February Brings a Focus on Prevention
February is National Cancer Prevention Month. We recently had the opportunity to speak with American Association for Cancer Research (AACR) Past President William Hait, MD, PhD, a leading expert in cancer prevention and interception. Hait, who is a Fellow of the AACR Academy and the current AACR treasurer, forecasted several key areas of advancement in this field. In this excerpt from our previous post, Hait shares his predictions for cancer prevention and interception research in 2020.
Reducing the cancer burden through interception
“In the coming years, I anticipate that there will be a greater appreciation that the largest payoff for the health of humanity will come from cancer prevention,” said Hait, who is the global head of Johnson & Johnson External Innovation. “Currently, the majority of the research community is invested in understanding established cancers, with less emphasis on preventing cancers from becoming established,” he continued.
“I would anticipate that as people incorporate this realization into their thinking, there will be a global movement to encourage funding agencies, advocacy groups, and public health groups to ensure that a greater percentage of the research dollar goes toward three core components: cancer prevention, cancer interception, and early detection to increase cures,” Hait said. “If we can prevent cancers, intercept a cancer-causing process, or detect cancers at an earlier stage, we will realize better outcomes.”
A major area of focus in the field should be the validation of actionable targets in premalignancies, said Hait, citing the work of the Precancer Atlas, which aims to characterize premalignant lesions and their evolution into cancer. “We have massive amounts of biological information about first diagnoses, first relapses, second relapses, and so on, but we have far less information about targets and pathways present in premalignant conditions,” he said.
A second research area that requires more attention is the need for validated surrogate endpoints for clinical trials of premalignancy, Hait continued. Endpoints such as cancer incidence or survival require extended years of expensive follow-up, and currently there are few validated surrogate endpoints that can indicate that a specific prevention or intervention strategy will prevent incidence or extend survival, he said. Hait cited the lowering of low-density lipoprotein (LDL) cholesterol as an example of both a validated pharmacodynamic biomarker and surrogate endpoint for cardiovascular disease. “We need similar biomarkers to provide early readouts to see if prevention/interception drugs are working in oncology.”
There is also a great need for accurate diagnostic tests to identify individuals that are harboring premalignancies, noted Hait. Further, if we could identify those with a premalignant condition, a test to identify individuals at the highest risk of progression is also an unmet need, he said. “We’re making progress in this area for patients with smoldering myeloma – we are able to stratify those with this premalignancy as having low or high risk for developing multiple myeloma, which is a huge advancement in the field,” Hait explained. But there are very few examples where those types of stratifications exist, he added. “Such tests will allow clinicians to focus on interventions for those at the highest risk, and spare low-risk individuals from unnecessary interventions,” he added.
Lowering cancer risk through Behavioral changes
Hait said behavioral science will receive increased interest in cancer prevention. As an example, he highlighted the fact that most people understand that cigarette smoking is a major cause for lung cancer, yet many people still choose to smoke. “What is happening in someone’s brain to override the evidence that shows us that smoking is bad for you?” posed Hait. “We can come up with several descriptive causes of smoking, such as stress or a desire to lose weight. But we don’t understand the underlying biological mechanisms that lead people to begin smoking in the first place. There’s a need for far greater research in this particular area of cancer prevention.”
Hait pointed to certain areas of progress in cancer prevention so far, such as a decline in the rates of cigarette smoking; invention of the human papillomavirus (HPV) vaccine, which can help prevent cervical and head and neck cancers, among others; and the availability of curative treatments for hepatitis C, which can help reduce the incidence of liver cancer.
However, “we still have a lot of work to do,” Hait concluded. “A greater focus on approaches to prevention and interception is needed if we hope to generate the knowledge that will ultimately lead to significant progress in reducing the number of people diagnosed with cancer and increasing the number who are cured.”
Hait recently looked back at his career as a physician-scientist in an interview with Leading Discoveries, a publication of the AACR. Hait discussed his role in developing the Cancer Institute of New Jersey, his transition from academia to industry, and his interest in cancer prevention and interception.