention may be primary, so that by eliminating cancer- causing agents the cancerincidence in our community will be decreased. For example, vaccination against hepatitis B couldsignificantly reduce liver cancer in Africa, or vaccination against HPV virus recently can reduce theincidence of cervical cancer in women sooner or later in the West. In a study constructed in ourcenter, more than 68% of Khuzestan population harbor the HP bacteria in their stomachs that is themost common cause of gastric cancer. So that gastric cancer that is the most common cancer in Iranmay be reduced in our country by helicobacter pylori (HP) eradication in early ages. Another type ofprevention is secondary prevention so that by detection of pre-cancerous conditions and theirtreatment, we can decrease incidence of cancer in the future. For example, treatment of mucousalmetaplasia or dysplasia of the stomach can prevent the development of gastric cancer, or bypolypectomy in colorectal adenomatous polyps, can reduce colorectal cancer in the future, or totalproctocolectomy in diseases such as FAP and ulcerative colitis can prevent colorectal cancer.Another type of prevention is tertiary, so that by actions reduce second primary carcinoma incancer patients. For example, hysterectomy and bilateral salpingo-oophrectomy (TH-BSO) in apatient with colorectal cancer in underlying Lynch syndrome (HNPCC) whom are menopause or arechild complete can eliminate the chance of malignancy in these organs that is higher than thegeneral population. Chemoprevention is a subtype of secondary prevention, so that we can reducethe chance of malignancies by using of some drugs or supplements like tamoxifen or raloxifen canreduce 50-60% breast cancer in women who are at risk. Celecoxib in patients with colorectal polypscan reduce the risk of colorectal cancer by decreasing polyps, or supplements such as 13-cisretinoicacid ( a certain metabolite of vitamin A) can be used as secondary prevention in patientswith head and neck precancerous lesions like leukoplakia or vitamin D can reduce the risk of breastcancer in women. The best way to find the cause and effect in cancer is cohort studies. For thispurpose, a cohort study was constructed in Hoveyzeh city located in the South West of Iran, thesepeople are similar in terms of ethnicity and cultural habits and behavior. Deputy Custodian of thisproject is Vice-Chancellor for development of research and technology of Ahvaz JundishapurUniversity of Medical Sciences. In this study we included 10000 persons of this town that has specialgeographic and warm weather condition with petroleum and environmental pollutants which isspecific for the south west of Iran. In addition to regional dust, there are intermittent micro andmacro dusts that are specifically for the south west of Iran. However, these people are similar incultural and habitual condition. In addition to the demographic questions, family and drug history,diet and exercise habits will be included, as well. Blood, urine, nail and hair specimens will beSecond international Nastaran Cancer Symposium (2016) taken, too. We will use these databases for comparing other cohort groups in a different geographicregion as North East in Iran without such weather and pollutant condition. When we synchronizethese data with incidence of cancer after two to three decades as registered in our center, we mayfind suspicious causal relationships. In addition, we hope to use these specimens for genetic studiesto find common regional mutations as APC or MMR in colorectal cancers that are very common inyoung people in this region (FAP families are relatively common in Khuzestan Province). Of course,we know that the cause of cancer is multifactorial, but causal effects of some factors such as smokingand alcohol in the lung, esophagus, liver and pancreatic cancers have been discovered in suchstudies. In the same way, the best way for finding a suitable and effective treatment is a randomizedcontrol trial (RCT) study that in medicine it is named as the clinical trial. In the registration unit ofour cancer research center, we witnessed an increasing trend of common cancers in our region(curves will be included in the presentation). We hope to find new specific cause effects using thesecohort studies. So, we could find effective ways for prevention. However, the effective therapy forcancer patients is starting it in the first stages of the disease. In addition to effectiveness, this waymay be easier, lower cost and longer survival. Of course, this requires cancer screening programsfor common types of cancer and this cannot be realized unless the results of cohort studies; forexample, esophageal cancer screening program in the Gonbad city in the North East of Iran, wherewas based on cohort studies in this area.