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Bitzer, M. Genes Dev. CAS PubMed PubMed Central Google Scholar. American Cancer Society. Estimated Cancer Deaths and New Cases by Sex and Site: Cancer Facts and Figures American Cancer Society, New York, Jemal, A. Cancer Statistics CA Cancer J. Download references. We thank M. Padgett for expert assistance in the preparation of the manuscript.

Our research is supported by grants from the National Cancer Institute, the Department of Defense, the National Foundation for Cancer Research, and the Oliver and Jennie Donaldson Trust. S is an Oscar M.

Cohn Professor. Department of Pharmacology, Dartmouth Medical School, Hanover, , New Hampshire, USA. You can also search for this author in PubMed Google Scholar. breast cancer. chronic myelogenous leukaemia.

colon cancer. endometrial cancer. gastric cancer. head and neck cancer. Hodgkin's disease. lung cancer. ovarian cancer. pancreatic cancer. prostate cancer. testicular cancer.

androgen receptor. familial adenomatous polyposis. inflammatory bowel disease. Reprints and permissions. Chemoprevention: an essential approach to controlling cancer. Nat Rev Cancer 2 , — Download citation. Issue Date : 01 July Anyone you share the following link with will be able to read this content:.

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nature nature reviews cancer opinion article. Abstract Mortality that results from the common forms of cancer is still unacceptably high. Access through your institution. Buy or subscribe. Change institution. Learn more. Figure 1: The TGF-β signalling pathway represents a new target for potential development of new drugs for chemoprevention.

Figure 2: A standard study design for evaluating a new chemopreventive agent. Figure 3: Extension of the latency period is important for chemoprevention in both animals and humans. References Sporn, M. CAS PubMed Google Scholar Chemoprevention Working Group. PubMed Google Scholar Lippman, S.

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Sporn View author publications. View author publications. Related links Related links DATABASES Cancer. Preventive Services Task Force, ; Alizadeh et al.

The epidemiological studies show that among all the NSAIDs, aspirin is the most promising agent in reducing adenomatous cancer recurrence due to the availability of remarkably consistent data with no cardiovascular risk and minimal gastrointestinal toxicity Umezawa et al.

Further, aspirin has also received a Grade B recommendation by the U. Preventive Services Task Force, for its use as a chronic prophylaxis agent for colorectal cancer Dehmer et al. Although it has been proved that aspirin alone or in combination have colon chemopreventive activity, nanoencapsulation of aspirin can further potentiate the efficacy with decreased dose.

Chaudhary et al. studied chemopreventive effect of a mixture of aspirin, folic acid, and calcium on azoxymethane treated 7-week-old male Sprague-Dawley rats. The polymeric nanocapsules of drug combination prepared using polylactic-co-glycolic acid PLGA polymer showed 1.

Celecoxib is another NSAID which is being widely explored in clinical setting for its chemoprevention potential but offers cardiotoxicity and pharmacokinetic variability Solomon et al.

Naturally derived phytochemicals are widely studied as potential chemopreventive agents for their pleiotropic effects and non-toxicity Thomasset et al. Curcumin has shown efficient chemoprotective activity in intestinal and colon cancer, but has minimal water solubility, poor absorption, and low bioavailability.

Jayaprakasha et al. In another study, it was revealed that curcumin encapsulated in polymeric nanocarrier improved the solubility of curcumin and showed significantly reduced number of tumors, less structural abnormalities and beta-catenin a key intracellular messenger in gastrointestinal tract malignancies in curcumin NPs-treated group when compared to the curcumin Alizadeh et al.

Pancreatic cancer is the third leading cause of all cancer-related deaths in the United States American Cancer Society, a. Hence, chemoprevention has gained wide attention as an alternative strategy to control the occurrence and relapse. Lipid nanocarriers have been widely investigated for this purpose, Prabhu et al.

developed solid lipid NPs comprising aspirin, curcumin, and free sulforaphane as a nanocombination chemoprevention platform. The developed formulation showed significant enhancement in inhibition in Panc-1 and Mia PaCa-2 cell line models and synergism due to use of multiple drugs eliciting chemoprevention activity via variable mechanisms.

In another study, self micro-emulsifying drug delivery system SMEDDS of classical antihistaminic drug loratadine and sulforaphane was reported with enhanced oral bioavailability and chemoprevention potential in Panc-1 and Mia PaCa-2 PC cell lines Desai et al. Based on similar rational liposomes, dendrimers, micelles of potent chemopreventive phytochemical like curcumin, ellagic acid, etc.

have been reported to show enhanced inhibition in pancreatic cancer cell lines and their application can be extended for pancreatic cancer chemoprevention Song et al.

Gene therapy has also been investigated for prevention purpose and various siRNAs, viral vectors have been studied Lebedeva et al.

In an interesting study by Fisher et al. Hence, this strategy can be considered as a future clinical solution for chemoprevention and treatment and can also play a critical role in arresting pancreatic cancer relapse Lebedeva et al. Breast cancer has highest incidence and is listed to be the fourth leading cause of cancer-associated deaths in the United States American Cancer Society, a.

Though chemotherapy using drugs like selective estrogen receptor modulators tamoxifen, raloxifene, etc. have shown treatment efficacy, very high incidence of breast cancer warrants development of promising preventive strategies Ales-Martinez et al.

In recent years, natural products and some antineoplastic agents such as tamoxifen or raloxifene have displayed potential in chemoprevention of breast cancer Mitra and Dash, ; Uramova et al. However, to enhance drug stability, achieve sustained drug release and to circumvent side effects, delivery of these agents using nanoformulations has been warranted.

According to the reports, various nanoformulations such as liposome, nanofibers, nanocapsules, and NPs have been developed and investigated for prevention of breast cancer cells proliferation, breast cancer recurrence and metastasis after chemotherapy Li et al.

A polymeric NPs formulation of curcumin NanoCurc was designed and studied to significantly attenuate incidence of mammary tumors in a rodent chemical carcinogenesis model, confirming its breast cancer chemoprevention potential in at-risk populations Chun et al.

Interestingly, dietary soy isoflavones genistein, etc. have shown potential in reducing cancer incidence and their nanoformulations like PEGylated silica NPs, Chitosan NPs have shown significant enhancement in breast and cervical cancer inhibition Sarkar and Li, ; Cai et al.

Also, poly ethylene glycol -modified chitosan NPs were synthesized to encapsulate and deliver small interfering RNA siRNA. The siRNA loaded NPs showed 4T1 cell inhibition both in vitro and in vivo ensuring its efficacy in reduction of tumor growth and metastasis Sun et al.

Wan et al. developed the lapatinib-loaded human serum albumin NPs that exhibited a core-shell structure with stealth properties preventing brain metastasis from triple-negative breast cancer Wan et al. Interestingly, overcoming drug resistance and increasing cancer cell sensitivity towards drugs have also been investigated under this umbrella using a glycolipid-like nanocarrier encapsulating anti-tumor drug doxorubicin, which restricted drug resistance upon long-term use Meng et al.

Hybrid NPs have also been explored for chemoprevention. Tran et al. developed the hyaluronic acid coated solid lipid NPs for co-delivery of ibuprofen and paclitaxel that resulted in synergistic inhibition on the proliferation of cancer cells Tran et al.

Zhang et al. designed a multifunctional hybrid nanomedicine integrating multiple FDA-approved modalities like radiotherapy, chemotherapy, photothermal therapy, and immunotherapy, which demonstrated elimination of the primary breast tumor and efficiently prevented tumor recurrence and metastasis to lung Zhang et al.

Further, small peptide T4 NLLMAAS has been reported to inhibit tyrosine kinase, immunoglobulin, and epidermal growth factor homology-2 Tie2 , required for blood vessels reconstruction during tumor recurrence.

The NPs were capable of releasing the peptide T4 under acidic tumor environment and could achieve targeted inhibition resulting in breast tumor relapse inhibition Zhang et al. In another study, nanographene oxide-methylene blue formulations in combination with photodynamic and photothermal treatment were reported to prevent breast tumor regrowth and metastasis to the liver, lung, and spleen Dos Santos et al.

Chemoprevention has also been studied in other less common forms of cancers including but not limited to head, neck, skin, prostate, liver. Head and neck squamous cell carcinoma is a fast progressive form of cancer and oral cancer is highly prevalent subtype therein Crooker et al.

Recently, indigenous extracellular vesicles like exosomes, microvesicles, apoptic bodies derived from mammalian or tumor cells are gaining wide attention as chemopreventive and treatment tools. They have been recognized as valuable carriers for drugs like paclitaxel, RNAs, peptides, etc.

and have shown potential in inhibiting of various types of cancers Wang et al. For the site-specific local treatment and chemoprevention of oral squamous cell carcinoma, several polymeric drug delivery systems have been developed using nanotechnology which has shown enhanced activity Desai, ; Ketabat et al.

Some studies include drugs nanoformulations such as naringenin NPs, ellagic acid chitosan NPs, which showed significant enhancement in both bioavailability and efficacy Arulmozhi et al. In addition, cisplatin when encapsulated in polymeric micelles was reported to eliminate cisplatin induced nephrotoxicity Endo et al.

Further, PEGylated nanoliposomes of paclitaxel, resveratrol, and 5-fluorouracil were reported to show controlled drug release in inhibition of head and neck carcinoma and liposomal formulation of irinotecan Onivyde ® has already been in market for pancreatic cancer management Nie et al.

Another natural chemopreventive agent, salvianolic acid B was encapsulated in phospholipid complex loaded NPs and the studies showed significant increase in intracellular uptake and improved cell inhibition when compared to drug for head and neck carcinoma Li et al. To improve the drug's bioavailability, stability, and tumor selectivity, nanotechnology-based drug delivery systems have been widely studied Tyagi et al.

To study the chemoprevention efficacy of combination, gold-conjugated green tea NPs were designed that demonstrated selective toxicity towards Ehrlich's Ascites Carcinoma and breast cancer cells MCF-7 and interestingly had hepatoprotective behavior against the tumor-induced cellular damage Mukherjee et al.

For prostate cancer prevention and therapy, targeted EGCG polymeric NPs were developed using a biocompatible polymer polylactic-co-glycolic acid—polyethylene glycol-A PLGA-PEG-A which have a specific binding and high inhibitory action against prostate cancer cells via specific membrane antigen resulting in enhanced bioavailability, limited toxicity, and in turn enhanced efficacy Sanna et al.

Hesperetin, a bio-flavonoid, plays a potential role in liver cancer management. To overcome it poor solubility, bioavailability, biocompatibility issues, hesperetin, loaded gold NPs were designed.

These NPs demonstrated significantly higher in vivo prevention activity against lipid per-oxidation, hepatic cell damage in diethylnitrosamine-induced liver cancer model compared to the drug alone Gokuladhas et al. In the area of skin cancer prevention, nanotechnology-based drug formulation such as nanoemulsion of 5-fluorouracil, bromelain polymeric NPs using PLGA, solid lipid NPs of doxorubicin, 5-flurouracil have been reported Bhatnagar et al.

Use of NPs to enhance the skin deposition of chemopreventive agents is an ideal way to enhance the chemopreventive efficacy. Such examples include shell-enriched solid lipid NPs of 5-fluorouracil, curcumin-ceramide niososmes, etc.

Heenatigala Palliyage et al. NPs have also been developed and studied to elicit enhanced protection against UV radiation.

Several studies including development of ultra-flexible NPs of an antioxidant diindolylmethane derivative, silver NPs, etc. Boakye et al. Application of nanotechnology in cancer chemoprevention has certainly proven its potential to deliver the drugs in more effective, safer, and targeted manner.

The research in this area is further advancing towards development of nanovaccines for cancer prevention. Also, early detection techniques using nanoplatforms capable of identifying pre-malignant markers are gaining attention as a preventive measure and nanodevices comprising nanochips, nanodots, quantum dots, nanoshells, and nanotubes have been reported Bentolila et al.

Despite of such advances in research, their bench-to-bedside translation for cancer prevention has a long way to go owing to regulatory and clinical considerations.

In this context, mainly NSAIDS, retinoids, cyclooxygenase inhibitors, etc. have shown clinical potential through randomized clinical studies. However, more concentrated efforts and well-planned studies with measurable clinical outcomes are warranted. Further, proving the safety of nanoformulations is an urgently needed aspect.

In view of regulatory approval of nanotechnology-based products for cancer treatment and other conditions, we should expect the clinical translation of nanotechnology-based products for cancer chemoprevention in near future.

PD, JW, and SP conceived and proposed the idea. PD compiled the manuscript with support from NT, PW, SZ. DA, JW and SP reviewed and revised the manuscript.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Ales-Martinez, J.

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Two vaccines to prevent infection by cancer-causing agents have been developed and approved by the US Food and Drug Administration FDA. One is a vaccine to prevent infection with hepatitis B virus.

The other protects against infection with strains of human papillomavirus HPV that cause cervical cancer. Scientists continue to work on vaccines against infections that cause cancer. Being exposed to radiation is a known cause of cancer. There are two main types of radiation linked with an increased risk of cancer:.

Scientists believe that ionizing radiation causes leukemia , thyroid cancer , and breast cancer in women. Ionizing radiation may also be linked to myeloma and cancers of the lung , stomach , colon , esophagus , bladder , and ovary.

Being exposed to radiation from diagnostic x-rays increases the risk of cancer in patients and x-ray technicians. Diagnostic radiation in children and adolescents has been linked with a higher risk of cancers at a young age. The growing use of CT scans over the last 20 years has increased exposure to ionizing radiation.

The risk of cancer also increases with the number of CT scans a patient has and the radiation dose used each time. Immunosuppressive medicines are used after an organ has been transplanted from one person to another. These medicines stop an organ that has been transplanted from being rejected.

These medicines decrease the body's immune response to help keep the organ from being rejected. Immunosuppressive medicines are linked to an increased risk of cancer because they lower the body's ability to keep cancer from forming.

The risk of cancer, especially cancer caused by a virus, is higher in the first 6 months after organ transplant, but the risk lasts for many years. The foods that you eat on a regular basis make up your diet. Diet is being studied as a risk factor for cancer.

It is hard to study the effects of diet on cancer because a person's diet includes foods that may protect against cancer and foods that may increase the risk of cancer. It is also hard for people who take part in the studies to keep track of what they eat over a long period of time.

This may explain why studies have different results about how diet affects the risk of cancer. Some studies have shown that a diet high in fat, proteins , calories , and red meat increases the risk of colorectal cancer , but other studies have not shown this. It is not known if a diet low in fat and high in fiber , fruits, and vegetables lowers the risk of colorectal cancer.

Studies have shown that drinking alcohol is linked to an increased risk of the following types of cancers:. Drinking alcohol may also increase the risk of liver cancer and female colorectal cancer. Studies show that people who are physically active have a lower risk of certain cancers than those who are not.

It is not known if physical activity itself is the reason for this. Some studies show that physical activity protects against postmenopausal breast cancer and endometrial cancer. Studies show that obesity is linked to a higher risk of the following types of cancer:.

Some studies show that obesity is also a risk factor for cancer of the gallbladder and liver cancer. Studies have shown that people who lose weight decrease their risk of these cancers.

Some studies show that having diabetes may slightly increase the risk of having the following types of cancer:. Diabetes and cancer share some of the same risk factors.

These risk factors include the following:. Because diabetes and cancer share these risk factors, it is hard to know whether the risk of cancer is increased more by diabetes or by these risk factors. Studies are being done to see how medicine that is used to treat diabetes affects cancer risk.

Being exposed to chemicals and other substances in the environment has been linked to some cancers:. Studies have been done to see if pesticides and other pollutants increase the risk of cancer. The results of those studies have been unclear because other factors can change the results of the studies.

An intervention is a treatment or action taken to prevent or treat disease, or improve health in other ways. Many studies are being done to find ways to keep cancer from starting or coming back. Chemoprevention is the use of substances to lower the risk of cancer, or keep it from recurring.

The substances may be natural or made in the laboratory. Some chemopreventive agents are tested in people who are at high risk for a certain type of cancer. The risk may be because of a precancerous condition, family history , or lifestyle factors.

Weight loss surgery, also called bariatric surgery , is a procedure that people with obesity can have to lose weight and improve their overall health and quality of life. The surgery changes the anatomy of the stomach or changes the way the body absorbs nutrients.

A person who undergoes this procedure will lose a lot of weight and as a result, will have a decreased risk of cancers that are linked to being overweight. See the NCI website for more information about cancer prevention.

Aspirin has been studied as chemoprevention. The studies show mixed results but most have shown that aspirin does not prevent cancer. However, there is evidence that taking aspirin for long periods of time may prevent colorectal cancer in certain people.

For more information, see Colorectal Cancer Prevention. Results from a randomized trial suggest that taking aspirin may make cancer grow more quickly in the elderly, but longer follow up is needed to confirm these results.

Bleeding in the gastrointestinal tract or brain is a side effect of aspirin. Even though aspirin has not been shown to reduce the risk of most cancers, it has many uses, including helping to lower the chances of dying from heart disease.

Before beginning long-term aspirin use, it is important to talk with your doctor about the related benefits and harms. There is not enough proof that taking multivitamin and mineral supplements or single vitamins or minerals can prevent cancer.

The following vitamins and mineral supplements have been studied, but have not been shown to lower the risk of cancer:. The Selenium and Vitamin E Cancer Prevention Trial SELECT found that vitamin E taken alone increased the risk of prostate cancer.

The risk continued even after the men stopped taking vitamin E. Taking selenium with vitamin E or taking selenium alone did not increase the risk of prostate cancer. Vitamin D has also been studied to see if it has anticancer effects. Skin exposed to sunshine can make vitamin D. Vitamin D can also be consumed in the diet and in dietary supplements.

The Physicians' Health Study found that men who have had cancer in the past and take a multivitamin daily may have a slightly lower risk of having a second cancer. Clinical trials supported by other organizations can be found on the ClinicalTrials.

gov website. Physician Data Query PDQ is the National Cancer Institute's NCI's comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine.

Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language.

Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish. PDQ is a service of the NCI. The NCI is part of the National Institutes of Health NIH.

The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH. This PDQ cancer information summary has current information about cancer prevention.

It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information.

The date on each summary "Updated" is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Screening and Prevention Editorial Board. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another.

Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works.

If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard. Some clinical trials are open only to patients who have not started treatment. Clinical trials can be found online at NCI's website.

For more information, call the Cancer Information Service CIS , NCI's contact center, at CANCER PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.

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It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3, scientific images.

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer. gov on the Managing Cancer Care page. More information about contacting us or receiving help with the Cancer.

gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer. Home About Cancer Cancer Causes and Prevention Cancer Prevention Overview PDQ® —Patient Version. Cancer Causes and Prevention Risk Factors Genetics Cancer Prevention Overview Research.

Front Matter Pages i-xxi. Chemopreventive Agent Development Science Front Matter Pages Characterization of Natural Product Chemopreventive Agents John M. Pezzuto, Jerome W.

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Shields Pages Design Issues in Prostate Cancer Chemoprevention Trials Ian M. Thompson, Charles A. Coltman Jr. Recruitment Strategies for Cancer Prevention Trials Paul P. Carbone, Karen Sielaff, Mary Hamielec, Howard Bailey Pages Cancer Chemoprevention at Major Cancer Target Sites Front Matter Pages Prostate Cancer Prevention William G.

Nelson, Angelo M. de Marzo, Scott M. Lippman Pages Use of PSA to Evaluate Risk and Progression of Prostate Cancer Bulent Akduman, Abelardo Errejon, E. David Crawford Pages Clinical Approaches to Discovering and Testing New Breast Cancer Prevention Drugs Carol J.

Fabian, Bruce F. Kimler, Matthew S. Mayo, William E. Grizzle, Shahla Masood, Giske Ursin Pages Back to top. About this book Despite significant advances in cancer treatment and measures of neoplastic progression, drug effect or early detection, overall cancer incidence has increased, pharmacodynamic markers , and markers that measure cancer-associated morbidity is considerable, and overall prognosis as well as predict responses to specific therapy.

cancer survival has remained relatively flat over the past All these biomarkers have the potential to greatly augment several decades 1,2. However, new technology the development of successful chemoprevention therapies, allowing exploration of signal transduction pathways, but two specific types of biomarkers will have the most identification of cancer-associated genes, and imaging of immediate impact on successful chemopreventive drug tissue architecture and molecular and cellular function is development—those that measure the risk of developing increasing our understanding of carcinogenesis and cancer invasive life-threatening disease, and those whose mo- progression.

Thus far, the biomarker that best measures to selectively suppress cancer progression. these two phenomena is intraepithelial neoplasia IEN Carcinogenesis is now visualized as a multifocal, because it is a near obligate precursor to cancer.