Division of Cancer Prevention and Genetics, European Institute of Oncology IRCCS, Milan, Italy.
Leicester Cancer Research Centre, University of Leicester, UK.
Mol Oncol. 2019 Mar;13(3):579-590. doi: 10.1002/1878-0261.12461. Epub 2019 Feb 21.
The constant increase of cancer incidence and the huge costs of new treatments make cancer prevention a crucial goal in order to maintain sustainable public health systems across the world. Carcinogenesis is a multistep process, which allows time for active intervention with natural or synthetic agents to stop or reverse the pathological process. Cancer prevention medicine can be considered to be treatment of premalignant cells or preneoplastic conditions. Clearly such interventions require well-defined risk classification so that personalized strategies and specific treatments can be applied to cohorts with a documented increased cancer risk, and not to the general population as a whole. Further development of these strategies in an efficient and timely manner requires investment in the discovery and validation of surrogate cancer biomarkers with both prognostic and predictive value to detect and monitor the efficacy of interventions in clinical trials and beyond. In the field of cancer prevention medicine, breast and colon cancer demonstrates the strongest clinical evidence that pharmacological intervention can lower cancer risk. Here, we offer an overview of the major clinical achievements for these cancers and the critical issues to improve implementation and clinical uptake of efficacious therapies, as well as further developments needed in the field of preventive medicine.
由于癌症发病率不断上升，新疗法的成本巨大，因此癌症预防成为维护全球公共卫生系统可持续发展的关键目标。癌症发生是一个多步骤的过程，这为使用天然或合成药物进行积极干预以阻止或逆转病理过程提供了时间。癌症预防医学可以被认为是治疗癌前细胞或癌前病变。显然，此类干预措施需要明确的风险分类，以便将个性化策略和特定治疗应用于已记录癌症风险增加的队列，而不是应用于整个普通人群。为了以高效和及时的方式进一步发展这些策略，需要投资于具有预后和预测价值的替代癌症生物标志物的发现和验证，以检测和监测临床试验及以后干预措施的疗效。在癌症预防医学领域，乳腺癌和结肠癌提供了最强的临床证据，表明药物干预可以降低癌症风险。在这里，我们概述了这些癌症的主要临床成就，以及改善有效治疗方法的实施和临床应用的关键问题，以及预防医学领域需要进一步发展的问题。
