Grech Godfrey, Zhan Xianquan, Yoo Byong Chul, Bubnov Rostyslav, Hagan Suzanne, Danesi Romano, Vittadini Giorgio, Desiderio Dominic M
Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
Key Laboratory of Cancer Proteomics of Chinese Ministry of Health, Xiangya Hospital, Central South University, Changsha, China.
EPMA J. 2015 Apr 15;6(1):9. doi: 10.1186/s13167-015-0030-6. eCollection 2015.
At present, a radical shift in cancer treatment is occurring in terms of predictive, preventive, and personalized medicine (PPPM). Individual patients will participate in more aspects of their healthcare. During the development of PPPM, many rapid, specific, and sensitive new methods for earlier detection of cancer will result in more efficient management of the patient and hence a better quality of life. Coordination of the various activities among different healthcare professionals in primary, secondary, and tertiary care requires well-defined competencies, implementation of training and educational programs, sharing of data, and harmonized guidelines. In this position paper, the current knowledge to understand cancer predisposition and risk factors, the cellular biology of cancer, predictive markers and treatment outcome, the improvement in technologies in screening and diagnosis, and provision of better drug development solutions are discussed in the context of a better implementation of personalized medicine. Recognition of the major risk factors for cancer initiation is the key for preventive strategies (EPMA J. 4(1):6, 2013). Of interest, cancer predisposing syndromes in particular the monogenic subtypes that lead to cancer progression are well defined and one should focus on implementation strategies to identify individuals at risk to allow preventive measures and early screening/diagnosis. Implementation of such measures is disturbed by improper use of the data, with breach of data protection as one of the risks to be heavily controlled. Population screening requires in depth cost-benefit analysis to justify healthcare costs, and the parameters screened should provide information that allow an actionable and deliverable solution, for better healthcare provision.
目前，癌症治疗正在从预测性、预防性和个性化医疗（PPPM）方面发生根本性转变。个体患者将更多地参与到自身医疗保健的各个方面。在PPPM的发展过程中，许多快速、特异且灵敏的癌症早期检测新方法将带来更高效的患者管理，从而提高生活质量。在初级、二级和三级医疗保健中，不同医疗专业人员之间各种活动的协调需要明确的能力、培训和教育项目的实施、数据共享以及统一的指导方针。在本立场文件中，将在更好地实施个性化医疗的背景下，讨论关于理解癌症易感性和风险因素、癌症细胞生物学、预测标志物和治疗结果、筛查与诊断技术的改进以及提供更好的药物研发解决方案等方面的现有知识。识别癌症发生的主要风险因素是预防策略的关键（《欧洲精准医学杂志》4(1):6, 2013）。有趣的是，癌症易感综合征，特别是导致癌症进展的单基因亚型已得到明确界定，应重点关注实施策略以识别有风险的个体，从而采取预防措施并进行早期筛查/诊断。这些措施的实施受到数据使用不当的干扰，数据保护违规是需要严格控制的风险之一。人群筛查需要深入的成本效益分析来证明医疗保健成本的合理性，并且所筛查的参数应提供能够带来可操作且可行解决方案的信息，以提供更好的医疗保健服务。
