Tomatis L
National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina 27709, USA.
Drug Metab Rev. 2000 May;32(2):129-37. doi: 10.1081/dmr-100100566.
For many decades, primary prevention of cancer was implemented on the basis of evidence for a causal relationship between exposure and human cancer that took into consideration biological plausibility, but did not depend on the degree of understanding of the underlying mechanisms. One of the credos of public health is that primary prevention can be implemented before reaching a complete understanding of mechanisms that could confirm/explain causality. Measures of primary prevention are taken on the basis of what is recognized as causative factors of human cancer. The most authoritative lists of recognized human carcinogens are those compiled from the evaluations of carcinogenic risk carried out by the International Agency for Research on Cancer (IARC) and the evaluations that the U.S. National Toxicology Program (NTP) publishes in its periodical Report on Carcinogens. Knowledge of mechanisms is accumulating at a fast pace, and although it has not yet led to the definition of an efficient strategy for primary prevention for the majority of cancer cases, it may drive the scientific establishment toward a high-risk approach to prevention. The most reasonable and socially acceptable development of primary prevention should be the blending of a population approach; that is, the shifting of the distribution of risk factors across an entire population in a favorable direction (e.g., a general decrease of the levels of exposure to environmental carcinogens) with the high-risk approach that will concern individuals with extreme values of genetically determined weaknesses in the interactions with the environment.
几十年来，癌症一级预防是基于暴露与人类癌症之间因果关系的证据来实施的，这种证据考虑了生物学合理性，但并不依赖于对潜在机制的理解程度。公共卫生的信条之一是，在完全理解能够证实/解释因果关系的机制之前，就可以实施一级预防。一级预防措施是根据被公认为人类癌症致病因素的因素来采取的。最具权威性的已确认人类致癌物清单是由国际癌症研究机构（IARC）进行的致癌风险评估以及美国国家毒理学计划（NTP）在其《致癌物报告》期刊上发表的评估所编制的。关于机制的知识正在迅速积累，尽管它尚未导致为大多数癌症病例确定有效的一级预防策略，但它可能促使科学界朝着高风险预防方法发展。一级预防最合理且社会可接受的发展应该是将人群方法与高风险方法相结合；也就是说，将风险因素在整个人口中的分布朝着有利方向转移（例如，普遍降低环境致癌物的暴露水平），同时高风险方法关注那些在与环境相互作用中具有由基因决定的极端弱点值的个体。
