Future directions in cancer prevention

Key Points

  • In the past three decades, the approach to cancer prevention has moved from population and epidemiological studies to molecular targeting and immunological approaches and to identifying high-risk pre-cancerous lesions in individuals using emerging early detection technologies.

  • Global implementation of these scientifically-sound lifestyle- and medical-based cancer prevention strategies has the potential to reduce worldwide cancer incidence, prevalence and mortality rates in the decades ahead.

  • As more is learned about the mechanisms and pathways that are influenced by genetic and molecular changes that initiate cancer or encourage its progression, targeted therapies are being developed to interrupt these processes. Additional strategies are specifically focused on interrupting the late-stage, but still pre-malignant, processes that lead to in situ cancers, with the goal of averting progression to actual invasive cancer.

  • The success of vaccines for human papilloma virus (HPV)- and hepatitis B virus (HBV)-related cancers has led to an increased focus on immunologically based research for many other cancers. Efforts are ongoing to develop immune response modulation strategies to augment the innate immunity and to develop vaccines against oncogenic infectious agents, as well as tumour-associated and tumour-specific antigens.

  • The groundwork for the future of cancer prevention is currently being developed through multidisciplinary initiatives that involve researchers from tradition biology-based laboratories, as well as collaborators from the fields of information technology, imaging technologies, '-omics' (such as genomics, proteomics and metabolomics) and communication. Expertise in communication is essential to disseminate research findings to the communities that are likely to benefit from these findings. Inherent to this future progress is a focus on precision (individualized) medicine that will include identifying those who are at a high risk of developing cancer.

Abstract

Prevention of cancer remains the most promising strategy for reducing both its incidence and the mortality due to this disease. For more than four decades, findings from epidemiology, basic research and clinical trials have informed the development of lifestyle and medical approaches to cancer prevention. These include selective oestrogen receptor modulators and aromatase inhibitors for breast cancer, the 5-α-reductase inhibitors finasteride and dutasteride for prostate cancer, and the development of vaccines for viruses that are associated with specific cancers. Future directions include genetic, proteomic and other molecular approaches for identifying pathways that are associated with cancer initiation and development, as well as refining the search for immunologically modifiable causes of cancer.

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Figure 1: Estimated timeline of progression of selected cancers and pre-malignant stages at which specific genes contribute to carcinogenesis.
Figure 2: Conceptual framework for the impact of cancer preventive interventions on carcinogenic progression.
Figure 3: Uses of biomarkers at various stages of the cancer continuum.

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Acknowledgements

The authors are indebted to E. Richmond, A. Ryan and D. Anderson for contributions to the writing and content of this manuscript.

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Correspondence to Asad Umar.

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Glossary

Biologically active food components

(BFCs). Found in foods or nutrients; responsible for increasing or decreasing the risk of cancer.

The Cancer Genome Atlas

(TCGA). Catalogues genetic mutations that are found in cancers.

Overdiagnosis

A diagnosis of cancerous lesions the clinical significance of which is undetermined.

Underdiagnosis

The failure to diagnose cancerous lesions that will ultimately recur, metastasize or lead to death.

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Umar, A., Dunn, B. & Greenwald, P. Future directions in cancer prevention. Nat Rev Cancer 12, 835–848 (2012) doi:10.1038/nrc3397

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