Loomans-Kropp Holli A, Umar Asad
1Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD USA.
2Gastrointestinal and Other Cancers Branch, Division of Cancer Prevention, National Cancer Institute, Rockville, MD USA.
NPJ Precis Oncol. 2019 Jan 28;3:3. doi: 10.1038/s41698-018-0075-9. eCollection 2019.
A primary mode of cancer prevention and early detection in the United States is the widespread practice of screening. Although many strategies for early detection and prevention are available, adverse outcomes, such as overdiagnosis and overtreatment, are prevalent among those utilizing these approaches. Broad use of mammography and prostate cancer screening are key examples illustrating the potential harms stemming from the detection of indolent lesions and the subsequent overtreatment. Furthermore, there are several cancers for which prevention strategies do not currently exist. Clinical and experimental evidence have expanded our understanding of cancer initiation and progression, and have instructed the development of improved, precise modes of cancer prevention and early detection. Recent cancer prevention and early detection innovations have begun moving towards the integration of molecular knowledge and risk stratification profiles to allow for a more accurate representation of at-risk individuals. The future of cancer prevention and early detection efforts should emphasize the incorporation of precision cancer prevention integration where screening and cancer prevention regimens can be matched to one's risk of cancer due to known genomic and environmental factors.
在美国,癌症预防和早期检测的主要模式是广泛开展筛查。尽管有许多早期检测和预防策略,但在采用这些方法的人群中,过度诊断和过度治疗等不良后果很普遍。乳腺钼靶检查和前列腺癌筛查的广泛应用就是关键例子,说明了检测惰性病变及随后的过度治疗可能带来的危害。此外,还有几种癌症目前尚无预防策略。临床和实验证据扩展了我们对癌症发生和发展的理解,并指导了改进的、精确的癌症预防和早期检测模式的发展。近期癌症预防和早期检测方面的创新已开始朝着整合分子知识和风险分层概况的方向发展,以便更准确地呈现高危个体。癌症预防和早期检测工作的未来应强调纳入精准癌症预防整合,使筛查和癌症预防方案能够根据已知的基因组和环境因素与个人患癌风险相匹配。