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Familiar drugs may prevent cancer
R A Sharma1, A J Gescher, K J O'Byrne
1Oncology Department, University of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, UK. ras20@le.ac.uk
Abstract:
Despite positive results in large scale chemoprevention trials, many physicians are unaware of the potential cancer preventive properties of drugs in common usage. The antioestrogen tamoxifen and the selective cyclo-oxygenase-2 inhibitor celecoxib have been licensed in the USA for the chemoprevention of breast and colorectal cancers respectively in selected high risk individuals. Similarly, folate and retinol have been shown to decrease the incidence of colorectal cancer and squamous cell carcinoma of the skin respectively in large scale intervention trials. Other retinoids have proved efficacious in the tertiary chemoprevention of cancers of the breast and head/neck. Epidemiological evidence also exists in favour of aspirin, non-steroidal anti-inflammatory drugs, and angiotensin converting enzyme inhibitors preventing certain cancers. Phytochemicals may represent less toxic alternatives to these agents. Although some of these drugs are available without prescription and most are not yet licensed for use in cancer chemoprevention, physicians and students of medicine should be aware of this accumulating evidence base. Practitioners should be amenable to patient referral to discuss complex issues such as risk estimation or potential benefit from intervention.
Insights
Many common drugs show cancer-preventive potential, yet awareness among physicians is low. Understanding these chemoprevention benefits is crucial for patient care and risk management.
Area of Science:
- Oncology
- Pharmacology
- Preventive Medicine
Background:
- Physician awareness of drug cancer-preventive properties is limited despite trial evidence.
- Several commonly used drugs have demonstrated efficacy in large-scale chemoprevention trials.
Purpose of the Study:
- To highlight the potential cancer-preventive properties of commonly used drugs.
- To inform physicians and medical students about the accumulating evidence base for chemoprevention.
Main Methods:
- Review of large-scale chemoprevention and intervention trials.
- Analysis of epidemiological evidence for drug efficacy in cancer prevention.
- Consideration of phytochemicals as alternative chemopreventive agents.
Main Results:
- Tamoxifen (antioestrogen) and celecoxib (COX-2 inhibitor) are licensed for breast and colorectal cancer chemoprevention, respectively.
- Folate and retinol reduce colorectal cancer and skin cancer incidence.
- Aspirin, NSAIDs, and ACE inhibitors show promise in preventing certain cancers; retinoids are effective in tertiary chemoprevention.
Conclusions:
- Physicians and medical students need to be aware of the evidence supporting drug use in cancer chemoprevention.
- Practitioners should discuss cancer risk estimation and intervention benefits with patients.
- Phytochemicals may offer less toxic alternatives for cancer chemoprevention.