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Cancer Prevention

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Cancer Prevention

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    1. Cancer Prevention Monica M. Bertagnolli, MD Brigham and Women’s Hospital Dana Farber Cancer Institute

    3. Milestones in cancer prevention 1919 James Ewing identifies pre-malignant neoplasia

    4. Milestones in cancer prevention

    5. Cancer Prevention Research

    7. Invasive cancer is the end stage of a long process of tumorigenesis

    11. Understanding the biology of pre-malignant disease is the key to developing effective prevention methods Which individuals are at risk and for what type of cancer?

    12. Understanding Risk

    14. Understanding Risk for Cancer Environment: Toxic exposures Radiation Asbestos

    15. Colorectal Cancer Risk Personal history Identification of adenomas Inflammatory bowel disease History of treated colorectal cancer

    16. Identifying and monitoring pre-malignant disease

    17. Survival following treatment for colorectal cancer

    18. Shifting the therapeutic target in breast cancer 1894 Halsted radical mastectomy 1960’s-70’s breast conserving surgery with XRT 1919 James Ewing “pre-malignant histology” 1932 Broder “carcinoma-in-situ” 1979 2,600 cases of DCIS in the US 2000 30,000 cases of DCIS in the US

    20. Screening modalities 2007 PAP smear Mammography Colonoscopy/upper endoscopy CT scan, sputum cytologies PSA and digital exam

    21. Risk Specific CRC Screening Recommendations Begin at age 50: Colonoscopy every 10 years Sigmoidoscopy every 5 years Annual FOBT (stool sample)

    22. Prevention Modalities

    25. Surgery

    29. Prevention of breast cancer by treatment of DCIS 30,000 US women per year diagnosed with DCIS in the US

    31. Successes and Challenges Breast cancer: tamoxifen Prostate cancer: finasteride Colorectal cancer: celecoxib Women’s Health Initiative Cervical cancer vaccine

    32. Breast Cancer Prevention Trial

    34. Prostate Cancer Prevention Trial

    45. Vaccination against human papilloma virus HPV infection is associated with development of cervical cancer and other anogenital tumors

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