© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 10, 743,
May 16, 2001
© 2001 Oxford University Press
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Chemoprevention: What’s in a Name?
As focus and funding for cancer research broadens to find more ways to prevent the beginning of the carcinogenic process, the concept of chemoprevention becomes increasingly important.
Chemoprevention is the use of pharmacologic or natural agents that inhibit the development of invasive cancer either by blocking the DNA damage that initiates carcinogenesis or by arresting or reversing the progression of premalignant cells in which such damage has already occurred. But there is concern that the word chemoprevention may be misunderstood by the public.
Michael B. Sporn, M.D., coined the term chemoprevention in a 1976 article in Federation Proceedings when writing about the work his group was doing with vitamin A analogues. Sporn, then of the Carcinogenesis Program at the National Cancer Institute, and others were doing the first work with agents that could be used to prevent cancer. The work in his laboratory was on animals, and clinical trials in people had not begun.
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"In terms of writing the article it became apparent to me that we needed a new term," said Sporn, now of Dartmouth Medical School, in a recent interview. "The word chemoprevention includes prevention of initiation, promotion, and progression of carcinogenesis to cancer."
Chemoprevention is a word now used extensively among both researchers and clinicians. Sporn’s coining of the term was integral to solidifying the concept of chemoprevention as an important area of research in the prevention of human cancer, said Peter Greenwald, M.D., Dr.P.H., chief of the NCI’s Division of Cancer Prevention.
"The idea of chemoprevention started taking hold in the early 1980s," Greenwald said.
That is to say, the concept took hold in the scientific community. The word "chemoprevention" may not be catching on with the public. Some see it as potentially self-contradictory; they equate "chemo" with cancer treatment and "prevention" with being free of cancer. Others read "chemo" and think sickness, and then read "prevention" and think health.
In an NCI focus group study of attitudes toward participation in prevention research that involved women at increased risk of breast cancer, the women had these reactions to the word chemoprevention:
"Sounds gross. You think of chemotherapy and throwing up, and all the things that go with it."
"You also don’t relate the word ‘chemo,’ whether it’s therapy or prevention, with health. If you are doing ‘chemo,’ then you’re sickly, or sick."
The issue of terminology has come up in chemoprevention trials, such as the National Surgical Adjuvant Breast and Bowel Project’s Study of Tamoxifen and Raloxifene and its predecessor, the Breast Cancer Prevention Trial.
"The Breast Cancer Prevention Trial Participant Advisory Board recommended that we not use the word chemoprevention," said Lori Garvey, director of public relations and communication for NSABP. "They said it’s not participant-friendly." NSABP does use the word chemoprevention in its research protocol but does not use it in any documents intended for the public.
At NCI, the Division of Cancer Prevention also uses different terms with different audiences. When speaking to basic research scientists, Greenwald said the division refers to "the chemopreventive agent program." In contrast, materials used to explain prevention research or to accrue patients to chemoprevention trials refer to "research to reduce clinical risk," or to "clinical trials to prevent cancer."
The distinction may be important, because NCI has 25 chemopreventive clinical trials in development.
Chemopreventive research as a concept has found its place in cancer research, thanks, in part, to the groundbreaking efforts of people like Sporn. "There is a continuum of chemoprevention, because we’re aiming to reduce cancer risk in people that are high risk, but also in the general population," said Greenwald. On the other end of the continuum, "the focus is on treatment of precancerous lesions."
"I believe that all forms of carcinoma are preventable if we can devise the appropriate chemopreventive agents," Sporn said.
As for use of the word chemoprevention while trials of those agents are ongoing, Greenwald said, "I think that gradually we may change. There could be an image (of the word chemoprevention) that’s a little misleading."
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