Ten Best Readings on
Cancer Prevention

Gail L. Shaw, MD, FACP

The ten best recent articles in the medical literature
relating to cancer prevention are reviewed here.

Hong WK, Lippman SM. Cancer chemoprevention. J Natl Cancer Inst. 1995;17:49­53.

The development of more effective, less toxic chemopreventive agents remains a high priority in furthering the use of this clinically valuable approach to the prevention and control of cancer.

Shaw GL, Mulshine JL. Biomarkers and histology of premalignant and malignant lesions. In: Greenwald P, Kramer BS, Weed DL, eds. Cancer Prevention and Control. New York, NY: Marcel Dekker, Inc; 1995:111-132.

An excellent review is presented on the biology and pathology of the development of invasive neoplasms.

Mao L, Lee JS, Fan YH, et al. Frequent microsatellite alterations at chromosomes 9p21 and 3p14 in oral premalignant lesions and their value in cancer risk assessment. Nat Med. 1996;2:682-685.

Losses of the 9p21 and 3p14 regions may be related to early processes of tumorigenesis in head and neck squamous cell carcinoma. These genetic alterations in premalignant tissues may serve as markers for cancer risk assessment.

Lotan R, Xu XC, Lippman SM, et al. Suppression of retinoic acid receptor-beta in premalignant oral lesions and its up-regulation by isotretinoin. N Engl J Med. 1995;332:1405-1410.

The expression of retinoic acid receptor-beta mRNA is selectively lost in premalignant oral lesions and can be restored by treatment with isotretinoin. Retinoic acid receptor-beta may have a role in mediating the response to retinoids and may be a useful intermediate biologic marker in trials of these agents for the prevention of oral carcinogenesis.

Omenn GS, Goodman GE, Thornquist MD, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med. 1996;334:1150-1155.

After an average of four years of supplementation, the combination of beta-carotene and vitamin A had no benefit and actually demonstrated an increase in the incidence of lung cancer and on the risk of death from lung cancer in smokers and workers exposed to asbestos.

Shin DM, Lee JS, Lippman SM, et al. p53 expression: predicting recurrence and second primary tumors in head and neck squamous cell carcinoma. J Natl Cancer Inst. 1996;88:519-529.

p53 expression may be a valuable marker for identifying individuals at high risk of developing a recurrence of primary disease and second primary tumors who may benefit from adjuvant therapy and chemoprevention after definitive local therapy.

Hong WK, Lippman SM, Hittelman WN, et al. Retinoid chemoprevention of aerodigestive cancer: from basic research to the clinic. Clin Cancer Res. 1995;1:677-686.

This review focuses on four issues -- biology, retinoids, retinoid clinical trials, and translational research -- in the chemoprevention of aerodigestive cancers.

Clark LC, Combs GF Jr, Turnbull BW, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin: a randomized controlled trial. Nutritional Prevention of Cancer Study Group. JAMA. 1996;276:1957-1963.

Selenium treatment did not protect against the development of basal or squamous cell carcinomas of the skin. However, supplemental selenium may reduce the incidence of, and mortality from, carcinomas of several sites. These effects of selenium require confirmation in independent trials.

Giovannucci E, Egan KM, Hunter DJ, et al. Aspirin and the risk of colorectal cancer in women. N Engl J Med. 1995;333:609-614.

Regular aspirin use, at doses similar to those recommended for the prevention of cardiovascular disease, reduces the risk of colorectal cancer. However, this benefit may not be evident until after at least a decade of regular aspirin consumption.

The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study Group. The effect of vitamin E and beta-carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med. 1994;330:1029-1035.

There was an 18% increase in the incidence of lung cancer among male smokers after five to eight years of dietary supplementation with alpha-tocopherol or beta-carotene. In fact, this trial raises the possibility that these supplements may actually have harmful as well as beneficial effects.

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