A common perception is that
cancer risk reduction is passive, such as not smoking. However, advances in the understanding of
cancer biology and in
cancer treatment modalities suggest that it is now timely to consider anew
cancer risk reduction by active, including pharmacologic, approaches. Risk avoidance approaches are certainly important, but other approaches are important as well, as exemplified by the irony that most new
lung cancers occur in former smokers, or current avoiders.
Cancer interception is the active way of combating
cancer and
carcinogenesis at earlier and earlier stages. A great challenge is to educate people that the development of
cancers, like
heart disease, typically takes years and accordingly can potentially be intercepted with risk-
reducing agents in the same way that advanced
cancers can be treated with drugs or that
cardiovascular disease can be intercepted with
antihypertensive and other risk-reducing drugs. The
cancer biology behind
cancer interception is increasingly solid. For example, hedgehog pathway studies of mutations in the
patched homolog 1 (PTCH1) gene, which constitutively activates Smoothened (SMO), led to development of an oral SMO inhibitor active in advanced
basal cell carcinoma and which, in very high-risk
Gorlin syndrome patients (germ line PTCH1 mutation), is nearly completely clinically effective in intercepting basal cell
neoplasia. Also, the oral
immunomodulator lenalidomide, first found to be active in advanced, relapsed
multiple myeloma, was highly effective in intercepting the precursor stage, high-risk
smoldering multiple myeloma from progressing. These are but two exciting, recent examples of the many advances in
cancer research that have created an optimal time to discover and implement
cancer interception. The multifaceted roles of telomere maintenance in both fueling advanced
cancers and, at early stages, keeping them at bay, also highlight how the growing knowledge of
cancer biology opens avenues for
cancer interception. Emerging molecular techniques, including next-generation sequencing platforms, that account for a large part of the remarkable recent advances in
cancer biology are now being applied to interception of premalignancy. Keeping the medical community and public at large informed about possibilities for actively intercepting
cancer will be important for gaining acceptance of this increasingly powerful approach to lessening the
cancer burden.