Tomatis L
National Institute for Environmental Health Sciences, P.O. Box 12233, Research Triangle Park, NC 27709-2233, USA.
Mutat Res. 2000 Apr;462(2-3):407-21. doi: 10.1016/s1383-5742(00)00029-6.
Primary prevention is based on the incontrovertible logic that a most efficient way to decrease the risk for a disease is to avoid, or reduce to minimal attainable levels, exposures to agents that can cause the disease or contribute to an increase in risk for the disease. This notwithstanding, the adoption of primary prevention measures has often encountered serious obstacles and unjustifiable delays. The success of primary prevention has also been limited by the combined effect of: (a) the inefficient and/or incomplete use of the cumulated etiological knowledge: (b) the spectrum of target organs for human carcinogens which does not include some of the most common cancer sites, a limitation that may be related to a disregard of epidemiological results and case reports that provide evidence that is less than sufficient of a causal relationship between an exposure and human cancer: (c) the pressure that powerful economic interests may have exerted in a variegated way to interfere or delay implementation of preventive measures that could have decreased their profit, and (d) the decreased acceptance of the ability of experimental results to predict similar effects in humans, in spite of the evidence that positive carcinogenicity results in experimental animals have often preceded and could indeed have predicted similar results in humans.
一级预防基于这样一个无可争议的逻辑，即降低疾病风险的最有效方法是避免接触或将接触可导致该疾病或促使疾病风险增加的因素降至可达到的最低水平。尽管如此，采取一级预防措施常常遇到严重障碍和不合理的延误。一级预防的成功还受到以下综合因素的限制：（a）对累积病因学知识的低效和/或不完整应用；（b）人类致癌物的靶器官范围不包括一些最常见的癌症部位，这种限制可能与忽视流行病学结果和病例报告有关，这些结果和报告提供的证据不足以证明某种接触与人类癌症之间存在因果关系；（c）强大的经济利益集团可能以各种方式施加压力，干扰或拖延实施可能降低其利润的预防措施；（d）尽管有证据表明实验动物的阳性致癌性结果往往先于人类出现，并且确实可以预测人类的类似结果，但人们对实验结果预测人类类似效应的能力的接受度降低。
