Developing the environmental and lifestyle exposure assessment (ELEA) tool for cancer epidemiology research in low resource settings

Globally, cancer incidence has been predicted to increase by 61% from 2008 to 2030 [1] presenting new health challenges for clinicians, researchers, prevention specialists and policy makers. Moreover, the largest increase is expected in countries with a low human development index, where cancer incidence is predicted to increase by 93% [1], mainly due to demographic shifts and the changing prevalence of risk factors [2]. Existing evidence, mainly from studies in developed and highly resourced countries, indicates that the reduction of known modifiable risk factors associated with cancer, and other non–communicable diseases (NCDs), could lower incidence by approximately 30–50% and is critical to cost–effective cancer control [3]. As a result, efforts are being made to actively reduce the burden of cancer (and associated NCDs) through prevention. However, associations between risk factors and cancer outcomes in low resource settings remain largely theorised [4]. This is largely a result of the lack of high quality local information available to guide cancer control programs. The far richer genetic diversity seen in populations in low resource settings, particularly from the African continent, would render additional findings in this area both novel and insightful [5].To close this information gap we propose that action is best taken by developing a sound, systematic approach to measuring leading and emerging risk factors to guide future cancer control programs. This would generate local evidence in Eleonora Feletto, Joachim Schüz, Freddy Sitas