Grand challenges in global health and the practical prevention program? Asian focus on cancer prevention in females of the developing world.

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.

Prevention and health education: how recent advances in the science and art of health education have been applied in practical ways within medical and other settings for prevention and public health.

The terms health education, patient education, self-care education, school health education, and health promotion are distinguished from each other as follows. Health education is a subset or strategy within each of these but is the primary and dominant strategy in health promotion. Health education occurs through the health care providers in various settings: worksites, medical, community agencies and schools. Nurses and midwives are the most important health care providers to train people for health promotion and cancer prevention. We appreciate the importance of the "Fight against Cancer" movement in the primary health care centre and its health care providers who inform people about cancer and its symptoms, how to find lesions and early stages, and how to avoid hazardous factors. This is as process of continuous information transfer by in-service education. Primary prevention should encompass all actions aimed to reducing the occurrence of cancer. In reviewing recent advances in science and how the art of health education has been applied in practical ways within medical and other settings for prevention and public health, we can point ot the necessity for facilities like an APOCP Training Centre as a venue for scientific courses.