A way forward for cancer prevention therapy: personalized risk assessment

// Zhenzhen Zhang 1 , Jeffrey Bien 2 , Motomi Mori 3 , 4 , Sonali Jindal 5 and Raymond Bergan 1 1 Division of Hematology/Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA 2 Division of Oncology, Stanford University, Palo Alto, California, USA 3 Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA 4 OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA 5 Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, Oregon, USA Correspondence to: Raymond Bergan, email: bergan@ohsu.edu Keywords: cancer; prevention; prevention therapy; multiple risk factors; screening Received: August 27, 2019     Accepted: November 19, 2019     Published: December 03, 2019 ABSTRACT Cancer is characterized by genetic and molecular aberrations whose number and complexity increase dramatically as cells progress along the spectrum of carcinogenesis. The pharmacologic application of agents in the context of a lower burden of dysregulated cellular processes constitutes an efficient strategy to enhance therapeutic efficacy, and underlies the rationale for using cancer prevention agents in high-risk populations. A longstanding barrier to implementing this strategy is that the risk in the general population is low for any given cancer, many people would have to be treated in order to benefit a few. Therefore, identifying and treating high-risk individuals will improve the risk: benefit ratio. Currently, risk is defined by considering a relatively low number of factors. A strategy that considers multiple factors has the ability to define a much-higher-risk cohort than the general population. This article will review the rationale for evaluating multiple risk factors so as to identify individuals at highest risk. It will use breast and lung cancer as examples, will describe currently available risk assessment tools, and will discuss ongoing efforts to expand the impact of this approach. The high potential of this strategy to provide a way forward for developing cancer prevention therapy will be highlighted.