title: Cancer Prevention: Obstacles, Challenges and the Road Ahead.
abstract: Approaches to reduce the global burden of cancer include two major strategies: screening and early detection and active preventive intervention. The latter is the topic of this Commentary and spans a broad range of activities. The genetic heterogeneity and complexity of advanced cancers strongly support the rationale for early interruption of the carcinogenic process and an enhanced focus on prevention as a priority strategy to reduce the burden of cancer; however, the focus of cancer prevention management should be on individuals at high risk and on primary localized disease in which screening and detection should also play a vital role. The timing and dose of (chemo-)preventive intervention also affects response. The intervention may be ineffective if the target population is very high risk or already presenting with preneoplastic lesions with cellular changes that cannot be reversed. The field needs to move beyond general concepts of carcinogenesis to targeted organ site prevention approaches in patients at high risk, as is currently being done for breast and colorectal cancers. Establishing the benefit of new cancer preventive interventions will take years and possibly decades, depending on the outcome being evaluated. We also propose that comparative effectiveness research designs and the value of information obtained from large-scale prevention studies are necessary in order for preventive interventions to become a routine part of cancer management.
authors.affiliation: Biological Chemistry, Public Health, and Epidemiology, Chao Family Comprehensive Cancer Center, School of Medicine - University of California, Irvine, Irvine, CA (FLMJr); Arizona Board of Regents Professor of Medicine, Pharmacology, Public Health, Nutritional Sciences & BIO5, University of Arizona Cancer Center, Skin Cancer Institute, Tucson, AZ (DSA); Wolfson Institute of Preventive Medicine and Head, Centre for Cancer Prevention; Centre for Cancer Prevention, Queen Mary University of London, Mile End Road, London, UK (JC); Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA (TWK); Moores Cancer Center (SML) and Department of Family Medicine and Public Health, Cancer Prevention and Control Program (CLR), UC San Diego, San Diego, CA (SML); Dermatology Research Laboratories, University of Wisconsin; Madison, WI (HM); Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (SDR); Center for Cancer Prevention Research, Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ (CSY). flmeyske@uci.edu.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Meyskens
authors.affiliation: Biological Chemistry, Public Health, and Epidemiology, Chao Family Comprehensive Cancer Center, School of Medicine - University of California, Irvine, Irvine, CA (FLMJr); Arizona Board of Regents Professor of Medicine, Pharmacology, Public Health, Nutritional Sciences & BIO5, University of Arizona Cancer Center, Skin Cancer Institute, Tucson, AZ (DSA); Wolfson Institute of Preventive Medicine and Head, Centre for Cancer Prevention; Centre for Cancer Prevention, Queen Mary University of London, Mile End Road, London, UK (JC); Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA (TWK); Moores Cancer Center (SML) and Department of Family Medicine and Public Health, Cancer Prevention and Control Program (CLR), UC San Diego, San Diego, CA (SML); Dermatology Research Laboratories, University of Wisconsin; Madison, WI (HM); Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (SDR); Center for Cancer Prevention Research, Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ (CSY).
authors.forename: Hasan
authors.initials: H
authors.lastname: Mukhtar
authors.affiliation: Biological Chemistry, Public Health, and Epidemiology, Chao Family Comprehensive Cancer Center, School of Medicine - University of California, Irvine, Irvine, CA (FLMJr); Arizona Board of Regents Professor of Medicine, Pharmacology, Public Health, Nutritional Sciences & BIO5, University of Arizona Cancer Center, Skin Cancer Institute, Tucson, AZ (DSA); Wolfson Institute of Preventive Medicine and Head, Centre for Cancer Prevention; Centre for Cancer Prevention, Queen Mary University of London, Mile End Road, London, UK (JC); Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA (TWK); Moores Cancer Center (SML) and Department of Family Medicine and Public Health, Cancer Prevention and Control Program (CLR), UC San Diego, San Diego, CA (SML); Dermatology Research Laboratories, University of Wisconsin; Madison, WI (HM); Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (SDR); Center for Cancer Prevention Research, Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ (CSY).
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Rock
authors.affiliation: Biological Chemistry, Public Health, and Epidemiology, Chao Family Comprehensive Cancer Center, School of Medicine - University of California, Irvine, Irvine, CA (FLMJr); Arizona Board of Regents Professor of Medicine, Pharmacology, Public Health, Nutritional Sciences & BIO5, University of Arizona Cancer Center, Skin Cancer Institute, Tucson, AZ (DSA); Wolfson Institute of Preventive Medicine and Head, Centre for Cancer Prevention; Centre for Cancer Prevention, Queen Mary University of London, Mile End Road, London, UK (JC); Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA (TWK); Moores Cancer Center (SML) and Department of Family Medicine and Public Health, Cancer Prevention and Control Program (CLR), UC San Diego, San Diego, CA (SML); Dermatology Research Laboratories, University of Wisconsin; Madison, WI (HM); Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (SDR); Center for Cancer Prevention Research, Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ (CSY).
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.affiliation: Biological Chemistry, Public Health, and Epidemiology, Chao Family Comprehensive Cancer Center, School of Medicine - University of California, Irvine, Irvine, CA (FLMJr); Arizona Board of Regents Professor of Medicine, Pharmacology, Public Health, Nutritional Sciences & BIO5, University of Arizona Cancer Center, Skin Cancer Institute, Tucson, AZ (DSA); Wolfson Institute of Preventive Medicine and Head, Centre for Cancer Prevention; Centre for Cancer Prevention, Queen Mary University of London, Mile End Road, London, UK (JC); Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA (TWK); Moores Cancer Center (SML) and Department of Family Medicine and Public Health, Cancer Prevention and Control Program (CLR), UC San Diego, San Diego, CA (SML); Dermatology Research Laboratories, University of Wisconsin; Madison, WI (HM); Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (SDR); Center for Cancer Prevention Research, Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ (CSY).
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Kensler
authors.affiliation: Biological Chemistry, Public Health, and Epidemiology, Chao Family Comprehensive Cancer Center, School of Medicine - University of California, Irvine, Irvine, CA (FLMJr); Arizona Board of Regents Professor of Medicine, Pharmacology, Public Health, Nutritional Sciences & BIO5, University of Arizona Cancer Center, Skin Cancer Institute, Tucson, AZ (DSA); Wolfson Institute of Preventive Medicine and Head, Centre for Cancer Prevention; Centre for Cancer Prevention, Queen Mary University of London, Mile End Road, London, UK (JC); Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA (TWK); Moores Cancer Center (SML) and Department of Family Medicine and Public Health, Cancer Prevention and Control Program (CLR), UC San Diego, San Diego, CA (SML); Dermatology Research Laboratories, University of Wisconsin; Madison, WI (HM); Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (SDR); Center for Cancer Prevention Research, Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ (CSY).
authors.forename: Chung S
authors.initials: CS
authors.lastname: Yang
authors.affiliation: Biological Chemistry, Public Health, and Epidemiology, Chao Family Comprehensive Cancer Center, School of Medicine - University of California, Irvine, Irvine, CA (FLMJr); Arizona Board of Regents Professor of Medicine, Pharmacology, Public Health, Nutritional Sciences & BIO5, University of Arizona Cancer Center, Skin Cancer Institute, Tucson, AZ (DSA); Wolfson Institute of Preventive Medicine and Head, Centre for Cancer Prevention; Centre for Cancer Prevention, Queen Mary University of London, Mile End Road, London, UK (JC); Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA (TWK); Moores Cancer Center (SML) and Department of Family Medicine and Public Health, Cancer Prevention and Control Program (CLR), UC San Diego, San Diego, CA (SML); Dermatology Research Laboratories, University of Wisconsin; Madison, WI (HM); Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (SDR); Center for Cancer Prevention Research, Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ (CSY).
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
authors.affiliation: Biological Chemistry, Public Health, and Epidemiology, Chao Family Comprehensive Cancer Center, School of Medicine - University of California, Irvine, Irvine, CA (FLMJr); Arizona Board of Regents Professor of Medicine, Pharmacology, Public Health, Nutritional Sciences & BIO5, University of Arizona Cancer Center, Skin Cancer Institute, Tucson, AZ (DSA); Wolfson Institute of Preventive Medicine and Head, Centre for Cancer Prevention; Centre for Cancer Prevention, Queen Mary University of London, Mile End Road, London, UK (JC); Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA (TWK); Moores Cancer Center (SML) and Department of Family Medicine and Public Health, Cancer Prevention and Control Program (CLR), UC San Diego, San Diego, CA (SML); Dermatology Research Laboratories, University of Wisconsin; Madison, WI (HM); Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (SDR); Center for Cancer Prevention Research, Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ (CSY).
authors.forename: Scott M
authors.initials: SM
authors.lastname: Lippman
authors.affiliation: Biological Chemistry, Public Health, and Epidemiology, Chao Family Comprehensive Cancer Center, School of Medicine - University of California, Irvine, Irvine, CA (FLMJr); Arizona Board of Regents Professor of Medicine, Pharmacology, Public Health, Nutritional Sciences & BIO5, University of Arizona Cancer Center, Skin Cancer Institute, Tucson, AZ (DSA); Wolfson Institute of Preventive Medicine and Head, Centre for Cancer Prevention; Centre for Cancer Prevention, Queen Mary University of London, Mile End Road, London, UK (JC); Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA (TWK); Moores Cancer Center (SML) and Department of Family Medicine and Public Health, Cancer Prevention and Control Program (CLR), UC San Diego, San Diego, CA (SML); Dermatology Research Laboratories, University of Wisconsin; Madison, WI (HM); Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (SDR); Center for Cancer Prevention Research, Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ (CSY).
authors.forename: David S
authors.initials: DS
authors.lastname: Alberts
mesh_terms: D000818:Animals; D016588:Anticarcinogenic Agents / Q000008:administration & dosage*; D018890:Chemoprevention / Q000379:methods*; D002986:Clinical Trials as Topic; D057186:Comparative Effectiveness Research; D055088:Early Detection of Cancer; D005247:Feeding Behavior; D006801:Humans; D008403:Mass Screening; D009369:Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D009374:Neoplasms, Experimental / Q000235:genetics / Q000517:prevention & control; D057285:Precision Medicine; D011322:Primary Prevention / Q000379:methods*; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention; D055512:Tertiary Prevention; D013997:Time Factors
chemical_list: D016588:Anticarcinogenic Agents