WITH news of research breakthroughs and discoveries happening every so often, sometimes the public gets the false impression that all that can be done to counter cancer is to wait for the miracle cure.

What about prevention? What about it indeed, save for the fact that people have forgotten about it, says top cancer scientist Sir David Lane, credited as one of those who discovered the p53 gene - a key cause of cancer.

Prof Lane is the executive director of the Institute of Molecular and Cell Biology and also heads a new set-up, Experimental Therapeutics Centre, which is an effort to take Singapore's scientific discoveries from bench to bedside.

'People get so excited about new research that they lose sight of the basic thing. Smoking ,for example, is a major cause of cancer. Some people think it's the biggest discovery but it's not. And it's free!' he says.

It has been reported that smoking accounts for one in four cancer deaths in the UK, for example, and kills five times more people than road accidents, overdoses, murder, suicide and HIV all put together.

Public health education in Singapore is commendable, he thinks, as the government does encourage a healthy diet, exercise and discourages smoking.

'About 70 per cent of cancers are preventable. We'd still have 30 per cent so we still need the research for those,' says Prof Lane.

But that is a message that doesn't get across clearly enough. The other thing is vaccination against known viruses which cause cancer - such as the papillomarivus virus which causes cervical cancer.

'While being infected alone isn't enough to give you cancer, if you don't get the infection, you don't get the cancer,' points out Prof Lane.

Other cancer-causing viruses are the helicobacter pylori virus which is associated with gastric cancer (for which there is no vaccine), and then hepatitis B associated with liver cancer (up to 80 per cent of liver cancers are due to hepatitis B).

'Again, when people talk about cancer research, they tend to under emphasise infection. Large fractions of cancer could be reduced by control of those infections - and that's something that's often not talked about enough,' stresses Prof Lane.

Early detection continues to be important, he says, although one has to be careful and thoughtful about what early detection means.

There's something called lead time bias, for instance, which is the period between early detection of disease and the time of its usual clinical presentation.

'The difficult clinical decision is whether the risk of cancer progressing is worth the ill-health from the treatment. So that's always the balance,' he notes.

Many researchers aren't just trying to find new treatments but focus more on definitive diagnoses and tests because that's where clinical choices are made.

'It's a difficult balance, because you don't want to under-treat someone; while on the other hand, if you could be absolutely certain that the tumour isn't going to kill that person, you wouldn't operate,' says Prof Lane.

'It's extremely important that the medical community and the patient communicate in the right way, especially as everyone's cancer is diagnosed at a different stage.'

In the UK, he says, surveys show that patients stop listening when the diagnosis has the word 'cancer' in it. 'So they actually need a chance to go back to the doctor in a week or so to talk about it again, because they were so overwhelmed the first time they find out,' he notes.

As for clinical trials, his view is that most patients in such trials find that their conditions improve, even if they're in the control group. That's usually because they're monitored more closely. 'Maybe it's also partly a psychological phenomenon. But it is true that participation in clinical trials generally help,' he says.

The improvements in the last 10 years have been great, with the discovery of highly successful treatments which are less toxic.

'We've gone away from the pattern of killing cancer cells and normal cells at the same time,' says Prof Lane.

This article first appeared in The Business Times on Jan 20, 2007