Clinical Review Science, medicine, and the future

Cancer chemoprevention

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7339.714 (Published 23 March 2002) Cite this as: BMJ 2002;324:714
  1. Peter Greenwald, director (pg37g@nih.gov)
  1. Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, 6130 Executive Boulevard, Suite 2040, Bethesda, Maryland 20892-7309, USA

    Chemopreventive agents show promise for preventing and reversing cancer development

    Chemoprevention of cancer aims to prevent, arrest, or reverse either the initiation phase of carcinogenesis or the progression of neoplastic cells to cancer. It has been an active area of research for several decades; the use of retinoids to prevent cancer of the head and neck is a notable example.1 Chemoprevention is widely used and readily accepted by doctors and patients in the form of drugs that lower cholesterol concentrations and blood pressure to reduce the risk of cardiovascular disease. It can also be used in some apparently healthy people at risk of cancer to prevent or reduce their risk of developing invasive disease. The biomedical community needs to recognise and advocate approaches to prevent cancer with the same enthusiasm that it currently directs towards treating it.

    Summary points

    Cancer is a multistage disease, not a single event, and doctors should emphasise cancer prevention in addition to cancer treatment and cure

    Chemoprevention with naturally occurring (many dietary) and synthetic agents shows promise for preventing, arresting, and reversing cancer development

    Chemopreventive agents must have low toxicities compared with chemotherapeutic agents used in cancer patients

    Physicians should identify patients at high risk of cancer who might benefit from participation in chemoprevention trials

    Validation of surrogate endpoint biomarkers for clinical cancer is essential to reduce size and duration of chemoprevention trials

    Methods

    I searched the databases PubMed and CANCERLIT for the period from 1 January 1996 to 31 July 2001 using the key words “chemoprevention” and “neoplasms.” I used recent reviews identified by these searches, plus several archived journal articles and textbooks on chemoprevention available at the US National Library of Medicine, to develop an overview of cancer chemoprevention.

    Identifying suitable chemopreventive agents

    Research into chemoprevention uses a systematic strategy that begins by surveying the results of epidemiological, laboratory, …

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