v.15, n.1, p.73-94, jan.-mar. 2008 9
v.17, supl.1, jul. 2010, p.9-10 9
GUEST EDITOR`S NOTE
Th rou gh ou t th e first h alf of th e twen tieth cen tu ry, can cer was viewed as an u n com m on d isease an d a m in or p roblem in Brazil. Health p olicy d ecision -m akers believed con trol sh ou ld be lim ited to h osp ital-based cu rative m edicin e an d to isolated san itary edu cation in itiatives th at sh owed th e valu e of early detection an d treatm en t. Th e closin g q u arter of th is p ast cen tu ry saw far-reach in g ch an ges in Brazil’s h ealth system an d with in th is con text can cer began to be viewed as a p u blic-h ealth p roblem th at cou ld n ot be lim ited to cu rative m edicin e. Today th e disease is at th e cen ter of th e cou n try’s p u blic h ealth debates, an d th e focu s of con trol efforts h as sh ifted in to p rim ary care, wh ere it en com p asses p reven tive testin g an d th e p rom otion of h ealth y h abits. Yet desp ite th ese ch an ges, p roblem s p ersist. Accord in g to Brazil’s Nation al Can cer In stitu te (In stitu to Nacion al d o Cân cer, or INCA), th e d isease is th e secon d lead in g cau se of d eath in th e cou n try an d it is estim ated th at n early 500,000 n ew cases will occu r in 2010. Alth ou gh p u blic an ti-sm okin g p olicies h ave m et with som e su ccess in brin gin g down th e m ortality rate for lu n g can cer, death rates for som e oth er avoidable form s of th e disease, like cervical can cer, are still h igh in Brazil.
Th e cu rren t con sen su s is th at can cer death s are n ot on ly th e resu lt of biological factors bu t also relate to livin g con dition s, th e efficacy of h ealth care system s, an d each society’s sp ecific cu ltu ral h abits an d n orm s. At th e sam e tim e, it is ever m ore com m on for n u m erou s can cer treatm en ts to dem an d costly, cu ttin g-edge tech n ologies, wh ich p resen ts a p articu lar h ealth policy ch allen ge in developin g n ation s like Brazil, wh ere poverty an d th e lack of basic h ealth care coexist alon gside state-of-th e-art tech n ology an d a robu st n etwork of research an d in n ovation in a variety of h ealth field s.
In su ch a co n t ext , h ist o rical st u d ies o f t h e scien ces an d o f h ealt h p ro vid e valu able tools in u n derstan din g th e h istory of can cer an d even con tem p orary asp ects of th e disease, wh ich in tu rn im p lies th at th is research con tribu tes to th e su ccess of efforts to con trol th e d isease.
1 0 História, Ciências, Saúde – Manguinhos, Rio de Janeiro In 2007, th e Bulletin of the History of Medicine devoted a sp ecial issu e to can cer in th e twen tieth cen tu ry. Sch olars from variou s cou n tries arou n d th e world addressed edu cation an d h ealth , treatm en ts, p reven tion , an d risks, am on g oth er issu es.
Becau se th ere is a close relation sh ip between can cer an d advan ced areas of scien ce an d t ech n o lo gical in n o vat io n s, research ers fro m so cio lo gy an d t h e h ist o ry o f t h e scien ces soon disp layed growin g in terest in th e th em e, esp ecially th ose in th e field we h ave com e to call th e social stu dy of th e scien ces. Of sp ecial n ote h ere are in vestigation s in to risk, in all it s sh ad es o f m ean in g. A gam u t o f o t h er co n sid erat io n s, like p at ien t view p o in t , p reven tion cam p aign s, an ti-sm okin g p olicies an d ad vertisin g, an d th e relation between can cer treatm en t an d m ilitary m ed icin e, h ave been th e target of th orou gh goin g stu d ies by au th ors su ch as Ilan a Löwy, Robert Aron owitz, Elizabeth Kirsten , Robert Proctor, Orn ella Moscu cci, an d David Can tor.
Alth ou gh m u ch on th e top ic of can cer h as been p rodu ced in Brazil’s field of m edicin e an d collective h ealth , th ere h ave been few h istorical stu d ies to d ate. Th e first title of a h istorical n atu re was released 21 years ago: História e saúde pública: a política de controle do câncer no Brasil (Hist o ry an d p u blic h ealt h : can cer co n t ro l p o licy in Brazil). Ed it ed by Regin a Bod stein , th is book p ain ted a vast p an oram a of govern m en t in itiatives to figh t th e d isease from th e early twen tieth cen tu ry th rou gh th e 1980s. A m ore com p reh en sive p u blication on th e disease cam e ou t recen tly: De doença desconhecida a problem a de saúde pública: o Inca e o controle do câncer no Brasil (From an u n kn own disease to a p u blic h ealth p roblem : INCA an d can cer con trol in Brazil). Written by m yself an d th e research er Cristin a Fon seca, th e book retraces th e p ath taken in th e earlier volu m e, th is tim e relyin g on n ew sou rces th at let u s exp an d th e an alysis of twen tieth -cen tu ry m ed ical action again st th e d isease.
Oth er stu dies con tin u e to ap p ear, esp ecially on can cer in stitu tes an d p olicies.
Th is issu e of História, Ciências, Saúde – Manguinhos is th e first collection of stu dies on th is top ic to be p u blish ed in Brazil. In its p ages you will fin d differen t ap p roach es to th e disease by research ers from h ere an d from oth er cou n tries. We h op e th at th is p u blication will m ake an im p ortan t con tribu tion to an alyses of can cer in th e h istory of th e scien ces an d o f h ealt h .
