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Barriers to preventive therapy for breast and other major cancers and strategies to improve uptake.

DeCensi A, Thorat MA, Bonanni B, Smith SG, Cuzick J - Ecancermedicalscience (2015)

Bottom Line: In this review, we discuss these barriers in detail and propose strategies to overcome them.Future research to improve therapeutic cancer prevention needs to include improvements in the prediction of benefits and harms, and improvements in the safety profile of existing agents by experimentation with dose.In order to move the field of therapeutic cancer prevention forwards, engagement with policymakers to correct research imbalance as well as to remove practical obstacles to implementation is also urgently needed.

View Article: PubMed Central - PubMed

Affiliation: Division of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, Genoa 16128, Italy ; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.

ABSTRACT
The global cancer burden continues to rise and the war on cancer can only be won if improvements in treatment go hand in hand with therapeutic cancer prevention. Despite the availability of several efficacious agents, utilisation of preventive therapy has been poor due to various barriers, such as the lack of physician and patient awareness, fear of side effects, and licensing and indemnity issues. In this review, we discuss these barriers in detail and propose strategies to overcome them. These strategies include improving physician awareness and countering prejudices by highlighting the important differences between preventive therapy and cancer treatment. The importance of the agent-biomarker-cohort (ABC) paradigm to improve effectiveness of preventive therapy cannot be overemphasised. Future research to improve therapeutic cancer prevention needs to include improvements in the prediction of benefits and harms, and improvements in the safety profile of existing agents by experimentation with dose. We also highlight the role of drug repurposing for providing new agents as well as to address the current imbalance between therapeutic and preventive research. In order to move the field of therapeutic cancer prevention forwards, engagement with policymakers to correct research imbalance as well as to remove practical obstacles to implementation is also urgently needed.

No MeSH data available.


Related in: MedlinePlus

Combination strategy to reduce breast cancer burden worldwide.
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figure1: Combination strategy to reduce breast cancer burden worldwide.

Mentions: Significant improvements in cancer treatments have occurred over the past few decades, but our cancer prevention efforts have not kept pace with them. As a result, the global cancer burden continues to rise. Therapeutic cancer prevention is an effective and essential tool in our fight against cancer, and yet utilisation of preventive therapy has been woefully inadequate. Use of drugs to cut risk by 40–50% in the top 20% of the general population can achieve a 30% reduction in the cancer burden (Figure 1). However, unlike early detection/screening interventions, at an individual level, the success of therapeutic prevention goes unnoticed, while the side effects get noticed, leading to a failure to appreciate its value within the medical profession. To elucidate this point further, an overdiagnosed case that would not become symptomatic within the person’s lifetime is actually a failure of a screening intervention, yet it often gets considered as a success by the public because from this individual’s point of view, his/her life was saved by cancer being caught early. For preventive therapy, we cannot identify individuals whose cancer was prevented or risk was substantially reduced because of the lack of measurable biomarkers of efficacy, which currently exist for other diseases, including cardiovascular diseases, prevention of diabetes complications or osteoporotic bone fractures. Therefore, from that person’s point of view, they either took medication unnecessarily or in the worst case scenario, unnecessarily suffered the adverse effects of such therapy. Thus, preventive therapy for cancer is often discounted as overtreatment and used as an example of overmedicalisation. Understanding and overcoming such perception differences, along with other barriers, is essential if we are to realise the full potential of this approach for cancer control. In this short review, we discuss important barriers to therapeutic cancer prevention, strategies to overcome these barriers and future research needs (Table 1), using breast cancer prevention as the main example.


Barriers to preventive therapy for breast and other major cancers and strategies to improve uptake.

DeCensi A, Thorat MA, Bonanni B, Smith SG, Cuzick J - Ecancermedicalscience (2015)

Combination strategy to reduce breast cancer burden worldwide.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664508&req=5

figure1: Combination strategy to reduce breast cancer burden worldwide.
Mentions: Significant improvements in cancer treatments have occurred over the past few decades, but our cancer prevention efforts have not kept pace with them. As a result, the global cancer burden continues to rise. Therapeutic cancer prevention is an effective and essential tool in our fight against cancer, and yet utilisation of preventive therapy has been woefully inadequate. Use of drugs to cut risk by 40–50% in the top 20% of the general population can achieve a 30% reduction in the cancer burden (Figure 1). However, unlike early detection/screening interventions, at an individual level, the success of therapeutic prevention goes unnoticed, while the side effects get noticed, leading to a failure to appreciate its value within the medical profession. To elucidate this point further, an overdiagnosed case that would not become symptomatic within the person’s lifetime is actually a failure of a screening intervention, yet it often gets considered as a success by the public because from this individual’s point of view, his/her life was saved by cancer being caught early. For preventive therapy, we cannot identify individuals whose cancer was prevented or risk was substantially reduced because of the lack of measurable biomarkers of efficacy, which currently exist for other diseases, including cardiovascular diseases, prevention of diabetes complications or osteoporotic bone fractures. Therefore, from that person’s point of view, they either took medication unnecessarily or in the worst case scenario, unnecessarily suffered the adverse effects of such therapy. Thus, preventive therapy for cancer is often discounted as overtreatment and used as an example of overmedicalisation. Understanding and overcoming such perception differences, along with other barriers, is essential if we are to realise the full potential of this approach for cancer control. In this short review, we discuss important barriers to therapeutic cancer prevention, strategies to overcome these barriers and future research needs (Table 1), using breast cancer prevention as the main example.

Bottom Line: In this review, we discuss these barriers in detail and propose strategies to overcome them.Future research to improve therapeutic cancer prevention needs to include improvements in the prediction of benefits and harms, and improvements in the safety profile of existing agents by experimentation with dose.In order to move the field of therapeutic cancer prevention forwards, engagement with policymakers to correct research imbalance as well as to remove practical obstacles to implementation is also urgently needed.

View Article: PubMed Central - PubMed

Affiliation: Division of Medical Oncology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, Genoa 16128, Italy ; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.

ABSTRACT
The global cancer burden continues to rise and the war on cancer can only be won if improvements in treatment go hand in hand with therapeutic cancer prevention. Despite the availability of several efficacious agents, utilisation of preventive therapy has been poor due to various barriers, such as the lack of physician and patient awareness, fear of side effects, and licensing and indemnity issues. In this review, we discuss these barriers in detail and propose strategies to overcome them. These strategies include improving physician awareness and countering prejudices by highlighting the important differences between preventive therapy and cancer treatment. The importance of the agent-biomarker-cohort (ABC) paradigm to improve effectiveness of preventive therapy cannot be overemphasised. Future research to improve therapeutic cancer prevention needs to include improvements in the prediction of benefits and harms, and improvements in the safety profile of existing agents by experimentation with dose. We also highlight the role of drug repurposing for providing new agents as well as to address the current imbalance between therapeutic and preventive research. In order to move the field of therapeutic cancer prevention forwards, engagement with policymakers to correct research imbalance as well as to remove practical obstacles to implementation is also urgently needed.

No MeSH data available.


Related in: MedlinePlus