Chemoprevention: from research to clinical oncology

Chemoprevention is by now an emerging area of clinical oncology addressed to healthy individuals at higher risk for cancer, subjects with precancerous conditions, and patients who are at risk for a second primary cancer. The important results of large trials with various agents and the more accurate methods of risk assessment have already had implications in clinical practice. Recently, a number of compounds have shown to be clinically effective at various organ levels, often covering all the three settings of primary, secondary and tertiary prevention. There is proof today that at least 3 of the 4 'big killers' in oncology--breast, colon and prostate cancer--and oral cancer are to a certain extent preventable by chemopreventive drugs. The missing piece so far is lung cancer. The expanding molecular drug development is providing the tools for a more effective and safer molecular-targeted prevention. Combination chemoprevention and the use of agents with multiple effects are other particularly promising chemoprevention strategies.