Advertisement

Early Disease, Early Detection, Early Treatment: Some Common Threads and Some Important Problems

  • John D. Potter
Chapter

Abstract

This chapter attempts to summarise and comment on the preceding chapters. It begins with some thoughts on differences between prevention and treatment. It notes that we have achieved a great deal in the accumulation of empirical data on cancer but still lack a coherent overall theory. The chapter then discusses, in the light of the rest of the book, the classification of cancers into five groups, based on the likely effectiveness of screening, early detection, and subsequent treatment and prevention strategies. It then notes, again referring to the earlier chapters, the next steps that might better inform our detection of early lesions. A section on the development, testing, and use of new screening markers follows, with an emphasis, as elsewhere in the chapter, on the problem of studies that are too small. The final section is concerned with the repeated failure of chemoprevention to deliver on its promise. It notes, in particular, the very primitive approach that we take in using single agents, a practice that we abandoned decades ago in chemotherapy, because clonal selection and progression are known to result. We do not yet seem to have noticed that the same is frequently true with chemoprevention.

Keywords

Mammographic Density Stomach Cancer Early Lesion Somatic Evolution Adenomatous Colorectal Polyp 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Etzioni R, Penson DF, Legler JM, di Tommaso D, Boer R et al (2002) Overdiagnosis due to prostate-specific antigen screening: lessons from U.S. prostate cancer incidence trends. J Natl Cancer Inst 94(13):981–990PubMedCrossRefGoogle Scholar
  2. 2.
    Zahl PH, Strand BH, Maehlen J (2004) Incidence of breast cancer in Norway and Sweden during introduction of nationwide screening: prospective cohort study. BMJ 328(7445): 921–924PubMedCrossRefGoogle Scholar
  3. 3.
    Pepe MS, Etzioni R, Feng Z, Potter JD, Thornquist MD et al (2001) Phases of biomarker development for early detection of cancer. J Natl Cancer Inst 93:1054–1061PubMedCrossRefGoogle Scholar
  4. 4.
    Subramanian S, Bobashev G, Morris RJ (2009) Modeling the cost-effectiveness of colorectal cancer screening: policy guidance based on patient preferences and compliance. Cancer Epidemiology Biomarkers Prev 18(7):1971–1978CrossRefGoogle Scholar
  5. 5.
    Bissell MJ, Labarge MA (2005) Context, tissue plasticity, and cancer: are tumor stem cells also regulated by the microenvironment? Cancer Cell 7(1):17–23PubMedGoogle Scholar
  6. 6.
    Potter JD (2007) Morphogens, morphostats, microarchitecture and malignancy. Nat Rev Cancer 7(6):464–474PubMedCrossRefGoogle Scholar
  7. 7.
    Palmer C, Duan X, Hawley S, Scholler N, Thorpe JD et al (2008) Systematic evaluation of candidate blood markers for detecting ovarian cancer. PLoS One 3(7):e2633PubMedCrossRefGoogle Scholar
  8. 8.
    Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP et al (2006) Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 355(17):1763–1771PubMedCrossRefGoogle Scholar
  9. 9.
    Hingorani SR, Petricoin EF, Maitra A, Rajapakse V, King C et al (2003) Preinvasive and invasive ductal pancreatic cancer and its early detection in the mouse. Cancer Cell 4(6):437–450PubMedCrossRefGoogle Scholar
  10. 10.
    Hingorani SR, Wang L, Multani AS, Combs C, Deramaudt TB et al (2005) Trp53R172H and KrasG12D cooperate to promote chromosomal instability and widely metastatic pancreatic ductal adenocarcinoma in mice. Cancer Cell 7(5):469–483PubMedCrossRefGoogle Scholar
  11. 11.
    Izeradjene K, Combs C, Best M, Gopinathan A, Wagner A et al (2007) Kras(G12D) and Smad4/Dpc4 haploinsufficiency cooperate to induce mucinous cystic neoplasms and invasive adenocarcinoma of the pancreas. Cancer Cell 11(3):229–243PubMedCrossRefGoogle Scholar
  12. 12.
    Bach PB (2008) Is our natural-history model of lung cancer wrong? Lancet Oncol 9(7):693–697PubMedCrossRefGoogle Scholar
  13. 13.
    Petricoin EF, Ardekani AM, Hitt BA, Levine PJ, Fusaro VA et al (2002) Use of proteomic patterns in serum to identify ovarian cancer. Lancet 359(9306):572–577PubMedCrossRefGoogle Scholar
  14. 14.
    Potter JD (2001) At the interfaces of epidemiology, genetics, and genomics. Nat Rev Genet 2:142–147PubMedCrossRefGoogle Scholar
  15. 15.
    Bissell MJ, Radisky D (2001) Putting tumours in context. Nat Rev Cancer 1:46–54PubMedCrossRefGoogle Scholar
  16. 16.
    Vachon CM, Sellers TA, Carlson EE, Cunningham JM, Hilker CA et al (2007) Strong ­evidence of a genetic determinant for mammographic density, a major risk factor for breast cancer. Cancer Res 67(17):8412–8418PubMedCrossRefGoogle Scholar
  17. 17.
    Potter J (2009) Chemoprevention: why do we keep getting it wrong? Presentation for 2009 AACR-American Cancer Society Award for Research Excellence in Cancer Epidemiology and Prevention, 100th AACR Meeting, Denver COGoogle Scholar
  18. 18.
    Cancer Prevention Study Group ATBC (1994) The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 330:1029–1035CrossRefGoogle Scholar
  19. 19.
    Omenn G, Goodman G, Thornquist M, Balmes J, Cullen M et al (1996) Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med 334:1150–1155PubMedCrossRefGoogle Scholar
  20. 20.
    Potter JD (1996) Chemoprevention: pharmacology or biology? Oncology 10:1487–1488Google Scholar
  21. 21.
    Neuhouser ML, Patterson RE, Thornquist MD, Omenn GS, King IB et al (2003) Fruits and vegetables are associated with lower lung cancer risk only in the placebo arm of the ­beta-carotene and retinol efficacy trial (CARET). Cancer Epidemiol Biomarkers Prev 12(4):350–358PubMedGoogle Scholar
  22. 22.
    Baron JA, Cole BF, Sandler RS, Haile RW, Ahnen D et al (2003) A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med 348(10):891–899PubMedCrossRefGoogle Scholar
  23. 23.
    Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E et al (2003) A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med 348(10):883–890PubMedCrossRefGoogle Scholar
  24. 24.
    Flossmann E, Rothwell PM (2007) Effect of aspirin on long-term risk of colorectal ­cancer: consistent evidence from randomised and observational studies. Lancet 369(9573):1603–1613PubMedCrossRefGoogle Scholar
  25. 25.
    Cook NR, Lee IM, Gaziano JM, Gordon D, Ridker PM et al (2005) Low-dose aspirin in the primary prevention of cancer: the Women’s Health Study: a randomized controlled trial. JAMA 294(1):47–55PubMedCrossRefGoogle Scholar
  26. 26.
    Arber N, Eagle CJ, Spicak J, Racz I, Dite P et al (2006) Celecoxib for the prevention of colorectal adenomatous polyps. N Engl J Med 355(9):885–895PubMedCrossRefGoogle Scholar
  27. 27.
    Bertagnolli MM, Eagle CJ, Zauber AG, Redston M, Solomon SD et al (2006) Celecoxib for the prevention of sporadic colorectal adenomas. N Engl J Med 355(9):873–884PubMedCrossRefGoogle Scholar
  28. 28.
    Psaty BM, Potter JD (2006) Risks and benefits of celecoxib to prevent recurrent adenomas. New Engl J Med 355(9):950–952PubMedCrossRefGoogle Scholar
  29. 29.
    Cole BF, Baron JA, Sandler RS, Haile RW, Ahnen DJ et al (2007) Folic acid for the prevention of colorectal adenomas: a randomized clinical trial. JAMA 297(21):2351–2359PubMedCrossRefGoogle Scholar
  30. 30.
    Ulrich CM, Potter JD (2007) Folate and cancer – timing is everything. JAMA 297(21):2408–2409PubMedCrossRefGoogle Scholar
  31. 31.
    Figueiredo JC, Grau MV, Haile RW, Sandler RS, Summers RW et al (2009) Folic acid and risk of prostate cancer: results from a randomized clinical trial. J Natl Cancer Inst 101(6):432–435PubMedCrossRefGoogle Scholar
  32. 32.
    Qiao Y-L, Dawsey SM, Kamangar F, Fan J-H, Abnet CC et al (2009) Total and cancer mortality after supplementation with vitamins and minerals: follow-up of the Linxian general population nutrition intervention trial. J Natl Cancer Inst 101(7):507–518PubMedCrossRefGoogle Scholar
  33. 33.
    Baron JA, Beach M, Mandel JS, van Stolk RU, Haile RW et al (1999) Calcium supplements for the prevention of colorectal adenomas. N Engl J Med 340:101–107PubMedCrossRefGoogle Scholar
  34. 34.
    Grau MV, Baron JA, Sandler RS, Haile RW, Beach ML et al (2003) Vitamin D, calcium supplementation, and colorectal adenomas: results of a randomized trial. J Natl Cancer Inst 95(23):1765–1771PubMedCrossRefGoogle Scholar
  35. 35.
    Kristal AR, Cohen JH, Qu P, Stanford JL (2002) Associations of energy, fat, calcium, and vitamin D with prostate cancer risk. Cancer Epidemiology Biomarkers Prev 11(8):719–725Google Scholar
  36. 36.
    McMichael AJ, Potter JD (1980) Reproduction, endogenous and exogenous sex hormones, and colon cancer: a review and hypothesis. J Natl Cancer Inst 65(6):1201–1207PubMedGoogle Scholar
  37. 37.
    Potter J, McMichael A (1983) Large bowel cancer in women in relation to reproductive and hormonal factors: a case-control study. J Natl Cancer Inst 4:703–709Google Scholar
  38. 38.
    Potter JD, Bostick RM, Grandits GA, Fosdick L, Elmer P et al (1996) Hormone replacement therapy is associated with lower risk of adenomatous polyps of the large bowel: the Minnesota Cancer Prevention Research Unit Case-Control Study. Cancer Epidemiol Biomarkers Prev 5(10):779–784PubMedGoogle Scholar
  39. 39.
    Chlebowski RT, Wactawski-Wende J, Ritenbaugh C, Hubbell FA, Ascensao J et al (2004) Estrogen plus progestin and colorectal cancer in postmenopausal women. N Engl J Med 350(10):991–1004PubMedCrossRefGoogle Scholar
  40. 40.
    Chlebowski RT, Hendrix SL, Langer RD, Stefanick ML, Gass M et al (2003) Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative Randomized Trial. JAMA 289(24):3243–3253PubMedCrossRefGoogle Scholar
  41. 41.
    Manson JE, Hsia J, Johnson KC, Rossouw JE, Assaf AR et al (2003) Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 349(6):523–534PubMedCrossRefGoogle Scholar
  42. 42.
    Shu XO, Jin F, Dai Q, Wen W, Potter JD et al (2001) Soyfood Intake during adolescence and subsequent risk of breast cancer among Chinese women. Cancer Epidemiology Biomarkers Prev 10(5):483–488Google Scholar
  43. 43.
    Nissen SE, Wolski K (2007) Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 356(24):2457–2471PubMedCrossRefGoogle Scholar
  44. 44.
    Psaty BM, Furberg CD (2007) Rosiglitazone and cardiovascular risk. N Engl J Med 356(24):2522–2524PubMedCrossRefGoogle Scholar
  45. 45.
    Ridker PM, Danielson E, Fonseca FAH, Genest J, Gotto AM Jr et al (2008) Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 359(21):2195–2207PubMedCrossRefGoogle Scholar
  46. 46.
    Platz EA (2007) Epidemiologic musing on statin drugs in the prevention of advanced prostate cancer. Cancer Epidemiology Biomarkers Prev 16(11):2175–2180CrossRefGoogle Scholar
  47. 47.
    Li CI, Malone KE, Weiss NS, Daling JR (2001) Tamoxifen therapy for primary breast cancer and risk of contralateral breast cancer. J Natl Cancer Inst 93(13):1008–1113PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA

Personalised recommendations