Public health strategies for cancer control are determined by the epidemiological, clinical and biological characteristic of each cancer. Primary prevention is most easily implemented in cancers due to one or few factors. Secondary prevention is best suited for frequent cancers with a long preclinical, detectable phase. Therapy has to be relied upon in rare cancers of unknown etiology. A critical evaluation of the accomplishments of these three approaches shows that the potential role in cancer control of early detection and treatment is severely hampered by the high social and human costs, that are only partially counterbalanced by the limited effectiveness. As a consequence, primary prevention should be regarded as the key approach to cancer control, and efforts should be concentrated on studies concerning cancer etiology and on the implementation of preventive measures.
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