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Division of Cancer Prevention

Description:

The Division of Cancer Prevention (DCP) directs an extramural program of cancer prevention research including chemoprevention, nutritional science, genetic, epigenetic, infectious agents, and early detection including biomarker development and validation and biometry for the Institute. DCP also supports research training and career development in cancer prevention and early detection and coordinates community-based clinical research in cancer prevention and dissemination of cancer treatment practice through a consortium of community clinical centers. For additional information, please visit our home page at http://www.cancer.gov/prevention/index.html.

A. Prevention. Research studies to identify, evaluate, and implement techniques and approaches for the prevention, risk assessment, and early detection of cancer. Those studies capable of achieving these objectives with minimal risk and cost are preferred.

1. Chemoprevention. Studies in which naturally occurring or synthetic agents are identified, or further evaluated for efficacy or safety. Studies involving in vitro assays with cell transformation systems, in vivo assays involving animal models to evaluate agents against typical carcinogenic agents at specific sites, and studies involving clinical chemistry measurement of agents in sera or other biological fluids are of highest program relevance. Studies aimed at improving future research designs for chemopreventive trials; providing additional biological understanding, identification and evaluation of modulation of quantitative or qualitative biological endpoints, and/or markers for surveillance of compliance will also be considered. Examples of tests might include measurements of biochemical parameters, cytological screening techniques, in vitro studies of suppression of oncogene protein products, enhancement of tumor suppressor genes, in vitro toxicological studies, and synthesis of novel chemopreventive agents based on structure/activity relationships.

2. Diet and Nutrition. The Nutritional Science Research Group supports studies that aim to reduce the incidence of cancer through dietary modification, which may include additions, deletions, or substitutions of foods or dietary factors.

Topics of interest include the development of:

a) Animal models, including transgenic and knockout, to examine the cancer prevention effects of bioactive food components.

b) Invertebrate models for the study of bioactive food component-gene interactions involved with cancer prevention.

c) Novel technologies for measuring the effects of diet on differential gene expression, epigenetic events, proteomics, and associated metabolomic changes.

d) New models/approaches for examining diet on cancer related processes; i.e., cell division, apoptosis, immunity, angiogenesis.

e) Educational interactive software packages that focus on dietary exposures and cancer prevention.

f) Effective methods for assessing the content of bioactive food components in foods and dietary supplements.

g) Bioengineering tools for the study of bioenergetics and obesity.

h) New and/or improved diagnostic markers for assessing the nutritional status of individuals prior to developing a neoplasm.

i) Technologies for detecting and identifying carcinogenic and cancer protective compounds in foods.

j) Surrogate cells for predicting the response to bioactive food components in target tissue(s).

k) Methods for the isolation and preparation or synthesis of candidate nutrients in quantities suitable for preclinical and clinical screening.

l) Blends/combinations of bioactive food components for cancer prevention.

m) Novel technologies for assessing the effects of dietary components on the extracellular matrix and tissue microenvironment.

n) Methodologies to understand stem and progenitor cells with the microenvironment as determined by dietary components.

o) Approaches for identifying responders from non-responders of dietary prevention intervention strategies.

B. Community Oncology. Introduction, application, and evaluation of effective and practical cancer control intervention programs in community settings. Primary emphasis is on the integration and involvement of community physicians and allied health professionals in cancer control efforts and the promotion of linkages between community practitioners/hospitals and other regional resources for cancer control.

Objectives are to: (1) reduce the time between research advances in prevention, detection, and patient management and their application in community settings; and (2) expand extend the cancer care knowledge and applications bases; and (3) evaluate new detection and diagnostic methods for specificity, sensitivity, reliability, validity, safety, feasibility and cost when applied to defined or target populations. This may include screening research as well.

C. Rehabilitation and Continuing Care. Development and evaluation of rehabilitation or continuing care strategies which directly enhance functioning of patients with cancer or which contribute to understanding of factors impacting utilization of supportive services by cancer patients. Clinical applications include development and testing of interventions to enhance multidisciplinary approaches to cancer rehabilitation, and research on effective symptom management (e.g., cancer-related pain, fatigue, nausea, mucositis). Areas of general program interest include innovative approaches to measuring and enhancing quality of life of cancer patients; research to investigate and enhance clinical decision-making by both patients and physicians; and studies of the impact of individual preferences for health care outcomes and their impact on cancer prevention practices in persons without cancer and on treatment decisions in patients with cancer.

D. Early Detection and Screening. New diagnostic or screening methods for early detection of cancer, especially for asymptomatic patients. Detection methods can include any cancer site, although there is more interest in the common cancers, such as those of the lung and colon. Methods should be cost beneficial and applicable in a clinical setting.

1. Studies which identify and document new databases relevant to early cancer detection and propose using new and experimental analytical techniques.

2. Analyses of long-term, follow-up data from completed studies for potential new interpretations based on the passage of time.

3. Studies which propose to develop and evaluate new detection techniques and measures for sensitivity specificity, reliability, validity and safety.

4. Determinations of the cost/benefit or risk/benefit ratios of cancer screening and detection methods when applied in defined or target populations.

5. Currently, the most commonly used method to detect prostatic cancer is the digital rectal examination. Various devices and models would be necessary for the early detection of prostate cancers by physical examination. They would include, but not limited to the following disease states: (1) absence of disease (normal model); (2) benign prostatic hypertrophy; (3) prostatitis; (4) Stage B1 prostatic cancer (T2a); (5) Stage B2 prostatic cancer (T2b); and (6) Stage C prostatic cancer (T3z, T3b, and T4).

6. Development of products that aid the systematic collection and transport of specimens used for the early detection of cancer, including devices for the collection and transport of urine, serum, fecal material, exfoliated cells, and other potential materials.

7. Develop computer utility programs that can increase the clinical uses of existing programs commonly found in medical offices creating age-sex registries, predicting population risks, determining screening needs of patients, reminder systems, etc. Develop bioinformatics to study gene profiling.

8. Develop personal computer programs that can be used to determine population risks and the effect of interventions. These programs might also be adopted to the concept of Community Oriented Primary Care.

9. Use of ultrasonography with color flow imaging for the early detection of cancer. Research on the use of ultrasonography with color flow imaging (US-CFI) for the early detection of cancer of the ovary, breast and/or prostate. Emphasis should be given to the ability of the US-CFI to differentiate between malignant and benign disease at these sites. Criteria for the discrimination of malignant from benign disease would be developed as well as performance characteristics of this method, particularly for breast and prostate. Studies on symptomatic populations should yield sensitivity, specificity and positive predicative values when breast and prostate are the target sites. Studies on asymptomatic populations should yield sensitivity, specificity and positive predicative values when ovarian cancer is the target site.

10. As more women seek mammographic breast screening, the importance of efficient, high speed, “intelligent” mammographic systems capable of acquiring and storing large volumes of images and enhancing image interpretation will become more important. Technological developments of interest are:

a. Develop digital mammographic systems for high volume applications with electronic archiving and image analysis capabilities.

b. Develop artificial intelligence based interactive image analysis software to enhance mammographic sensitivity and specificity.

E. Cancer Biomarkers. The Cancer Biomarkers Research Group (CBRG) promotes research on the discovery, development, and validation of biomarkers for pre-cancer and early cancer detection and relevant technologies so that risk can be more accurately assessed and cancers can be detected at early stages of development. Early detection has the potential to reduce cancer morbidity and mortality. In cancer research, biomarkers refer to substances that are indicative of the presence of cancer in the body. Biomarkers include genes, RNAs, proteins, and metabolites. As the molecular changes that occur during tumor development can take place over a number of years, biomarkers can be potentially used to detect cancers early. Topics of interest include, but are not limited to, the following areas:

1. Discovery, development and/or validation of biomarkers (genomic, epigenomic, proteomic and metabolomic) for precancerous lesions, early cancer detection, and identification of risk.

2. Development of new biological, genetic, histochemical, immunologic, and molecular assay or analyses applied to early cancer detection, risk assessment, or susceptibility.

3. Development of new tools and technologies, including microfluidics and nanotechnologies, for analyzing biomarkers for early cancer detection and risk assessment.

4. In silico data analysis for the discovery and identification of cancer biomarkers.

5. Ancillary studies to discover biomarkers from ongoing prevention and treatment trials and any large studies.

6. Development of statistical and epidemiological approaches to biomarkers evaluation for early cancer detection and risk.

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