title: Strategies to Prevent "Bad Luck" in Cancer.
abstract: It is impossible to predict exactly who will develop a cancer and who will not. We know that several "risk factors" may increase the chance of getting cancer and that risk increases with age. However, even with that in mind we seem to be able to explain only a certain number of cancers. Recently, Tomasetti and Vogelstein published a provocative article in Science stating that a large percentage of cancers may be due to "bad luck" (stochastic mutation events during DNA replication) and only a few to carcinogens, pathogens, or inherited genes and that this should impact public health policies. However, their intriguing analysis has numerous limitations, some of which have already been commented upon, including the likely biased subset of cancers and that finding a correlation does not signify a cause-effect mechanism. Here, we point out that there may also be an alternative explanation for the data, the cancer stem cell hypothesis, which postulates that cancers are derived from tissue stem cells and not from somatic differentiated cells. We also highlight the importance of the tissue microenvironment in the growth of transformed cells and outline a table of concurrent factors for several cancers. The message communicated to the public should not be one of helplessness in avoiding cancers, particularly given the now extensive knowledge of known risk factors and several agents/behaviors that can lower risk for specific cancers. While some tumors will still be due to chance, prevention should still be a primary goal for public health policies.
authors.affiliation: IRCCS-Arcispedale Santa Maria Nuova in Reggio Emilia, Italy (AA, SC, GA); Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy (DMN); Science and Technology Center, IRCCS MultiMedica, Milano, Italy (DMN). albini.adriana@gmail.com.
authors.forename: Adriana
authors.initials: A
authors.lastname: Albini
authors.affiliation: IRCCS-Arcispedale Santa Maria Nuova in Reggio Emilia, Italy (AA, SC, GA); Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy (DMN); Science and Technology Center, IRCCS MultiMedica, Milano, Italy (DMN).
authors.forename: Silvio
authors.initials: S
authors.lastname: Cavuto
authors.affiliation: IRCCS-Arcispedale Santa Maria Nuova in Reggio Emilia, Italy (AA, SC, GA); Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy (DMN); Science and Technology Center, IRCCS MultiMedica, Milano, Italy (DMN).
authors.forename: Giovanni
authors.initials: G
authors.lastname: Apolone
authors.affiliation: IRCCS-Arcispedale Santa Maria Nuova in Reggio Emilia, Italy (AA, SC, GA); Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy (DMN); Science and Technology Center, IRCCS MultiMedica, Milano, Italy (DMN).
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Noonan
mesh_terms: D016588:Anticarcinogenic Agents / Q000008:administration & dosage; D018890:Chemoprevention / Q000379:methods; D004261:DNA Replication; D055088:Early Detection of Cancer / Q000009:adverse effects; D006801:Humans; D008403:Mass Screening / Q000009:adverse effects; D009154:Mutation; D009369:Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000235:genetics / Q000401:mortality / Q000628:therapy; D014411:Neoplastic Stem Cells; D012306:Risk; D012307:Risk Factors; D040242:Risk Reduction Behavior; D015983:Selection Bias; D059016:Tumor Microenvironment
chemical_list: D016588:Anticarcinogenic Agents