Chapter 23 • The six hallmarks, or cardinal derangements, characterizing all epithelial cancers are sustained proliferative signaling, evasion of growth suppressors, activation of invasion and metastasis, replicative immortality, induction of angiogenesis, and resisting cell death. These six hallmarks tend to occur in a permissive context characterized by four features: suppressed immune surveillance, tumor-promoting inflammation, cellular dysregulation, and genome instability and mutation. • Tobacco, which accounts for 30% of all cancers and 90% of lung cancers, is the greatest modifiable risk factor for cancer. The use of tobacco is on the rise in developing nations, and declines in smoking prevalence in the United States have recently begun to slow. Tobacco is likely to remain an important public health issue in the United States and globally for the foreseeable future unless tobacco control strategies can be more fully implemented and sustained. • After tobacco, obesity has the highest attributable cancer mortality. Recent evidence suggests that obesity, resulting at least in part from excess caloric intake, is a key driver in cancer development. Diet, physical inactivity, infections, and sun exposure contribute to cancer risk as well. • Data related to the role of nutrition in cancer risk is more persuasive for specific foods, rather than for specific nutrients or other food constituents. A few factors have been “convincingly” associated with an increased risk of cancer, as classified by the American Institute for Cancer Research, but none has been “convincingly” associated with a decreased risk. • Cancer incidence is set to double by 2030 as a result of a growing and aging population. • Nearly two thirds of all cancer deaths are attributable to tobacco, poor diet, physical inactivity, and obesity. • We can prevent approximately half of all cancers occurring today by implementing tools and knowledge we already have. • Thirteen chemopreventive agents have been approved by the U.S. Food and Drug Administration for treatment of precancerous lesions or to reduce the risk of invasive cancer, nearly all of which are for accessible organs. • The identification and eradication of a number of infectious, oncogenic agents can yield significant cancer preventive benefits as well. Globally, about 18% of cancers have an infectious etiology. In addition to the use of the human papillomavirus vaccines, vaccination for hepatitis B, “triple therapy” for Helicobacter pylori
Cancer Prevention, Screening, and Early Detection
Summary of Key Points
Etiology and Pathogenesis
Prevention
Chemoprevention
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Cancer Prevention, Screening, and Early Detection
