WHAT IS CHEMOPREVENTION OR “PREVENTIVE” CHEMOTHERAPY?

Medically Reviewed by Dr. Sony Sherpa, (MBBS)

In the recent past, discussions about Kate Middleton and "preventive chemotherapy," dominated the headlines, leading to some confusion about its exact meaning in the context of cancer treatment.

In this case, "preventive chemotherapy" likely referred to adjuvant chemotherapy, a treatment administered after the primary treatment (such as surgery or radiation) to reduce the risk of cancer recurrence by eliminating any residual microscopic cancer cells. Adjuvant chemotherapy is a common practice in many types of cancer, including breast, colon, and lung cancer.

It is important to distinguish between preventive chemotherapy and adjuvant chemotherapy. The term "preventive chemotherapy" is not medically recognized for cancer treatment. Instead, the World Health Organization (WHO) uses it to describe interventions aimed at preventing neglected tropical diseases by administering medication to safeguard against future infections.

On the other hand, Adjuvant chemotherapy is a common practice in cancer treatment and has been shown to significantly improve outcomes for many patients. It can be used in combination with surgery, radiation therapy, or other treatments to reduce the risk of cancer recurrence.

This article will look into cancer prevention strategies, particularly chemoprevention and other related methods, to clarify the existing confusion and provide insights into effective cancer prevention measures.

Chemoprevention

Chemoprevention is a preventive strategy that involves using medications (not necessarily chemotherapy drugs) to reduce the risk of cancer development in people identified as being at high risk. The approach targets various cancers and aims to mitigate the disease's onset.

Examples of Chemoprevention Medications:

• Tamoxifen: Often prescribed to women at high risk of developing breast cancer, this medication has been shown to significantly reduce the likelihood of the disease.
• Finasteride: This medication is recommended for men at high risk of prostate cancer, helping to lower their risk.
• Raloxifene (Evista), Aspirin, NSAIDs, and Aromatase inhibitors (such as anastrozole): These medications have also demonstrated potential in reducing cancer risk, particularly for certain cancer types.

Risk Assessment

Before considering chemoprevention medications, it is crucial to conduct a comprehensive risk assessment. This assessment helps to weigh the benefits against the potential drawbacks, including possible side effects, which may vary depending on the medication used.

Side Effects

Potential side effects of chemoprevention medications may include:

• Tamoxifen: Increased risk of blood clots, uterine cancer, and other hormonal side effects.
• Finasteride: Can cause sexual dysfunction, depression, and potential hormonal imbalances.
• Aspirin and NSAIDs: Risks include gastrointestinal bleeding, kidney issues, and cardiovascular problems.

Future Advancements

Research into chemoprevention continues to explore its potential applications for specific cancer types. Ongoing studies aim to refine and expand our understanding of how these medications can play a significant role in cancer prevention, potentially introducing new, effective options in the future.

Prophylactic or Preventive Surgery

Prophylactic surgery is a preventive measure that prevents the development of cancer in people who are at high risk. The aim is to remove precancerous tissues or organs susceptible to cancerous growth, thereby reducing or eliminating the likelihood of developing the disease.

Types of Prophylactic Surgeries

• Mastectomy: This surgery involves removing one or both breasts to prevent breast cancer. It is particularly recommended for women with BRCA gene mutations or a high risk of breast cancer.
• Oophorectomy: This surgery removes the ovaries and is recommended for women with BRCA mutations or a high ovarian cancer risk.
• Salpingectomy: This surgery involves removing the fallopian tubes, either alone or in conjunction with an oophorectomy, to reduce the risk of ovarian cancer.
• Colectomy: This preventive surgery involves removing a portion or the entire colon for individuals diagnosed with hereditary non-polyposis colorectal cancer (HNPCC) or familial adenomatous polyposis (FAP) to significantly reduce their risk of developing colon cancer.
• Thyroidectomy: This surgery removes the thyroid gland and is recommended for people with certain genetic mutations or a family history of thyroid cancer.

In addition to these procedures, removing a precancerous polyp can serve as another preventive measure for specific cancers, particularly those affecting the colon.

Weight Loss Surgery

Bariatric surgery, or weight loss surgery, is increasingly recognized as a potential cancer prevention tool. Obesity is a proven risk factor for multiple cancers, including breast, colorectal, kidney, pancreatic, and liver cancers, according to the National Cancer Institute (NCI). By reducing obesity, weight loss surgery can contribute to lowering the risk of these cancers.

Types of Weight Loss Surgery

• Gastric Bypass: The procedure involves creating a smaller stomach pouch, connecting it directly to the small intestine to limit food intake and absorption.
• Sleeve Gastrectomy: This surgery removes a significant portion of the stomach. The reduced capacity of the stomach helps in restricting food intake and promoting weight loss.
• Gastric Banding: An adjustable band is placed around the upper stomach to create a smaller pouch, limiting food intake.

These procedures help people lose weight, which in turn may lower their risk of developing cancer. The strong link between obesity and cancer underscores the importance of weight management. The risk of developing cancer can be considerably reduced by achieving and maintaining a healthy weight either by surgical intervention or lifestyle modifications.

Vaccinations

Vaccines protect against certain cancers by boosting the immune system's ability to fight off cancer-causing viruses.

Types of Cancer Prevention Vaccines:

• HPV Vaccine: This vaccine protects against the Human Papillomavirus (HPV), which is a significant cause of cervical cancer and can also lead to other cancers, including those affecting the anus, oropharynx, and genitals. The vaccine is ideally given to boys and girls aged 11-12 years for optimal protection before potential HPV exposure.
• Hepatitis B Vaccine: The hepatitis B vaccine protects against liver cancer by preventing the hepatitis B virus. It is recommended for everyone, starting at birth.

Other Potential Vaccines

Researchers are actively developing vaccines targeting the viruses responsible for various types of cancer. For example, the Epstein-Barr virus (EBV) has been linked to some lymphomas and other cancers. Ongoing studies aim to develop vaccines that can target and prevent infections caused by these viruses, potentially reducing the risk of associated cancers.

Other Cancer Preventive Measures

The National Cancer Institute highlights that adopting healthy lifestyle habits helps reduce the risk of developing cancer.

Healthy Lifestyle

• Diet: The risk of cancer can be significantly lowered by incorporating a diet rich in whole grains, vegetables, and fruits. Reducing consumption of processed and red meats, as well as sugary foods, is also beneficial for overall health.
• Exercise: Obesity is a significant contributor to cancer risk. The risk of several cancers can be significantly reduced by maintaining a healthy weight. Walking, jogging, cycling, and other regular physical activity can help.

Sun Protection

• Reducing exposure to ultraviolet (UV) radiation is essential for preventing skin cancer. This can be achieved by using sunscreen, wearing protective clothing, and seeking shade when outdoors.

Avoiding Tobacco

• Smoking and other forms of tobacco use are major contributors to various cancers. The risk of lung, oral, and several other cancers can be considerably reduced by avoiding tobacco.

Early Detection

• Regular screenings are crucial for early diagnosis and better treatment outcomes for specific cancers, including mammography for breast cancer, colonoscopy for colorectal cancer, Pap tests for cervical cancer, and lung cancer screening.

Alcohol

• Reducing alcohol consumption lowers your risk of developing several cancers, including liver, breast, and colorectal cancer.

Breastfeeding and Hormone Therapy

• Breastfeeding offers potential protection against breast cancer. Additionally, limiting hormone therapy after menopause is another way to reduce this risk.

By choosing to adopt a healthy lifestyle, you can considerably reduce your cancer risk and improve overall well-being.

To search for the best Oncology healthcare providers in Germany, India, Malaysia, Singapore, Spain, Thailand, Turkey, the UAE, the UK and the USA, please use the Mya Care search engine.

To search for the best healthcare providers worldwide, please use the Mya Care search engine.

References:

• West H, Jin JO. Adjuvant therapy. JAMA Oncol. 2015;1(5):698. doi:10.1001/jamaoncol.2015.2095
• Cleveland Clinic. Adjuvant therapy.
• American Society of Clinical Oncology. Chemoprevention.
• World Health Organnization. Preventive chemotherapy.
• Cancer Prevention Overview (PDQ®)–Patient Version
• National Cancer Institute. Cancer Prevention Interventions Available Today
• Center for Disease Control and Prevention. How to Prevent Cancer or Find It Early
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854742/

Disclaimer