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Jan-Willem Coebergh

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Prof.dr.J.W.CoeberghPersonal web Page

Having been active in the field of Cancer Surveillance since about 1981 (the year of apparition of the Doll & Peto monograph Causes of Cancer) somehow with increasing satisfaction. Nevertheless, I often wonder what still attracts me in that field, apparently being without feelings of 'more of the same', and after having been so involved in so many studies of any tumour and in more general studies, at regional, multi-regional, national and European level. Is it the pure and often exciting content of cancer epidemiology , broad enough due to the 100+ tumours that all need to be described in its variation in time and place to contribute to prevention or cure? What makes it so interesting is that every tumour, every major involved medical specialty has a story of involvement of rational and often irrational behavior. The same is also true for every exposure involved.

In that sense offers cancer control very interesting history from which often a future becomes visible. This future most often knows a long term. It seems that cancer control resembles very much an Echternacht procession (3 steps forward and 2 steps back) with the difference that the first 4 steps are backward (introduction of a carcinogenic exposure, with a long latency time and a denial phase upon first 'vague' suspicion) after which 8 steps (each of which being threatened by a set-back) have to be made before success looms after many decades often more than 100 years. (see my paper in EJC of september 2010 )

Recently we had difficulties of getting a paper published about the extinction of occupational scrotal cancer, being described for the first time 235 years ago in England by Percival Potts, thus a major success of cancer control.  Articles on the fantastic decrease of stomach cancer are considered boring and are overshadowed by worrying papers on clinical problems with the remaining  few cancers. So, it is indeed the strategic and societal aspect  and the generally heroic (the patient rather being the hero than the warrior)  tremendous efforts needed to get the terrible cancers under control, but let us be honest often with a lot of collateral damage. That is in fact an underestimated aspect: the battle against cancer conveys a lot of collateral damage as the successful management of the 1970's of childhood and adolescent cancer still shows through the now manifold studies of long term side effects.  We can learn so much more from these histories, also that quick fixes do not seem to exist. That is why survivorship studies are a useful correction on clinical behavior that was by definition based on imperfect knowledge. More studies may be upfront needed of just giving halving doses (prescribed by somebody with early half-way knowledge) than of doubling the dose, of decentralizing rather than centralizing. Realize that two thirds of the patients is over 65 years and became more dependent upon his or her environment than often anticipated. Moreover, the advantages of frequently doing something (e.g. an operation) are obvious until the wrong things are being done, wrong drugs prescribed, in a dangerous place full of resistant bacteria and with very slow correction because it the policy of the institute is often sacrosanct. According to 'Searching for Safety' by Aaron Wildavski (1988) technological mistakes made at a large scale are less easily admitted. Let our knowledge be used widely by publishing in the first place. The more our epidemiological knowledge are used for learning and awareness processes, especially among patient groups,  the more useful I feel. That is also why I feel that the setting of a population-based cancer registry, i.e. the Eindhoven Cancer Registry  within a coordinating Comprehensive Cancer Centre, by definition regional, worked out so well, for which the connections with the department of Public Health at Erasmus MC were essential. That is what I shall promote strongly in the Eurocourse project (EU FP7) that will determine the future of cancer registration in Europe. www.eurocourse.org