Bian Que was a famous physician in ancient China during the Spring and Autumn Warring States Period. He was the first in the world to use the pulse for diagnosis and excelled in the art of acupuncture and herbal prescriptions.
One day Bian Que had a conversation with the king of the state of Wei. The king asked: “ I heard that you have two other brothers who are also practicing medicine. Who among you is the best and why aren’t they as celebrated as you?”
Bian Que replied: “ Among us, my eldest brother is the most talented and skillful. He can detect potential illnesses by observation, palpation and recognition of risk factors. He can find ways to prevent and control the potential illnesses before they arise. This is indeed the highest of all skills and the most difficult stage for physicians to attain, but people don’t appreciate how excellent my eldest brother is. Therefore, in my opinion, my brother is the most brilliant physician.
My second brother can diagnose and cure people when their illnesses are still in the early stages with simple remedies. However, because of this, people say that he is only capable if curing simple illnesses, not realizing that he has actually prevented the illnesses from deteriorating to a serious state. The patient recovers from his illness and is able to return to normalcy. Thus, I think my second brother is also more skilful than me. As for me, I can only recognize an illness when it has become very serious, but because I use acupuncture, boiled herbs and apply dramatic efforts to make them better, people think I’m the most skilful and brilliant. Have I really cured them? Although I succeeded in controlling their illnesses at the final stages, the patients are often too weak to return to his normal activities. So, who do you think is the most talented?”
This story reminds us of a very basic principle: prevention is better than cure. To prevent cancer, it is important that we understand its causation and risk factors.
We have witnessed impressive progress in oncology over the last few years but much of the focus and efforts have been on discovering new anti-cancer agents such as newer monoclonal antibodies, molecular targeted agents, immune therapy and so on. Although these new therapeutic agents do represent significant advances, they are hardly magic bullets and we cannot yet claim victory over cancer. Meanwhile, despite billions of dollars spent on cancer research, the incidence of cancer worldwide continues to increase? Why?

Therefore, it’s important that we “return to the root” and start paying more attention to cancer epidemiology, prevention and early detection. By describing the distribution of cancer and discovering risk factors for cancer, epidemiology plays a key role in cancer prevention and control. Thus, in this issue of Cancer Update, we aim to explore some of the environmental and lifestyle factors that may contribute to the development of cancer, evaluate the merits of several popular cancer prevention strategies and discuss recent advances in early cancer detection.

Dr Lim Soon Thye
Editor