We have entered a transformative period in
cancer prevention (including early detection). Remarkable progress in
precision medicine and immune-oncology, driven by extraordinary recent advances in genome-wide sequencing, big-data analytics, blood-based technologies, and deep understanding of the
tumor immune microenvironment (TME), has provided unprecedented possibilities to study the biology of premalignancy. The pace of research and discovery in
precision medicine and immunoprevention has been astonishing and includes the following clinical firsts reported in 2015: driver mutations detected in circulating
cell-free DNA in patients with premalignant lesions (lung); clonal hematopoiesis shown to be a premalignant state; molecular selection in
chemoprevention randomized controlled trial (RCT; oral); striking efficacy in RCT of combination
chemoprevention targeting signaling pathway alterations mechanistically linked to germline mutation (duodenum); molecular markers for early detection validated for
lung cancer and showing promise for pancreatic, liver, and
ovarian cancer. Identification of HPV as the essential cause of a major global
cancer burden, including HPV16 as the single driver of an epidemic of
oropharyngeal cancer in men, provides unique opportunities for the dissemination and implementation of public health interventions. Important to immunoprevention beyond
viral vaccines, genetic drivers of premalignant progression were associated with increasing immunosuppressive TME; and Kras
vaccine efficacy in pancreas genetically engineered mouse (GEM) model required an inhibitory adjuvant (Treg depletion). In addition to developing new (e.g., epigenetic) TME regulators, recent mechanistic studies of repurposed drugs (
aspirin,
metformin, and
tamoxifen) have identified potent immune activity. Just as
precision medicine and immune-oncology are revolutionizing
cancer therapy, these approaches are transforming
cancer prevention. Here, we set out a brief agenda for the immediate future of
cancer prevention research (including a "Pre-
Cancer Genome Atlas" or "PCGA"), which will involve the inter-related fields of
precision medicine and immunoprevention - pivotal elements of a broader domain of personalized public health.