296 Seminars in Oncology Nursing, Vol 21, No 4 (November), 2005: pp 296-298 OBJECTIVES: 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. DATA SOURCES: CANCER Peer-reviewed research and fed- eral government reports. PREVENTION CONCLUSION: Cancer prevention will exist in the future as an important public health strategy involving lifestyle PETER GREENWALD C 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 IMPLICATIONS FOR NURSING 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 firstname.lastname@example.org 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 doi:10.1016/j.soncn.2005.06.005 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.8 298 PETER GREENWALD CREATING A FUTURE CANCER PREVENTION proteomic, metabolomic, and environmental fac- tors are being developed today and should pro- PARADIGM 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. REFERENCES 1. Calle EE, Rodriguez C, Walker-Thurmond K, et al. Over- 6. O’Brien TR, Kirk G, Zhang M. Hepatocellular carci- weight, obesity, and mortality from cancer in a prospectively noma: Paradigm of preventive oncology. Cancer J 2004; 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- Opin Clin Nutr Metab Care 2004;7:397-402. macotherapy for tobacco dependence. Expert Opin Emerg 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 approach in dietetics. Curr Opin Clin Nutr Metab Care against HER 2/neu in a murine mammary carcinoma model. 1998;1:539-547. Breast Cancer Res 2004;6:R275-R283. 5. Schiller JT, Davies P. Delivering on the promise: HPV vac- 9. Alivisatos P. The use of nanocrystals in biological detec- cines and cervical cancer. Nat Rev Microbiol 2004;2:343-347. tion. Nat Biotechnol 2004;22:47-52.
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