22 AACR CANCER PROGRESS REPORT 2016
A WHOLE-PATIENT PICTURE
Research has powered an explosion in our understanding
of the individual factors inside and outside a cell that
cause cancer initiation, development, and progression.
It is also beginning to provide us with a picture of how
these factors work together and are influenced by each
person’s unique biological characteristics. This knowledge
is the essence of precision medicine, as well as the more
nascent strategy of precision prevention (see Figure 2).
Precision prevention and medicine aim to tailor each
person’s health care to the prevention and/or treatment
strategies most likely to be of benefit, sparing each person
the cost of and potential harms from those prevention
interventions and/or treatments that are unlikely
to be of benefit ( 25, 26). As we develop an even more
comprehensive, whole-patient understanding of the way
in which cancer starts, progresses, and results in sickness,
we can expect to see an acceleration in the pace of progress
in precision medicine and prevention for cancer (see
Anticipating Future Progress, p. 100).
PRECISION MEDICINE AND PREVENTION FIGURE 2
Precision medicine, sometimes referred to as
personalized medicine, molecular medicine, or
tailored therapy, is broadly defined as treating
patients based on characteristics that distinguish
them from other patients with the same disease.
Factors such as a person’s genome, the genome
of his or her cancer, disease presentation, gender,
exposures, lifestyle, microbiome, and other yet-to-be-discovered features (indicated by the question
mark) are considered in precision medicine ( 25).
Precision prevention is a conceptual framework that
aims to tailor cancer prevention to the individual
patient by accounting for the various factors that
may play a role in developing a particular cancer
( 26); it is analogous to the manner in which precision
medicine treats patients. The following factors could
be considered in the implementation of precision
prevention: a person’s genome; age; gender;
family history, including genetic predisposition to
developing cancer (see Table 5, p. 43); lifestyle factors
including tobacco and alcohol use, being overweight
or obese, and levels of exercise; reproductive and
medical factors; exposures to known carcinogens
like viruses; socioeconomic status; and geography,
as well as yet-to-be identified factors (indicated by
the question mark). The order in which the factors
appear in the images is not meant to imply that one
factor is more important than another.