3rd EurocanPlatform Translational Research Course
Medical cancer prevention
Dr Bernardo Bonanni - European Institute Of Oncology, Milan, Italy
I hope there will be more than one message and essentially I’m here to bring the flag of cancer prevention which is hopefully already a clinical thing, a clinical thing after many years of research, translational and clinical research. But actually now we are in a position that we can talk with some individuals, some families, talking about their risk, their cancer risk, and discussing the options to reduce that risk in many ways. Medical cancer prevention is essentially the clinical way of reducing the risk of one individual, particular individual, at high risk, probably or surely at high risk. There are several ways to go and you can use different tools from drugs to natural compounds to other tools but we are now in a position to have a good result with several high risk population cohorts.
What significance does this have for clinical practice?
Very significant, as a matter of fact in your particular country, for example in the UK, cancer prevention is already a public thing. The UK government through the NICE guidelines sustain cancer prevention with the use of tamoxifen or raloxifene, two very well-known and very much validated drugs, to reduce the risk of breast cancer, for example. We have other examples that are very much established as well, for example the non-corticosteroidal anti-inflammatory drugs and especially aspirin for colon cancer prevention, for example, and we have other examples that can be made.
What are the next steps?
There are several next steps to my mind. There is essentially one particular problem that cancer prevention and the clinical explication of it is not yet very well spread. There are obstacles to the spreading of cancer prevention in the general population. The reasons are many – cultural, psychological, economical, educational and, speaking of education, this is the instance, in this particular course, the summer course, we are here for education, for discussing these problems, these principles, issues, solutions and implementations for cancer prevention, for example. So education is particularly important.
Besides money, what obstacles have you faced?
There are some technical issues as regards the toxicity, say better the risk-benefit balance between the pros and cons of taking a drug for cancer prevention in a healthy individual. A healthy individual may be one who is completely healthy but at familial risk, for example, or a carrier of a previous pre-cancerous condition like DCIS for breast or an adenoma for colon etc. So these particular individuals may have a great benefit from taking drugs but there is still this risk-benefit ratio to be discussed and to be ameliorated. We are very much investing in our clinical research trials in different dose, lower doses of drugs such as tamoxifen for example, of different schedules, for example weekly schedules of these drugs, again to ameliorate this risk-benefit ratio and to make compliance better.
What will be the eventual benefit of this work?
If we get over these obstacles, or the vast majority of these obstacles, clinical prevention, cancer prevention, may become as cardiovascular disease prevention. They have their own… the cardiologists, the internal medicine experts, have their own risk factors, their own drugs, their own way of reducing the risk. We are not so very different from them, we have our own risks, we have our drugs and most of them are very well known and established now. We are ameliorating this risk-benefit ratio, as I was saying, and in the near future I’m quite optimistic we will be in a position of spreading much more cancer prevention through people.
What is your take home message?
We have to educate a new generation of experts in cancer prevention. We still are missing, lacking the right academic pathway for professionals and I’m speaking about translational researchers and clinicians, of course. We probably have to create a new professional figure of cancer preventionists with several expertise fields from basic cancer translational research to pharmacological and clinical approach of the patient, of the healthy individual at risk.