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									296                                               Seminars in Oncology Nursing, Vol 21, No 4 (November), 2005: pp 296-298

 To hypothesize on the future of can-
 cer prevention based on past and
 current progress of the field, as well
 as possible assimilation of knowl-
                                                    THE FUTURE OF
 edge in other fields that may be ap-
 plied to cancer prevention.
 Peer-reviewed research and fed-
 eral government reports.                            PREVENTION
 Cancer prevention will exist in the
 future as an important public
 health strategy involving lifestyle
                                                                      PETER GREENWALD

 and medical approaches that in-
 clude behavior in relation to risk
                                                                 ANCER prevention, as a public health and re-
 factors, chemoprevention, biomar-                               search strategy that encompasses both lifestyle
 ker assessment, vaccines, and                                   and medical approaches, represents the first line
 emerging technologies to better                                 of defense in reducing the number of deaths
 identify individuals at risk for                                resulting from cancer. The future of cancer pre-
 cancer.                                       vention will be based on continuing progress in discovering and
                                               implementing these approaches. Predicting the future of cancer
                                               prevention requires an assessment of the research pathways at the
 PRACTICE:                                     present time, as well as hypothetical suppositions about the future
 In the future nurses will play an             directions of biotechnology and medical, genetic, and behavioral
 enhanced role in cancer preven-               research. This brief look at the future of cancer prevention will
 tion through their efforts support-           focus on how current research in various fields is creating an
 ing risk assessment, education,               environment for meeting the challenges identified in systematic
 and medical approaches in an                  cancer prevention research. Although cancer as a disease is un-
                                               likely to be completely eliminated in the near future, a realistic
 expanded role with diagnostic
                                               goal will be to achieve an understanding of environmental, behav-
 testing, and support for preven-
                                               ioral, genetic, and metabolic factors that contribute to cancer risk.
 tion clinical trials.
                                               A tailored cancer prevention strategy based on an individual risk
                                               profile can then be developed to include behavioral and nutritional
                                               interventions, chemoprevention, and screening, and will comple-
                                               ment broader social changes that may impact cancer rates.
    From the Division of Cancer Preven-
 tion, National Cancer Institute, National
 Institutes of Health, Bethesda, MD.
    Peter Greenwald, MD, DrPH: Director,
                                                       LIFESTYLE    AND   PUBLIC HEALTH APPROACHES
 Division of Cancer Prevention, National
 Cancer Institute, National Institutes of
 Health, Bethesda, MD.
    Address correspondence to Peter Green-
 wald, MD, DrPH, Division of Cancer Pre-
                                               E    fforts to promote healthy lifestyle practices such as tobacco
                                                    control policies, recommendations for dietary modification,
                                               and weight control programs have yielded mixed results in reduc-
 vention, National Cancer Institute, Na-
 tional Institutes of Health, 6130 Executive
                                               ing cancer risk. The future likely will see a continued effort to
 Blvd, Room 2040, 31 Center Dr, MSC            increase research— basic biomedicine, animal studies, and clinical
 2580, Bethesda, MD 20892-7309: e-mail:        trials—that provides new information on the relationships among
                                               biology, behavior, and cancer. Recent studies, for example, have
                                               described the association of obesity and overweight with approx-
   This is a US government work. There         imately 15% to 20% of cancer deaths, as well as significant per-
 are no restrictions on its use.               centages of deaths from cardiovascular, kidney, and other diseas-
   1055-937X/05/2104-/0                        es.1 Strategies to decrease the number of obese and overweight
                                               Americans will demand a creative, multidisciplinary approach that
                                                                 THE FUTURE OF CANCER PREVENTION         297

includes increased research, disease prevention,         to assess chemoprevention agents for multiple
and programs to encourage weight loss and in-            conditions such as cancer, cardiovascular disease,
creased physical activity. One example of promis-        and diabetes. In cancer prevention clinical trials,
ing future research may be on peroxisome prolif-         new chemoprevention agents are being investi-
erator-activated receptors, which are key                gated for major cancer sites. Future trials for
regulators of metabolism and energy homeostasis          breast cancer will investigate new generations of
and are associated with the pathogenesis of vari-        selective estrogen receptor modulators, aromatase
ous tumors.2 Recent metabolic studies show that          inhibitors, and nutrition-based agents such as soy
peroxisome proliferator-activated receptors play         and its analogues. As we better understand the
an important role as key regulators of energy            differences between hormonally and nonhormon-
balance and insulin signaling that strongly influ-        ally driven breast tumors, considerable effort will
ence obesity.3                                           be made to develop newer agents to target those
   Successful institutional strategies used in the       differences. Another priority will be preventing
past against tobacco use, which included policy          and treating estrogen-receptor negative tumors
initiatives such as smoking restrictions and in-         with various tyrosine kinase inhibitors, retinoid-
creased taxes on tobacco products, can be encour-        like compounds, statins, and farnesyl transferase
aged by cancer prevention researchers and public         inhibitors, all of which have shown promise in
health professionals. To address the challenges of       small clinical studies.
obesity and overweight, future strategies may in-           A significant public health strategy that in-
clude advocating city and suburban planning or-          cludes both lifestyle and medical approaches for
dinances that encourage a more active living en-         future cancer prevention is the development of
vironment in cities and suburbs, such as the urban       vaccines that prevent both cancer and cancer
planning of pedestrian-friendly streets and build-       recurrence. Recently, efficacy trials have begun to
ings, active transport polices, increased require-       test vaccines directed against two forms of human
ments for physical education in schools, and the         papillomavirus responsible for approximately 80%
promotion of physical activity (eg, parks, game          of cervical cancers.5 Vaccines are being used to
fields, trails, public transportation, and activity       reduce the risk of liver cancer related to Hepatitis
centers) in new housing development ordinances.          B infection,6 and it is possible that a vaccine
Cancer prevention researchers will lend critical         against Hepatitis C will be available in the future.
knowledge of health promotion to this effort.            Anti-nicotine vaccines take a different approach
                                                         from traditional vaccine use; immunization is de-
                                                         signed to decrease an activity or behavior (ie,
             MEDICAL APPROACHES                          smoking) that increases cancer risk. In this ap-
                                                         proach, binding of nicotine by anti-nicotine anti-

T    he primary medical approach for cancer pre-
     vention in the future will be an integrated
chemoprevention program that combines re-
                                                         bodies raised by immunization reduces or elimi-
                                                         nates the effect of nicotine on the brain; thus,
                                                         most of nicotine’s psychoactive affects and re-
search findings from basic research, genetics and         wards are prevented, reducing the drive for con-
proteomics, nutritional science, biomarker devel-        tinued nicotine consumption. Future anti-nico-
opment and validation, and clinical trials to deter-     tine vaccines will be used for cessation for current
mine those at risk for cancer and to develop indi-       smokers and for preventing relapses in smokers
vidualized prevention regimens. The use of               who have quit recently, as well as for potential use
chemoprevention agents in combination with spe-          in those who have never smoked, again by elimi-
cific dietary and behavior modifications will pro-         nating the pleasant effects of nicotine usually ex-
vide a level of individualization not currently pos-     perienced by smokers.7 In addition, advances in
sible. Our future understanding of bioactive food        molecular biology are making possible the de-
components and their interactions with genomic,          velopment of therapeutic vaccines that can be
proteomic, and metabolomic factors is key to de-         used for adjuvant therapy for melanoma and
signing appropriate interventions that target indi-      metastatic breast cancer. Animal studies have
vidual risk profiles.4 Clinical trials will continue to   shown vaccination with virus-like replicon par-
be the gold standard for understanding prevention        ticles containing the HER2/neu gene after con-
strategies; in the future, however, prevention tri-      ventional chemotherapy increases effectiveness
als are likely to have multiple primary endpoints        of the chemotherapy.8

 CREATING A FUTURE CANCER PREVENTION                              proteomic, metabolomic, and environmental fac-
                                                                  tors are being developed today and should pro-
                                                                  duce enormous benefits in the future. The wealth
                                                                  of information becoming available, along with ad-

T    he success of cancer prevention in the future
     will require organizational structures that in-
clude researchers and professionals from diverse
                                                                  vances in bioinformatics and pattern recognition
                                                                  algorithms, for example, will allow researchers
                                                                  and clinicians to move away from a “one-size-fits-
fields of study. Cancer prevention must become                     all” approach to individualized chemoprevention,
multidisciplinary at the earliest planning stage for              dietary recommendations, and other cancer pre-
research initiatives to be most effective. Biomet-                vention strategies.
rics and standardized sample collection and stor-                    This brief look at the potential future of cancer
age procedures and procedures and formats for                     prevention is not meant to be comprehensive or to
well annotated data sets will gain more attention                 cover all of the scientific advances that will change
in the future because there will be a greater                     the course of this field. Decisions made today will
amount of information available from future trials                become part of the accumulated knowledge used
through the use of emerging biometric and imag-                   by future cancer prevention scientists to mold
ing technologies. Currently there is an emerging                  strategies for intervention and research. Many ar-
relationship between nanotechnology and medical                   eas not covered here—animal models, behavioral
sciences that will take biochemical targeting and                 strategies, sample repositories, and dissemination
imaging into the single-molecule level in living                  strategies—will play major roles in cancer preven-
cells.9 Advances in computer science will afford                  tion and are not meant to be minimized. The
numerous possibilities for prevention researchers                 future of cancer prevention is bright and the par-
to use ever stronger analytic tools to understand                 adigm of multidisciplinary research coupled with
ever smaller impacts of interventions.                            training and cross-training opportunities can se-
   The groundwork for investigations of cancer-                   cure a future that reduces and manages the risk
related nutritional, hormonal, metabolic, genetic,                and consequences of cancer.


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studied cohort of U.S. adults. N Engl J Med 2003;348:1625-1638.   10:67-73.
  2. Nahle Z. PPAR trilogy from metabolism to cancer. Curr           7. Foulds J, Burke M, Steinberg M, et al. Advances in phar-
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  3. Evans RM, Barish GD, Wang YX. PPARs and the complex          Drugs 2004;9:39-53.
journey to obesity. Nat Med 2004;10:355-361.                         8. Eralp Y, Wang X, Wang JP, et al. Doxorubicin and pacli-
  4. Andlauer W, Stehle P, Furst P. Chemoprevention–A novel       taxel enhance the antitumor efficacy of vaccines directed
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  5. Schiller JT, Davies P. Delivering on the promise: HPV vac-      9. Alivisatos P. The use of nanocrystals in biological detec-
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