Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
Genes Dev. 2018 Jul 1;32(13-14):868-902. doi: 10.1101/gad.314849.118. Epub 2018 Jun 26.
Annually, there are 1.6 million new cases of cancer and nearly 600,000 cancer deaths in the United States alone. The public health burden associated with these numbers has motivated enormous research efforts into understanding the root causes of cancer. These efforts have led to the recognition that between 40% and 45% of cancers are associated with preventable risk factors and, importantly, have identified specific molecular mechanisms by which these exposures modify human physiology to induce or promote cancer. The increasingly refined knowledge of these mechanisms, which we summarize here, emphasizes the need for greater efforts toward primary cancer prevention through mitigation of modifiable risk factors. It also suggests exploitable avenues for improved secondary prevention (which includes the development of therapeutics designed for cancer interception and enhanced techniques for noninvasive screening and early detection) based on detailed knowledge of early neoplastic pathobiology. Such efforts would complement the current emphasis on the development of therapeutic approaches to treat established cancers and are likely to result in far greater gains in reducing morbidity and mortality.
仅在美国，每年就有 160 万例新癌症病例和近 60 万例癌症死亡。这些数字给公众健康带来的负担促使人们做出巨大努力，以了解癌症的根本原因。这些努力使人们认识到，40%至 45%的癌症与可预防的风险因素有关，重要的是，已经确定了这些暴露通过哪些特定的分子机制来改变人体生理机能，从而引发或促进癌症。我们在这里总结了这些机制的日益精确的知识，强调需要通过减轻可改变的风险因素，来加大一级癌症预防的力度。它还基于对早期肿瘤病理生物学的详细了解，为改进二级预防（包括开发用于癌症干预的治疗方法和增强非侵入性筛查和早期检测技术）提供了可利用的途径。这些努力将补充当前对开发治疗方法以治疗已确立的癌症的重视，并可能在降低发病率和死亡率方面取得更大的收益。
