Chemoprevention of esophageal squamous cell carcinoma with berries

Esophageal squamous cell carcinoma (SCC) is responsible for about one-seventh of all cancer-related mortality worldwide. This disease has a multifactorial etiology involving numerous environmental, genetic, and dietary factors. The 5-year survival from esophageal SCC is poor because the disease has usually metastasized at the time of diagnosis. Clinical investigations have shown that primary chemoprevention of this disease is feasible; however, only a few agents have shown efficacy. The Fischer 344 (F-344) rat model of esophageal SCC has been used extensively to investigate the pathophysiology of the disease and to identify chemopreventive agents of potential use in human trials. Multiple compounds that inhibit tumor initiation and/or tumor progression in the rat model have been identified. These include the isothiocyanates which inhibit the metabolic activation of esophageal carcinogens and agents that inhibit the progression of dysplastic lesions to cancer including inhibitors of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF), and c-Jun (a component of activator protein-1 [AP-1]). The present review deals principally with the use of berry preparations for the prevention of esophageal SCC in rodents, and summarizes recent data from a human clinical trial in China. Our results suggest that the use of berry preparations might be a practical approach to the prevention of esophageal SCC in China and, potentially, other high risk regions for this disease.