Transcript precancer - Jules J. Berman

Precancer Workshop
Sponsored by
Division of Cancer Biology, NCI
and
Department of Pathology, George
Washington University Medical School
November 8-9, 2004
Overview – Jules Berman, Ph.D., M.D.,
Cancer Diagnosis Program, NCI
Precancers are the
morphologically identifiable
lesions that precede invasive
cancers.
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In theory, the identification and
elimination of precancers
would lead to the eradication
of most human cancers.
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Most clinicians and health
provider organizations already
have a good understanding of
what lesions are precancers
and what lesions are not
precancers.
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Most researchers have a pretty
good idea of the biologic
properties that distinguish
precancers from fully
developed cancers.
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Precancers do not exist as
entitities separable from
cancers. The lesions that are
called precancers are really
just small or early cancers that
have not yet invaded or
metastasized.
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Precancers exist but most of
the lesions people label as
precancers are spontaneously
regressing foci, and not truly
precancerous.
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Another term for precancer is
intraepithelial neoplasia.
Therefore, the concept of
precancers is narrow, applying
only to some epithelial tumors.
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The term "precancer" includes
different biological classes of
lesions. For instance,
adenomas, myelodysplasias,
microscopic intraepithelial
neoplasias, and diffuse atypical
hyperplasias are all very
different classes of precancers.
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There is no need to develop a
comprehensive precancer
classification. It’s already been
done by the WHO.
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It is not generally worthwhile to
screen for precancers because
the small subset of precancers
that will progress to cancer
can't be distinguished from the
non-progressing lesions.
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Prophylactic chemotherapy
makes no sense for precancers.
Nobody will accept
chemotherapy for a tumor that
they don’t yet have.
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It is not worthwhile trying to
develop surgical methods to
excise precancers. There are
too many of them and most are
not easily detectable or
amenable to surgical treatment.
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The precancers are not suitable
lesions for research. They are
so small that it is impossible to
obtain enough tissue for useful
experimental studies.
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There are currently no useful
mouse models for human
precancers. Mice are shortlived animals with an
accelerated carcinogenesis
pathway that does not
typically involve an
identifiable precancer lesion.
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At this time, there is no
regulatory infrastructure that
will permit us to develop
treatment protocols for the
precancers.
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When you eliminate a
precancer, you’re preventing
the occurrence of a cancer.
Therefore, methods of treating
precancers fall under the
general area of cancer
prevention, not cancer
treatment
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If you treat a precancer with
medicine or surgery, you are
treating a neoplastic condition,
and this research falls in the
general area of cancer
treatment, not cancer
prevention.
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The National Cancer Institute
already supports precancer
research and provides funds
commensurate with the
importance of the field.
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The purpose of Workshop
Establish Precancer as a distinct
area of scientific research with its
own set of:
1. basic biologic principles
2. fundamental research
questions
3. translational research
objectives
and has proven ability to reduce
the number of cancer deaths.