A preventive strategy is more attractive than treating progressive or advanced cancer, but neither the primary care community nor medical oncologists have embraced chemoprevention as their own responsibility, despite the fact that professional organizations have endorsed primary prevention as a standard of care. In order for a preventive strategy to be both effective and efficient, we need an easily identified target population, criteria for identifying those who would benefit from risk reduction, a safe and effective agent, an informed group of practitioners who can provide care to the high-risk group, and an educated population of patients who understand the advantages and the risks of taking a drug to modify their risk. Despite strong evidence that it is efficacious, chemoprevention has been underused. For breast cancer risk reduction, for example, the number needed to treat to prevent a single case of breast cancer are comparable to similar costs of statins to reduce cardiovascular events or of antihypertensives to lower the risk of stroke. Reasons not to adopt and initiate strategies to reduce risk include the fear of adverse effects, medication costs, lack of reasonably accurate and feasible methods for assessing personal and individual risks, and the lack of established risk thresholds that clearly and objectively maximize benefit and minimize harms. Lack of reimbursement for the cost of risk counseling and for the agents administered to reduce risk are also impediments to widespread adoption of preventive strategies. Methods to improve this situation include both professional and public education, tort reform, inclusion of preventive drugs in health care insurance coverage, and the identification of safer, more effective agents for risk reduction.
Citation Format: Victor G. Vogel. Lessons learned from 20 years of chemoprevention research. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr FO02-01.