Drug-prevention: Frequently Asked Questions
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What do you mean by "drug prevention"?

These drugs may or may replace traditional instruments to reduce the risk of cancer, based on lifestyles?

What are the substances that have already entered clinical practice for this purpose?

There is no evidence that supplements of vitamins, minerals and trace elements may protect against the onset of cancer?

What could be the role of aspirin and other anti-inflammatory drugs?

Although statins, which usually take to lower cholesterol, can produce similar effects?

It is true that the antibiotics to eradicate Helicobacter pylori responsible for gastric ulcer, also eliminate the risk of later developing stomach cancer?

Finasteride for the treatment of benign prostate, also protects against cancer?

There are also studies on drugs that can be used for the prevention of lung cancer?

What other substances are candidates to become the anti-cancer pill of the future?

What do you mean by "drug prevention"?

For "drug prevention" means the administration of medicines, vitamins or natural substances deemed capable of reducing the risk of developing certain diseases. In other words, the idea is to take a drug to prevent disease, rather than treat them after their onset. Since, however, are sometimes not actual drugs used, but trace elements, minerals or vitamins, they are administered as a preventive measure, rather than "drug prevention" is called by experts as "chemo-prevention."

A group of experts from around the world who met recently in St. Gallen, Switzerland, however, has suggested to avoid this term, which refers to the public chemotherapy, which has nothing to do, replacing it with ' expression "preventive therapy".

Beyond it may be defined as the practice is already well established in cardiology, where the low-dose aspirin, or medicines that reduce blood pressure or those that lower cholesterol (statins), are regularly prescribed to lower the probability of experiencing a heart attack or stroke in people most at risk.

In these cases the effectiveness of care is established especially for people who have already had a heart attack or an episode of low blood flow to the brain, as well as in oncology, the most relevant results were obtained with products antihormonal such as tamoxifen, in women who have had breast cancer. The treatment reduces the likelihood that the disease may reappear in the same breast (if you have made a conservative therapy) or in the contralateral. The same drugs have been shown, however, can reduce the risk of illness in women at high risk.

In people who are still healthy and without any particular risk factors the opportunity to take these or other substances must be carefully weighed.

To qualify as a tool for the prevention of an entire population, a molecule should:

- Have been shown to reduce the risk of one or more types of cancer frequently enough to warrant treatment of large numbers of individuals;

- To be absolutely safe and cause minimal side effects so they can be easily outweighed by the benefits expected;

- Have an affordable cost.

"To fight cancer more effectively must be done in the early stages of transformation of normal cells into cancer cells, even when the phenomenon did not sign them," said Michael B. on the pages of Nature Sporn, Dartmouth Medical School pharmacologist Hanover, New Hampshire, considered the founding father of this branch of cancer research.

"The most important and most common cancers, such as breast or lung, prostate or colon, it takes up to twenty years of latency of the disease because symptoms can start to give this process. We must learn to take advantage of this long lag time before cells accumulate so many mutations that it becomes difficult to find an effective target for defeat. "

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These drugs may or may replace traditional instruments to reduce the risk of cancer, based on lifestyles?

At the present state of knowledge can be answered that the best way to reduce the risk of getting cancer is to adhere as closely as possible to a healthy lifestyle: no smoking, avoid alcoholic beverages, with the power to introduce less fat and fewer animals refined carbohydrates, take plenty of fruits and vegetables and regular physical activity play. In this way you can also avoid obesity, which is now a recognized risk factor for cancer, as well as heart disease and diabetes.

No medication can replace the habit with these healthy behaviors in everyday life can only possibly enhance its effectiveness. Even in people considered at increased risk of cancer (for example, who carries a particular genetic variants and familiarity with a certain type of cancer), however, the pills are not enough, because even in these cases has established the role of lifestyle in contributing or not the actual development of the disease.

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What are the substances that have already entered clinical practice for this purpose?

In women operated on for breast cancers sensitive to estrogen is the common practice of prescribing so-called "selective estrogen receptor modulators (SERMs)," such as tamoxifen, which not only cure cancer reduces the risk of disease recurrence.

Their use by individuals who have not yet ill, but are considered high risk (eg genetic predisposition), shall be approved by U.S. regulatory authorities (FDA), but not European ones, and in any case is not particularly circulated.

The latest available data, for 2005, show that only 0.08 percent of American women between 40 and 79 years who had never had breast cancer, but they were deemed as high risk, have been subjected to such treatment.

Yet, a recent study published in the Journal of the National Cancer Institute suggests, even if only on the basis of statistical models, the protective effect of tamoxifen with five years of treatment may be prolonged for ten years after cessation of therapy, with is an advantage that would offset the side effects of medications, both its costs.

The efficacy of these drugs stems from the fact that almost eight out of ten breast cancers depend on hormones to grow by the presence of estrogen, tamoxifen and raloxifene (as well as other similar products in the studio) "trick" cells because they interact with receptors for estrogen as if they were, but without producing the same effects. In terms of other organs seem to have to keep an activity similar to estrogen, so it strengthens bones, protecting the women from osteoporosis after menopause and lower cholesterol and reduce the risk of diseases of the heart and blood vessels.

However, also cause unwanted side effects such as hot flashes and vaginal discharge, pushing about one in ten women to discontinue treatment, may also increase the risk of venous thrombosis.

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There is no evidence that supplements of vitamins, minerals and trace elements may protect against the onset of cancer?

It is known that a diet rich in fruits and vegetables protects against various forms of cancer, as is well known the importance of encouraging the development of the disease, the so-called oxidative processes, the originators of the famous "free radicals" on basis of these data has therefore tried to administer pills elements or vitamins with antioxidant such as vitamin A, beta carotene and vitamin E.

In most cases, however, the contribution in pill form has not proved as effective as that achieved by diet and unfortunately many of the so far most research in this field has given disappointing results. Indeed, in some studies the use of such substances even seems to have favored the occurrence of cancer or increased overall mortality, probably due to loss of control of the defense mechanisms against oxidative stress, such as programmed cell death of cells oxidised.

A large study called SELECT, for example, who wanted to check on some 32,000 adult men the effectiveness of selenium and vitamin E in reducing the risk of prostate cancer, was stopped early for the treatment ineffective. Other studies have investigated the effect of these substances on various forms of cancer have not shown substantial benefits, in fact, occurred between those who took a slight reduction in survival compared to those taking a placebo.

Similarly, supplements of vitamin A and beta carotenoids may seem high doses increase the risk of lung cancer in smokers. Separate mention a derivative of vitamin A, fenretinide, which is currently focusing the attention of many researchers, which looks very promising to reduce the risk of breast cancer in women before menopause.

The role of folic acid is however still controversial: it is likely that its deficiency promotes the development of cancer, and particularly the colon, but take more the form of pills could even be counterproductive, especially for those who are already carrying conditions that predispose to cancer.

Deserves a separate discussion also vitamin D, whose deficiency has been associated with many pathological conditions, including cancer. The International Agency for Research on Cancer, in 2008, after having assessed all the studies conducted so far, said that this substance may reduce the risk of colon cancer, but not that of the prostate, while the evidence regarding cancer breast cancer are still controversial. Some studies with adequate doses of vitamin D (about 10,000 IU per week) are in progress to evaluate the preventive effect in different organs.

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What could be the role of aspirin and other anti-inflammatory drugs?

In an attempt to find a way to block cancer development by acting on mechanisms common to different forms of the disease, and possibly also on other important and widespread diseases, many researchers have focused on inflammation. The inflammatory processes, in fact, seem to be able to support the growth of new blood vessels and an environment conducive to tumor growth, but are considered also the basis of heart disease and diabetes: controlling them so you could get with a single intervention, with considerable success on many fronts.

Very promising results were obtained in the past with anti-inflammatory drugs of the family of coxibs. One of these, celecoxib, was approved by the Food and Drug Administration to reduce the risk of colon cancer, daily doses of the medicine, people with a rare syndrome, familial adenomatous polyposis. It seemed that the same product could also protect other forms of cancer, including its ability to push cancer cells to programmed cell death and stimulate the immune system against them. The promises of this medicine, however, are gone. The company that produced it has in fact withdrawn from the market after other substances of the same family had been banned, following the demonstration that prolonged use increased the risk of stroke and heart attack.

For the prevention of cancer have been tested, however, other anti-inflammatory drugs such as sulindac. The attempt was to find a safer alternative to aspirin, which in the long run can cause gastrointestinal bleeding.

No new substance, however, has far exceeded the old drug, used by more than a century against pain, fever and colds. Indeed, ever new studies confirm its effectiveness in reducing the risk of many cancers, especially of those of the colon. More recent studies have shown that the protective effect is obtained even with small doses of the drug used in cardiology (75-100 mg daily) and after only one year of treatment. Not only that, but the benefit was found in the general population, not on high-risk categories. For this reason, in addition to the advantage of protecting against heart attack and stroke, a 75-mg tablet of aspirin is the favored candidate for the role of anti-cancer pill fits all, or nearly so. However, still lacks the approval of the agencies of the drug, FDA and EMEA, for this purpose.

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Although statins, which usually take to lower cholesterol, can produce similar effects?

In an attempt to catch two birds with one stone, to protect that with a single pill, cancer and heart disease, statins have also been studied, born substances to lower cholesterol in the blood but have revealed many other qualities, mainly due to their anti-inflammatory properties.

In fact, the relationship between these widely used drugs and cancer is very controversial. Research is ongoing to determine whether these medicines may reduce the risk of cancers of the colon or skin, but in the past there were also warning signs that these medicines could increase the risk of developing cancer, eg breast cancer. More recent studies have reassured that individuals who take these medicines for lowering cholesterol does not run an increased risk of cancer, but not justify, the current state of knowledge, their use as a preventive measure.

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It is true that the antibiotics to eradicate Helicobacter pylori responsible for gastric ulcer, also eliminate the risk of later developing stomach cancer?

Unfortunately this is not so. The discovery of the role of bacteria in gastric ulcer formation, and its possible degeneration into cancer, has quite possibly contributed to modify the characteristics of the disease in most developed countries, where antibiotic therapy has become widespread.

In fact, since 1994 the International Agency for Research on Cancer (IARC) included Helicobacter pylori in the list of carcinogens, but in recent times has shown that the bacterium behaves differently at the entrance of the stomach, in the area of ​​the cardia the valve that connects the esophagus. Here it seems that the helicobacter, contrary to what happens in other parts of the stomach, somehow prevents the formation of tumors.

Even for this, as well as the ease with which you can contract the infection again after therapy, antibiotics will not allow you to eliminate once and for all the risk of stomach cancer. Economically advanced nations in their use in this field has probably contributed somewhat to reduce cases of cancer that does not concern the cardia, perhaps thanks to improved sanitation and food. Rather increases the frequency of cancer of the cardia, once rare in the United States and now represents almost half of all cancers of the stomach.

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Finasteride for the treatment of benign prostate, also protects against cancer?

Finasteride is a drug that blocks the hormonal action of androgens and is used to treat benign prostate hypertrophy. The medicine has been tested in the Prostate Cancer Prevention Trial (PCPT) in 2003, a large-scale study involving 35,000 patients, to see if he could play a preventive role against prostate cancer.

Research has actually shown that people who take the drug has a risk reduction of 25 percent of cancer, but the medicine does not prevent the hormone-sensitive tumors and more aggressive, which are responsible for the aggravation of the disease. A more recent study, the veteran, showed similar effects with a similar drug, dutasteride, in subjects with elevated PSA and negative biopsies. The role of these drugs as a preventive measure is therefore promising, but has not yet been approved and requires further study.

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There are also studies on drugs that can be used for the prevention of lung cancer?

Yes, lung cancer, as well as that for breast or colon cancer for women, for its widespread use, is one of the cancers against which you are looking for a possible preventive approach through drugs. The drug does not prevent, however, should never replace the most important measure, which is to avoid or quit cigarette smoking, the primary cause of the disease.

Rather may offer a therapeutic alternative when, thanks to new techniques for early diagnosis, especially with low-dose CT, the pulmonary nodules discovered in heavy smokers than for their features do not justify immediate action, but may evolve with time in adenocarcinomas . In these cases at the European Institute of Oncology in Milan is trying to administer a cortisone spray, budesonide, which is widely used in the treatment of asthma.

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What other substances are candidates to become the anti-cancer pill of the future?

In spite of 35 years, leading many studies in this field, there is still no safe and effective substance so that it can be recommended to everyone, even those without specific risk factors for one or the other form of cancer. "Maybe we should get to the combination of two or more medicines" offers Sporn, "exactly as it was for the development of chemotherapy." And how do you plan to do with the polypill under discussion for the prevention of heart disease.

But there are also other approaches to the study, many of which are focusing on well known and old medicines on the market for decades, just like aspirin. If any of these prove to be effective, in fact, one might protect against cancer with a moderate expense and without risking unpleasant surprises in terms of side effects, once the substance was spread more widely.

This is the case for example of metformin, an oral antidiabetics most popular and safe: a recent study has shown that diabetics who take this medicine regularly have a lower risk of cancer in various organs compared to those taking other antidiabetic agents, such as insulin and sulfonylureas. Just insulin, which is partially offset by metformin when produced in excess, seems responsible for the increased risk of cancer in diabetics or obese. Several studies are underway to test the effect of metformin therapeutic and preventive tumor.


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