Cancer prevention: chemoprevention vs dietary modifications.

Abstract

The goal of cancer chemoprevention research is to identify agents which can reverse or arrest the process of carcinogenesis. Dietary supplementation with a specific agent or micro- or macronutrient has advantages over dietary manipulation. Prescribing a specific "pill" or supplement for long-term daily administration can lead to improved adherence over a behavior or dietary modification. Preclinical studies and clinical trials exploring pharmacokinetics, dose-response relationships, side effects, and ultimately efficacy are greatly facilitated when the agent of interest is defined. The discovery of new agents based on structure/activity relationships and mechanisms of action can be facilitated when an active agent is identified. The primary disadvantage of developing a drug as a cancer prevention agent is the potential for side effects. If active, the agent has the potential to be given to large unmonitored populations over prolonged periods of time. Any agents causing a significant increase in morbidity or mortality for whatever cause, may be more of a liability than an asset from a public health standpoint. Whether chemoprevention ultimately turns out to be a dietary constituent, a modification of a naturally occurring substance, or a synthetic compound, the recommendations for use will be based on side effect profile, dose-response, and convenience.