Latin America and the Caribbean Code against Cancer

Specialists on the subject and civil society representatives from Latin America and the Caribbean, convened by the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) and the Pan American Health Organization (PAHO), have reviewed the scientific evidence and recommend the following 17 actions people can take to help prevent cancer:

 

1. Don't smoke or use any type of tobacco. If you do, quitting is possible, with professional help if needed. Don't use e-cigarettes either, as they lead to tobacco use.

 

2. Make your home a smoke-free place. Respect and promote laws that ensure smoke-free spaces to protect our health.

 

3. Achieve or maintain a healthy weight throughout your life to help prevent several types of cancer.

 

4. Get daily physical activity throughout your life and limit the time you spend sitting. Being a physically active person helps prevent several types of cancer.

5. Eat a healthy diet:

• Eat as many fruits and vegetables as possible at each meal, and regularly include legumes such as beans and lentils.
• Eat whole grains, such as whole-grain bread, corn tortillas, and brown rice, rather than refined grains such as white bread or rice.
• Avoid sugar-sweetened beverages; drink water instead.
• Limit your consumption of ultra-processed foods, such as sweets, sweetened breakfast cereals, salty snacks, pastries, and cookies, among others. Instead, eat natural foods or foods prepared at home.
• Avoid processed meats, such as deli meats, sausages, or cured meats, and limit your consumption of red meat.
• Limit your consumption of very hot beverages, such as tea, coffee, and mate. Wait a few minutes until the liquid no longer feels hot enough to burn your lips or tongue.

 

6. Avoid drinking alcoholic beverages. This helps prevent several types of cancer.

 

7. Breastfeed your baby –the more months the better– to help prevent breast cancer and excess weight in your baby.

 

8. Protect yourself from direct sun exposure during peak sunlight hours to help prevent skin cancer.

 

9. If you cook or heat your home with coal or firewood, make sure smoke doesn’t build up inside your home.

 

10. If air pollution is high where you are, limit your time outdoors.

 

11. Find out if your job exposes you to substances that can cause cancer, and request and adopt the recommended protective measures.

 

12. Infection from Helicobacter pylori bacteria can cause stomach cancer. Check with health professionals to find out if you might benefit from screening and treatment for this bacterial infection.

 

13. Infection with viruses such as hepatitis B and C, human papillomavirus (HPV), and human immunodeficiency virus (HIV) can also cause cancer. Therefore:

• Vaccinate children for hepatitis B virus in their first 24 hours of life. Vaccinate yourself and your family at any age if you have not yet done so.
• Vaccinate girls and teens against human papillomavirus (HPV), primarily to help prevent cervical cancer, as well as other types of cancer. Take this preventive measure at the ages recommended in your country. If available, vaccinate boys as well.
• Talk to health professionals to see if you might benefit from screening and treatment for hepatitis B and C viruses to help prevent liver cancer.
• Get tested for human immunodeficiency virus (HIV), and ask about the prevention and treatment programs available in your country.
• Make sure to use condoms consistently and correctly, especially with new or casual partners.

 

14. Do not use hormone replacement for menopause unless directed to do so by your healthcare provider. Hormone replacement can cause breast cancer.

Cancer can be controlled and cured if it is detected and treated early:

15. If you are between the ages of 50 and 74, visit a healthcare provider and ask for an early detection test for colon and rectal cancer (fecal occult blood test or colonoscopy). Based on the results, follow your health professional's recommendations promptly.

16. If you are 40 years of age or older, visit a healthcare provider every two years for a clinical breast exam. From age 50 to 74, get a mammogram every two years. Based on the results, follow your health professional's recommendations promptly.

17. If you are between the ages of 30 and 64, visit a healthcare provider and ask for a molecular human papillomavirus (HPV) test at least every 5–10 years for early detection of cervical cancer. Ask if you can collect the sample yourself. If you don’t have access to the HPV test, ask for the exam that is available in your country. Based on the results, follow your health professional's recommendations promptly.

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Ref. 1, 2, 3, 4, 5, 6, 7, 8

• Implement tax policies, considering best practices, aimed at discouraging the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages.
• Implement health warning labels for the containers of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages. For foods and beverages, it is recommended to implement warning labels that include the PAHO nutrient profile model.
• Create healthy environments in the community, schools, educational centers, and public buildings: ban the use of products that contain tobacco and generate emissions in shared environments, as well as the use of e-cigarettes, which are a gateway for tobacco use; prohibit alcohol use in these settings; decrease the availability of unhealthy foods and beverages and increase the availability of healthy foods and beverages; promote the creation of spaces for physical activity, as well as spaces to facilitate breastfeeding, and ensure access to drinking water.
• Include quality physical education classes in curricula, promote physical activity at recess, and encourage active transportation to and from school.
• Ban advertising, promotion, and sponsorship of tobacco, e-cigarettes, alcohol, and breast-milk substitutes; and ban the advertising of unhealthy foods and beverages to children.
• Implement communication, education, and counseling programs to encourage behavioral changes in the population regarding the use of tobacco, e-cigarettes, alcohol, and unhealthy foods and beverages, and to promote physical activity, healthy eating, and breastfeeding.
• Safeguard the design, implementation, and evaluation of these policies from potential conflicts of interest.
• Adopt the international codes and conventions related to the recommendations above, and ensure that they are correctly implemented:

1. WHO Framework Convention on Tobacco Control.
2. International Code of Marketing of Breast-milk Substitutes.
3. The WHO Technical package SAFER to prevent and reduce alcohol-related death and disability.
4. The International Labour Organization Maternity Protection Convention and related recommendations.

Ref. 9

• Promote public programs to reduce sun exposure, including the design of public spaces that protect the population.
• Regulate occupational exposure to the sun and monitor the implementation of programs to reduce sun exposure.

Ref. 10

• Implement actions and programs to progressively reduce the indoor use of coal and firewood, such as using updated stoves or switching to cleaner energies.

Ref. 11

• Establish environmental air quality standards consistent with WHO guidelines or interim targets, and implement strategies to meet them in the short term.
• Increase the coverage of the air quality monitoring network in heavily populated areas.
• Establish communication and information systems to keep the community informed of air quality.

Ref. 12

• Report, regulate, and monitor economic activities that expose workers –whether formal or informal– to type 1 carcinogens in the workplace.
• Ensure that both public and private companies eliminate or at least control the use of carcinogenic substances to reduce employees' exposure.

Ref. 13

• Define national policies on the screening and treatment of Helicobacter pylori infection according to the various at-risk population groups. Develop organized programs to implement these policies.
• Ensure the availability of the lab tests, treatment, follow-up, and diagnostic procedures required for these programs, and implement antibiotic resistance testing to ensure high eradication rates.

Ref. 14, 15, 16, 17, 18, 19, 20, 21

• Ensure universal hepatitis B virus vaccination for boys and girls immediately after birth, and implement strategies to proactively find unvaccinated individuals in order to vaccinate them, preferably before they are sexually active (catch-up vaccination).
• Ensure access to diagnosis of hepatitis B and C, and availability of treatment for anyone diagnosed with these viral infections.
• Ensure the availability of HPV vaccines to sustain vaccination programs. Give one or two doses in vaccination programs, as recommended by WHO. Promote vaccination as a priority in girls 9–14 years of age and extend, if possible, to 18 years; include boys based on the availability of resources. Ensure WHO's global goal of vaccinating 90% of girls by age 15 by 2030.
• Establish a program to promote and facilitate HIV testing in the general population. Ensure treatment of at least 95% of people with the infection. Ensure that at least 95% of patients have suppressed viral load.
• Implement sex education programs. Ensure free and widespread access to condoms.

Ref. 22, 23, 24

• Develop consensus on national guidelines on the use of hormone replacement during menopause, as well as on customizing dose, regimen, and duration of treatment.
• Prohibit the over-the-counter sale (without medical prescription) of hormone replacement therapies for menopause.

Ref. 25

• Implement secondary prevention programs for colon and rectal cancer. According to current scientific evidence, mortality from colon and rectal cancer can be reduced by a fecal occult blood test every two years followed by colonoscopy for patients who have a positive result, and by at least one colonoscopy in a person’s lifetime between the ages of 50 and 74.
• Ensure a reasonable and regulated supply of fecal occult blood tests and colonoscopy services as needed for national programs.

Ref. 26, 27

• Ensure the availability of quality mammograms and clinical breast examinations performed by health professionals with appropriate training, and discourage the use of breast self-examinations, as they have no benefit.
• Ensure timely diagnosis and treatment of patients with abnormal mammograms or clinical breast examinations. According to the WHO Global Breast Cancer Initiative, no more than 60 days should pass between first symptoms (or first interaction of the person with symptoms with the corresponding health system) (or detection of patients with abnormal results via screening) and complete diagnosis, including a comprehensive pathology report. Once cancer is confirmed, the best multimodal treatment available in the country should be offered.
• Adopt the recommendations for screening and early diagnosis in people at high risk of developing breast cancer.

Ref. 28, 29, 30

• Following the WHO cervical cancer elimination initiative, ensure that at least 70% of women over 30 years of age are screened with a high-performance test (such as the HPV test) at least twice in their lifetime, once before age 35 and again before age 45. Where HPV molecular testing is not available, continue to use the available test (cytology or visual inspection with acetic acid) until HPV molecular testing is implemented.
• Ensure that 90% of patients with precancerous lesions or cervical cancer receive treatment, regardless of the screening algorithm offered (e.g., screening followed by colposcopy, biopsy, and treatment of confirmed lesions, or screening and treatment of patients with abnormal results).
• Ensure the availability of early detection tests, triage, diagnosis, treatment, and follow-up, according to the national program.

These recommendations are the result of a project coordinated by the International Agency for Research on Cancer (IARC) of the World Health Organization, in collaboration with the Pan American Health Organization, and co-financed by amigo_h (Amigos Einstein da Oncologia e Hematologia) which integrates the Social Responsibility pillar of the Sociedade Beneficente Israelita Brasileira Albert Einstein and the IARC. The amigo_h was not involved in the design and execution of the project or its final result.

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