Chemoprevention and Heritable Cancer Risk

Abstract

Chemoprevention can be defined as the use of specific natural or synthetic chemical agents to reverse, suppress, or prevent the progression of premalignant lesions to invasive carcinoma.^1,2,3 Our basic understanding of human carcinogenesis indicates that the process proceeds through multiple discernible stages of molecular and cellular alterations that provide the basis and scientific rationale for clinical cancer chemoprevention. There are, however, a number of unique features of the clinical discipline of primary cancer prevention. First, is the issue of the “target population.” Cancer is a rare disease among individuals who are at usual risk. It is clear, however, that individuals with a family history of the disease, with or without an identified predisposing genetic mutation, constitute a unique target population for primary preventive interventions. It is difficult, though, to determine whether these individuals should be considered “patients,” “subjects,” or “participants.” Labeling healthy individuals as patients carries the potentially negative connotations of illness in all of the behavioral metaphors associated with illness. The creation of new classes of the asymptomatic sick (e.g., considering gene carriers as ill), and the medicalization of conditions for which there may not be a medical solution, have important implications for the predisposed individual’s sense of self identity, health beliefs, and behaviors, and specific social institutions such as health insurance and employment.