title: EPMA position paper in cancer: current overview and future perspectives.
abstract: 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.
authors.affiliation: Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Grech
authors.affiliation: Key Laboratory of Cancer Proteomics of Chinese Ministry of Health, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Xianquan
authors.initials: X
authors.lastname: Zhan
authors.affiliation: Colorectal Cancer Branch, Division of Translational and Clinical Research I, Research Institute, National Cancer Center, Gyeonggi, 410-769 Republic of Korea.
authors.forename: Byong Chul
authors.initials: BC
authors.lastname: Yoo
authors.affiliation: Clinical Hospital 'Pheophania' of State Management of Affairs Department, Kyiv, Ukraine ; Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Kyiv, Ukraine.
authors.forename: Rostyslav
authors.initials: R
authors.lastname: Bubnov
authors.affiliation: Dept of Life Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hagan
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Romano
authors.initials: R
authors.lastname: Danesi
authors.affiliation: Bracco Imaging, Centro Ricerche Bracco, San Donato Milanese, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Vittadini
authors.affiliation: Department of Neurology, University of Tennessee Center for Health Science, Memphis, USA.
authors.forename: Dominic M
authors.initials: DM
authors.lastname: Desiderio
keywords: Biobank; Biomarker; Disease modeling; Expert recommendation; Individual profile; Multimodal diagnostics; Predictive preventive personalized medicine; Risk assessment; Screening; Standardization