Greenwald P, Stern H R
Division of Cancer Prevention and Control, National Cancer Institute, National Institutes of Health, Bethesda, Md 20892.
J Natl Cancer Inst Monogr. 1992(13):3-14.
Primary prevention aimed at smoking control and chemoprevention for high-risk persons or patients at risk for a second cancer provide strong potential for cancer prevention and control of aerodigestive cancers. The National Cancer Institute (NCI) has a major effort to build this area of research. The Third Upper Aerodigestive Tract Cancer Task Force Workshop, held in 1989 under the auspices of the National Cancer Institute's Organ System Program, reviewed the opportunities for chemoprevention research on aerodigestive epithelial cancers such as the regulation of growth and differentiation in normal and malignant cells. The chemoprevention program's drug development effort is evaluating several promising candidate agents for future clinical testing and the NCI clinical intervention program is supporting several trials of selected chemoprevention agents with demonstrated potential for inhibiting cancers of the lung, bronchus, oral cavity, and esophagus. Of special interest to this program is the assessment of beta-carotene, retinol and related synthetic retinoids, and several vitamin and mineral combinations under study in high-risk international populations. Chemoprevention in the medical setting is a major focus of NCI's Community Oncology Program (CCOP), a network designed not only to increase accrual of patients to trials but also to speed adoption of state-of-the-art therapies. Public health strategies are directed toward control of exposure to tobacco. The focal point for these activities is NCI's Smoking, Tobacco, and Cancer Program (STCP). STCP smoking cessation efforts are targeted at specific populations that are at greater risk for developing cancer including youth, minority and ethnic groups, women, smokeless tobacco users, and heavy smokers. Two of the world's largest controlled intervention trials conducted by the STCP are underway: the Community Intervention Trial for Smoking Cessation (COMMITT), which focuses on 6.5 million heavy smokers in 11 pairs of matched communities in North America, and the American Stop Smoking Intervention Study (ASSIST), a coalition model designed to reach millions of Americans through existing health promoting systems.
针对吸烟控制以及对高危人群或有二次患癌风险的患者进行化学预防的一级预防措施，为预防和控制气消化道癌症提供了强大的潜力。美国国立癌症研究所（NCI）在大力推动这一研究领域的发展。1989年，在国立癌症研究所器官系统项目的主持下召开了第三届上消化道癌症特别工作组研讨会，会上回顾了气消化道上皮癌化学预防研究的机会，比如正常细胞和恶性细胞生长与分化的调控。化学预防项目的药物研发工作正在评估几种有前景的候选药物以供未来进行临床试验，国立癌症研究所的临床干预项目正在支持多项针对选定化学预防药物的试验，这些药物已证明有抑制肺癌、支气管癌、口腔癌和食管癌的潜力。该项目特别感兴趣的是对β-胡萝卜素、视黄醇及相关合成类视黄醇，以及在高危国际人群中正在研究的几种维生素和矿物质组合的评估。医疗环境中的化学预防是国立癌症研究所社区肿瘤项目（CCOP）的主要关注点，该网络不仅旨在增加参与试验的患者数量，还旨在加速采用最先进的治疗方法。公共卫生策略旨在控制烟草接触。这些活动的重点是国立癌症研究所的吸烟、烟草与癌症项目（STCP）。STCP的戒烟工作针对的是患癌风险更高的特定人群，包括青年包括青少年、少数族裔和种族群体、女性、无烟烟草使用者以及重度吸烟者。STCP正在进行两项世界上最大规模的对照干预试验：戒烟社区干预试验（COMMITT），该试验聚焦于北美11对匹配社区中的650万重度吸烟者；以及美国戒烟干预研究（ASSIST），这是一种联合模式，旨在通过现有的健康促进系统覆盖数百万美国人。
