Cancer prevention and screening: the next step in the era of precision medicine

Abstract

A primary mode of cancer prevention and early detection in the United States is the widespread practice of screening. Although many strategies for early detection and prevention are available, adverse outcomes, such as overdiagnosis and overtreatment, are prevalent among those utilizing these approaches. Broad use of mammography and prostate cancer screening are key examples illustrating the potential harms stemming from the detection of indolent lesions and the subsequent overtreatment. Furthermore, there are several cancers for which prevention strategies do not currently exist. Clinical and experimental evidence have expanded our understanding of cancer initiation and progression, and have instructed the development of improved, precise modes of cancer prevention and early detection. Recent cancer prevention and early detection innovations have begun moving towards the integration of molecular knowledge and risk stratification profiles to allow for a more accurate representation of at-risk individuals. The future of cancer prevention and early detection efforts should emphasize the incorporation of precision cancer prevention integration where screening and cancer prevention regimens can be matched to one's risk of cancer due to known genomic and environmental factors.

Fig. 1

Cancer risk varies within a population. Individuals within a population will have differing baseline levels of cancer risk, which may be influenced by genetic and environmental factors, or the interaction of genetic and environmental factors. The general population (black) is considered individuals of average cancer risk. Over time, one’s risk may increase as a consequence of age or exposure (purple). However, an individual may be considered high-risk if, despite age or exposure, he or she has a heritable condition (e.g. Lynch syndrome), a family history of cancer suggesting genetic susceptibility, or a personal history of cancer (red). The high-risk population may also incur increased risk over time due to age and exposure

Fig. 2

Cancer prevention can occur throughout the cancer initiation and progression spectrum. Prevention strategies may be efficacious throughout the span of cancer initiation and progression. Primary prevention mechanisms, which include alterations in physical activity or diet, tobacco cessation, or use of sunscreen, may reduce the impact of exposures in cancer initiation. Secondary prevention strategies, such as cancer screening or use of non-steroidal anti-inflammatory drugs (NSAIDs), allow for the early detection of precancerous lesions or help inhibit progression to cancer. Tertiary prevention methods, including chemotherapy or targeted therapy, may be used to help keep a localized cancer from spreading or metastasizing