Fundamentals of Cancer Prevention

Contents
1: Introduction to€Cancer Prevention
	1.1	 Introduction
	1.2	 Overview of€Cancer Prevention
	1.3	 Primary Prevention
	1.4	 Secondary Prevention
	1.5	 Tertiary Prevention
	1.6	 Molecular Approach to€Carcinogenesis
	1.7	 Cancer Prevention Clinical Trials
	References
2: Assessing the€Impact of€Cancer Prevention on€Self-Reported Health and€Well-Being
	2.1	 Introduction to€Chapter
	2.2	 Outcome Assessment
	2.3	 Humanistic Outcomes
	2.4	 Measuring Humanistic Outcomes
	2.5	 Cancer-Specific Measures
	2.6	 Generic or General Measures
		2.6.1	 Health Profiles
		2.6.2	 Preference-Based Measures
		2.6.3	 Quality-Adjusted Life Years (QALYs)
	2.7	 Reviews of€Empirical Evidence
	2.8	 Conclusion
	References
3: Assessing the€Economic Value of€Cancer Prevention
	3.1	 Part 1: The€Value of€Cancer Prevention
		3.1.1	 Demand for€Cancer Prevention
			3.1.1.1	 Revealed Preference
			3.1.1.2	 Stated Preference
		3.1.2	 Regulatory Perspective on€the€Value of€Cancer Prevention
		3.1.3	 Resource Allocation in€Cancer Prevention
		3.1.4	 Descriptive and€Evaluative Analyses in€Cancer Prevention
			3.1.4.1	 Descriptive Studies
			3.1.4.2	 Evaluative Analyses
		3.1.5	 Clinical Recommendations on€Cancer Prevention
			3.1.5.1	 Budget-Impact Analysis
			3.1.5.2	 Decision Analysis
			3.1.5.3	 Shared Decision-Making
	3.2	 Part 2: Outcomes of€Cancer Prevention
		3.2.1	 Defining and€Measuring Economic Outcomes
			3.2.1.1	 Unit of€Economic Outcomes
			3.2.1.2	 The Value of€Economic Outcomes
			3.2.1.3	 Perspective of€Economic Outcomes
		3.2.2	 Measuring and€Defining Humanistic Outcomes
			3.2.2.1	 Unit of€Humanistic Outcomes
			3.2.2.2	 The Value of€Humanistic Outcomes
	3.3	 Conclusions
	References
4: The Role of€Diet, Physical Activity, and€Body Composition in€Cancer Prevention
	4.1	 Current Lifestyle Recommendations for€Cancer Prevention
		4.1.1	 The WCRF/AICR Guidance
		4.1.2	 The American Cancer Society Guidelines
	4.2	 Mechanisms of€Carcinogenesis Modifiable Through Lifestyle Behavior
		4.2.1	 Insulin Resistance
		4.2.2	 Immune Modulation
		4.2.3	 Inflammatory Response
		4.2.4	 Oxidative Damage
		4.2.5	 Hormonal Modulation
		4.2.6	 Carcinogen Exposure
		4.2.7	 Adipose-Associated Mechanisms of€Cancer Risk
		4.2.8	 Diet and/or Physical Activity and€Gene Interactions
	4.3	 Diet, Physical Activity, Body Weight, and€Cancer Prevention: Review of€the€Evidence
		4.3.1	 Diet and€Cancer Prevention: Review of€Evidence
		4.3.2	 Physical Activity and€Cancer Prevention
		4.3.3	 Body Weight and€Body Composition and€Cancer Prevention
		4.3.4	 Summary of€the€Lifestyle Behavior-Cancer Risk Evidence
		4.3.5	 The Need for€More Rigorous Research
	4.4	 Diet, Physical Activity, Body Weight, and€Cancer Survival
		4.4.1	 Body Weight and€Cancer Survival
		4.4.2	 Survivorship and€Diet
		4.4.3	 Physical Activity and€Cancer Survivorship
	4.5	 Advancing Cancer-Preventive Lifestyles
		4.5.1	 Lifestyle Interventions in€Childhood Cancers
	4.6	 Tools for€Clinical Practice
		4.6.1	 Measuring Diet
		4.6.2	 Assessment of€Physical Activity and€Energy Expenditure
			4.6.2.1	 Physical Activity Questionnaires
			4.6.2.2	 Physical Activity Logs, Records, and€Recalls
			4.6.2.3	 Indirect Measures of€Energy Expenditure
		4.6.3	 Measurement of€Body Composition
			4.6.3.1	 Anthropometric Measurements
			4.6.3.2	 Bioelectric Impedance Analysis (BIA)
			4.6.3.3	 Dual-Energy X-Ray Absorptiometry (DXA)
			4.6.3.4	 Other Techniques
		4.6.4	 Promoting Behavior Change
	4.7	 Conclusion
	References
5: Innate and€Adaptive Immune Responses to€Cancer
	5.1	 Importance of€the€Immune System in€Cancer Prevention
	5.2	 Innate Immune Responses to€Cancer
		5.2.1	 Natural Killer Cells
		5.2.2	 Gamma Delta T Cells
		5.2.3	 Phagocytes
			5.2.3.1	 Dendritic Cells
			5.2.3.2	 Macrophages
			5.2.3.3	 Myeloid-Derived Suppressor Cells
		5.2.4	 Cytokines
			5.2.4.1	 TNF
			5.2.4.2	 Type I€Interferons
			5.2.4.3	 IL-12
	5.3	 Adaptive Immune Response
		5.3.1	 Recognition of€Tumor Antigens
		5.3.2	 Tumor Antigens
			5.3.2.1	 Tumor-Specific Antigens
			5.3.2.2	 Tumor-Associated Antigens
		5.3.3	 T Lymphocytes
			5.3.3.1	 CD8+ Cytotoxic T Lymphocytes
			5.3.3.2	 CD4+ T Helper Lymphocytes
		5.3.4	 B Lymphocytes
		5.3.5	 Cytokines
			5.3.5.1	 IL-2
			5.3.5.2	 IL-15
			5.3.5.3	 IL-17
			5.3.5.4	 IFN-γ
			5.3.5.5	 TGF-β
	5.4	 Vaccines for€Cancer Prevention
	5.5	 Immune Checkpoint Inhibitors
		5.5.1	 Cytotoxic T-Lymphocyte-Associated Protein-4
		5.5.2	 Programmed Cell Death Protein 1
		5.5.3	 Biomarkers of€Immune Checkpoint Inhibitor Activity
		5.5.4	 Future Directions of€Immunotherapy
	References
6: Hereditary Risk for€Cancer
	6.1	 Introduction
	6.2	 Cancer as€a€Genetic Disorder
		6.2.1	 Tumor-Suppressor Genes
		6.2.2	 Oncogenes
		6.2.3	 DNA Repair Genes
		6.2.4	 Epigenetic Mechanisms
	6.3	 Cancer as€a€Hereditary Disease
	6.4	 Common Hereditary Cancer Syndromes
		6.4.1	 Hereditary Breast and€Ovarian Cancer
		6.4.2	 PALB2
		6.4.3	 Cowden Syndrome
		6.4.4	 Li-Fraumeni Syndrome
		6.4.5	 CHEK2
		6.4.6	 ATM
		6.4.7	 Other Genes for€Hereditary Ovarian Cancer
		6.4.8	 Hereditary Nonpolyposis Colorectal Cancer
		6.4.9	 Familial Adenomatous Polyposis
		6.4.10	 Attenuated Familial Adenomatous Polyposis
		6.4.11	 MUTYH-Associated Polyposis (MAP)
		6.4.12	 Peutz-Jeghers Syndrome
		6.4.13	 Hereditary Diffuse Gastric Cancer
		6.4.14	 Other Hereditary Gastrointestinal Cancer Risk Genes
	6.5	 Genetic Counseling
		6.5.1	 Cancer Risk Assessment Models
		6.5.2	 Epidemiologic Models of€Breast Cancer Risk
		6.5.3	 Genetic Testing Models
		6.5.4	 Informed Consent Prior to€Genetic Testing
	6.6	 Genetic Testing
		6.6.1	 Types of€Genetic Testing Results
		6.6.2	 Genetic Testing for€Hereditary Breast and€Ovarian Cancer
		6.6.3	 Genetic Testing for€Hereditary Nonpolyposis Colon Cancer
		6.6.4	 Genetic Testing for€Familial Adenomatous Polyposis
		6.6.5	 Genetic Testing for€Attenuated FAP and€MUTYH (MAP)
		6.6.6	 Next-Generation Genetic Testing Panels
	6.7	 Cancer Screening, Surveillance, and€Prophylactic Management for€Hereditary Cancer Syndromes
		6.7.1	 High-Risk Screening Strategies for€Hereditary Breast/Ovarian Cancer
		6.7.2	 High-Risk Screening Strategies for€Hereditary Colorectal Cancer Syndromes
		6.7.3	 Prophylactic Surgery
		6.7.4	 Chemoprevention
		6.7.5	 Impact of€Germline Mutation on€Cancer Treatment
	6.8	 Conclusion
	References
7: Cancer Health Disparities
	7.1	 Introduction
	7.2	 Cancer Health Disparities
	7.3	 Epidemiology
	7.4	 Potential Causes of€Cancer Health Disparities
		7.4.1	 Social Determinants
		7.4.2	 Disparities in€Access to€Care and€Insurance Coverage
		7.4.3	 Disparities in€Quality of€Care
		7.4.4	 Behavioral Risk Factors
		7.4.5	 Patient-Level Causal Factors
			7.4.5.1	 Patient Preferences
			7.4.5.2	 Provider Concordance
			7.4.5.3	 Patient Mistrust and€Experiences with€Discrimination
			7.4.5.4	 Patient Refusal of€Recommended Treatment
		7.4.6	 System-Level Causal Factors
			7.4.6.1	 Lack of€Diversity in€Medicine
	7.5	 Cancer Site-Specific Disparities
		7.5.1	 Breast Cancer Disparities
			7.5.1.1	 Epidemiology of€Breast Cancer Disparities
			7.5.1.2	 Causes of€Breast Cancer Disparities
			7.5.1.3	 Strategies to€Reduce and€Eliminate Breast Cancer Disparities
		7.5.2	 Cervical Cancer Disparities
			7.5.2.1	 Introduction to€Cervical Cancer Disparities
			7.5.2.2	 Epidemiology of€Cervical Cancer Disparities
			7.5.2.3	 Causes of€Cervical Cancer Disparities
			7.5.2.4	 Strategies to€Reduce and€Eliminate Cervical Cancer Disparities
		7.5.3	 Colorectal Cancer Disparities
			7.5.3.1	 Introduction to€Colorectal Cancer Disparities
			7.5.3.2	 Epidemiology of€Colorectal Cancer Disparities
			7.5.3.3	 Causes of€Colorectal Cancer Disparities
			7.5.3.4	 Strategies to€Reduce and€Eliminate Colorectal Cancer Disparities
		7.5.4	 Prostate Cancer Disparities
			7.5.4.1	 Introduction to€Prostate Cancer Disparities
			7.5.4.2	 Epidemiology of€Prostate Cancer Disparities
			7.5.4.3	 Causes of€Prostate Cancer Disparities
			7.5.4.4	 Strategies to€Reduce and€Eliminate Prostate Cancer Disparities
		7.5.5	 Lung Cancer Disparities
			7.5.5.1	 Introduction to€Lung Cancer Disparities
			7.5.5.2	 Causes of€Lung Cancer Disparities
			7.5.5.3	 Strategies to€Reduce and€Eliminate Lung Cancer Disparities
	7.6	 Strategies for€Reducing and€Eliminating Cancer Disparities
		7.6.1	 Community-Based Outreach and€Education
		7.6.2	 Access to€Health Services
		7.6.3	 Healthcare Providers
		7.6.4	 Knowledge and€Awareness
		7.6.5	 Health Policy
		7.6.6	 Clinical Trial Participation
	7.7	 Conclusion
	References
8: Human Categories and€Health: The€Power of€the€Concept of€Ethnicity
	8.1	 Why the Concept of Ethnicity Matters: Cancer Health Disparities—Introduction
	8.2	 Epidemiology, Risk Factors, and€Cancer
	8.3	 The Meanings of€Race and€Ethnicity
		8.3.1	 The Problem of€Race
		8.3.2	 Ethnicity Replaces the€Term Race
	8.4	 The Role of€Genes
	8.5	 The Interactive View of€Human Development
		8.5.1	 Biologic, Genetic, and€Environmental
		8.5.2	 Learned and€Innate
		8.5.3	 Heritability and€Inheritable
		8.5.4	 Cultural
		8.5.5	 Traditional
	8.6	 The Interactive View of€Development and€Health
	8.7	 Identifying Ethnicity Using Proxy Measures
	8.8	 Ethnicity and€Health Research
	8.9	 Discussion and€Concluding Remarks
	References
9: Cancer Alternative Medicine and€Cancer Prevention Research
	9.1	 CAM and€Cancer Prevention Research
	9.2	 Botanical Agents: Foods, Spices, and€Herbs
		9.2.1	 Food and€Cancer Prevention
		9.2.2	 Curcumin
		9.2.3	 Green Tea
		9.2.4	 Immune-Modulating Mushrooms
		9.2.5	 Ginseng
		9.2.6	 Flaxseed
		9.2.7	 Rosemary
		9.2.8	 Chinese Herbs
	9.3	 Vitamins and€Cancer Prevention
		9.3.1	 Cancer, the€Inflammatory Nonhealing Wound
			9.3.1.1	 Reactive Oxygen Species Activity and€Inflammation in€Cancer
			9.3.1.2	 Tocopherols and€Tocotrienols as€Antioxidants
			9.3.1.3	 Tocopherols and€Tocotrienols as€Anti-malignant Inflammatory Agents
			9.3.1.4	 Tocopherols and€Tocotrienol as€Pro-apoptotic, Pro-senescent Agents
		9.3.2	 Tocotrienols and€Cancer Metastasis
			9.3.2.1	 Effects of€Tocotrienols on€the€Early Metastatic Events of€Invasion and€EMT
		9.3.3	 Clinical Trials
			9.3.3.1	 Trial 1: Linxian General Population Nutrition Intervention Trial (China, 1991)
			9.3.3.2	 Trial 2: Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC, Finland, 1994)
				Post-intervention Follow-Ups
			9.3.3.3	 Trial 3: European Prospective Investigation into Cancer and€Nutrition (EPIC-Spain, 2007)
			9.3.3.4	 Trial 4: Pilot Clinical Trial: Tocotrienol and€Tamoxifen in€Women with€Early Breast Cancer (Malaysia, 2010)
			9.3.3.5	 Trial 5: Selenium and€Vitamin E Cancer Prevention Trial (SELECT, US/Canada/Puerto Rico 2011)
			9.3.3.6	 Trial 6: A Phase I Safety, Pharmacokinetic, and Pharmacodynamic Pre-surgical Trial of Vitamin E δ-Tocotrienol in Patients with Pancreatic Ductal Neoplasia (Florida, US, 2015)
		9.3.4	 Underlying Reasons for€Conflicting Results in€Clinical Trials
		9.3.5	 Metabolomics Studies
	9.4	 Adiposity, Marrow Adipose Tissue, and€Cancer
	9.5	 The Mind–Body Connection
		9.5.1	 Physiological Responses to Stress in the Mind–Body Connection
		9.5.2	 Meditation and€Meditative Movement
		9.5.3	 Mindfulness Meditation and€Mindfulness-Based Stress Reduction
	9.6	 Psychosocial Factors and€Stress
	9.7	 Wellness
	9.8	 Indigenous Cultural Systems of€Healing
	9.9	 Ayurveda
	9.10	 Native American Healing Traditions
	9.11	 Energy Medicine
	9.12	 Conclusions
	References
10: Telemedicine, Telehealth, and€e-Health Technologies in€Cancer Prevention
	10.1	 Telemedicine, Telehealth, and€e-Health
	10.2	 Telemedicine, Telehealth, and€e-Health in€Cancer Care and€Cancer Prevention
	10.3	 Primary Cancer Prevention
		10.3.1	 Smoking Prevention
		10.3.2	 Nutrition Counseling
		10.3.3	 Physical Activity
		10.3.4	 Genetic Counseling
		10.3.5	 Psychosocial Support
	10.4	 Secondary Prevention
		10.4.1	 Breast Cancer and€Telehealth
		10.4.2	 Cervical Cancer and€Telecolposcopy
		10.4.3	 Skin Cancer Prevention and€Teledermatology
		10.4.4	 Colorectal Cancer and€Virtual Colonoscopy
		10.4.5	 Telepathology
	10.5	 Mobile Technologies
	10.6	 Community Health Workers as€Cancer Prevention Partners
	10.7	 Future Directions
	References
11: Global Cancer Prevention
	11.1	 Introduction
	11.2	 The Double Burden: Cancer in€Low- and€Middle-Income Countries
	11.3	 Modifiable Cancer Risk Factors
		11.3.1	 Global Burden of€Tobacco
		11.3.2	 Global Diet and€Physical Activity Patterns
		11.3.3	 Global Alcohol Consumption
		11.3.4	 Global Risks of€Infection
	11.4	 Global Opportunities for€Prevention
		11.4.1	 Framework for€Prevention
		11.4.2	 The Complexity of€Cancer Prevention
	11.5	 Action Steps to€Cancer Prevention: FCTC and€NCD
		11.5.1	 Framework Convention for€Tobacco Control (FCTC)
		11.5.2	 United Nations and€Noncommunicable Disease (NCD)
	11.6	 Conclusion
		11.6.1	 Inequality and€Cancer
		11.6.2	 Future Directions and€Prevention Strategies
	References
12: Sunscreen-Based Skin Protection Against Solar Insult: Molecular Mechanisms and€Opportunities
	12.1	 Sunscreens as€Skin Photoprotectants and€Cancer Chemopreventive Agents
	12.2	 FDA-Approved Sunscreen Drugs
	12.3	 FDA New Regulations Concerning Sunscreens
	12.4	 Rational Molecular Design of€Optimized Sunscreen Ingredients
		12.4.1	 General Considerations
		12.4.2	 Sunscreen Optimization by coformulation
		12.4.3	 Sunscreen Optimization Using Nanoparticle and€Encapsulation Technology
		12.4.4	 Sunscreen Optimization by Designing Improved Chromophores
		12.4.5	 Sunscreen Optimization Through Potential Synergism with “Non-Sunscreen” Molecular Approaches
			12.4.5.1	 Quenchers of€Photoexcited States (QPES)
			12.4.5.2	 Photoprotective Phytochemicals
			12.4.5.3	 NRF2 Activators
			12.4.5.4	 Nutritional Photoprotection
	12.5	 Future Developments Improving Skin Photoprotection: Concerns and€Opportunities
	References
13: Skin Cancer Prevention
	13.1	 Epidemiology of€Skin Cancer
	13.2	 Risk Factors
		13.2.1	 Ultraviolet Radiation Exposure
		13.2.2	 Other Risk Factors
		13.2.3	 Genetic Alterations in€NMSC
	13.3	 Genetic Alterations in€Melanoma
	13.4	 Screening and€Early Detection
	13.5	 Prevention of€Skin Cancer
		13.5.1	 Primary Prevention
		13.5.2	 Secondary Prevention
		13.5.3	 Targeting Precursor Lesions for€Chemoprevention
		13.5.4	 Molecular Targets for€Chemoprevention Identified in€UVR Signaling Pathways
		13.5.5	 Animal Models for€Studying Chemoprevention Agents
		13.5.6	 Endpoints for€Evaluating Efficacy of€Chemoprevention Agents
	13.6	 Potential Chemoprevention Agents for€Skin Cancer
	13.7	 Conclusion
	References
14: Colorectal Cancer Prevention
	14.1	 Molecular Etiology and€Pathology of€Colorectal Cancer
		14.1.1	 Inherited and€Sporadic Colorectal Cancer
		14.1.2	 Genetic Model of€Colorectal Cancer
		14.1.3	 Consensus Molecular Subtypes of€Colorectal Cancer
	14.2	 Adenomas, Metachronous Adenomas, Advanced Adenomas, and€Serrated Polyps
		14.2.1	 Metachronous Adenoma
		14.2.2	 Advanced Adenoma
		14.2.3	 Serrated Polyps
	14.3	 Anatomic Distribution and€Staging of€Colorectal Cancers
		14.3.1	 Anatomic Distribution
		14.3.2	 Stage-Related Survival
	14.4	 Epidemiology
		14.4.1	 Early-Onset Colorectal Cancer
		14.4.2	 Colorectal Cancer Disparities
	14.5	 Risk Factors for€Colorectal Cancer
		14.5.1	 Lifestyle Factors
		14.5.2	 Non-lifestyle Factors
			14.5.2.1	 Family History
			14.5.2.2	 Inflammatory Bowel Disease
			14.5.2.3	 Cystic Fibrosis
			14.5.2.4	 Medications
		14.5.3	 Colorectal Cancer Screening
			14.5.3.1	 Stool-Based Tests
			14.5.3.2	 Colorectal Structural Evaluation
			14.5.3.3	 Blood Test
		14.5.4	 Triaging Screening According to€Risk of€Colorectal Cancer
		14.5.5	 CRC Screening in€Individuals at Increased Risk of€Colorectal Cancer
			14.5.5.1	 Family History
			14.5.5.2	 Inflammatory Bowel Disease
			14.5.5.3	 Cystic Fibrosis
		14.5.6	 CRC Screening in€Individuals at Average Risk of€Colorectal Cancer
			14.5.6.1	 Surveillance Colonoscopy Intervals
			14.5.6.2	 Colonoscopy Performance Metrics
			14.5.6.3	 Age for€Initiating Colorectal Cancer Screening
			14.5.6.4	 Disparities in€Colorectal Cancer Screening in€the€US
			14.5.6.5	 Cost-Benefits and€Costs of€Screening
	14.6	 Chemoprevention of€Colorectal Neoplasia
	14.7	 Future Directions in€Colorectal Cancer Prevention
	References
15: Lung Cancer Prevention
	15.1	 Epidemiology of€Lung Cancer
		15.1.1	 Patterns of€Occurrence
		15.1.2	 Trends in€Tobacco Use and€Lung Cancer
		15.1.3	 Risk Factors for€Lung Cancer
			15.1.3.1	 Tobacco Products
			15.1.3.2	 Environmental Exposures
			15.1.3.3	 Family History and€Genetic Susceptibility
	15.2	 Early Lung Carcinogenesis
		15.2.1	 Natural History of€Lung Premalignancy
		15.2.2	 Molecular Characterization of€Lung Premalignancy
	15.3	 Chemoprevention of€Lung Cancer
		15.3.1	 Principles of€Chemoprevention
			15.3.1.1	 Targets for€Intervention
			15.3.1.2	 High-Risk Cohorts
			15.3.1.3	 Intermediate Endpoint Biomarkers
		15.3.2	 Chemopreventive Agents
			15.3.2.1	 Dietary Supplements, Foods, and€Phytonutrients
			15.3.2.2	 Agents Targeting Inflammation: Inhaled Steroids and€Nonsteroidal Anti-inflammatory Drugs
			15.3.2.3	 Prostacyclin Analogues
			15.3.2.4	 Antidiabetic Agents
			15.3.2.5	 Vaccines and€Immunoprevention
	15.4	 Screening for€Early Detection of€Lung Cancer
		15.4.1	 Standard Chest X-rays and€Sputum Cytology
		15.4.2	 Low-Dose Helical Computed Tomography
		15.4.3	 Alternative Approaches to€Early Detection
	15.5	 Conclusion
	References
16: Breast Cancer Prevention
	16.1	 Introduction
	16.2	 Epidemiology of€Breast Cancer and€Breast Cancer Subtypes
		16.2.1	 Breast Cancer Incidence and€Secular Trends
		16.2.2	 Invasive Breast Cancer Incidence in€the€US, Subtypes and€Race/Ethnicity
	16.3	 Established Breast Cancer Risk Factors
		16.3.1	 Age, Gender, and€Breast Cancer Risk
		16.3.2	 Family History of€Breast Cancer
		16.3.3	 Reproductive Risk Factors
		16.3.4	 Endogenous Hormone Exposures
		16.3.5	 Exogenous Hormone Exposures
		16.3.6	 Prior Breast Health History
		16.3.7	 Breast Density and€Breast Cancer Risk
		16.3.8	 Lifestyle Risk Factors
		16.3.9	 Chemical and€Toxic Environmental Risk Factors
	16.4	 Mammographic Screening and€Early Breast Cancer Detection
		16.4.1	 Breast Self-Exam (BSE) and€Clinical Breast Exam (CBE)
		16.4.2	 Alternative Screening Modalities and€Future Directions
	16.5	 Primary Prevention of€Breast Cancer
		16.5.1	 Chemoprevention
			16.5.1.1	 Selective Estrogen Receptor Modulators (SERMs)
			16.5.1.2	 Aromatase Inhibitors
			16.5.1.3	 Non-hormone Targets for€Breast Cancer Prevention
			16.5.1.4	 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
			16.5.1.5	 Metformin
			16.5.1.6	 RANK Ligand for€Breast Cancer Chemoprevention
	16.6	 Risk Assessment and€Clinical Applications
		16.6.1	 Elevated Risk
		16.6.2	 Risk Assessment Models
	16.7	 Conclusion
	References
17: Prostate Cancer Prevention
	17.1	 Introduction
	17.2	 USPSTF Guidelines
	17.3	 Role of€Lifestyle Factors in€Primary and€Secondary Prevention of€Prostate Cancer
		17.3.1 Plant Products
		17.3.2 Coffee and€Tea
		17.3.3 Soy
		17.3.4 Dairy Products
		17.3.5 Poultry and€Eggs
		17.3.6 Fish
		17.3.7 Red Meat
		17.3.8 Vitamins
		17.3.9 Minerals and€Supplements
		17.3.10 Body Composition and€Lifestyle Factors
		17.3.11 Physical Activity
		17.3.12 Smoking
		17.3.13 Comprehensive Lifestyle Modification Interventions
	17.4	 Prostate Cancer Survivorship: A€Perspective on€Tertiary Prevention
	17.5	 Innovative Research in€Secondary and€Tertiary Prevention of€Prostate Cancer
	17.6	 Conclusion
	References
18: Cervical Cancer Prevention
	18.1	 Epidemiology of€Cervical Cancer
	18.2	 Etiology of€Cervical Cancer
	18.3	 Natural History of€Cervical Cancer
	18.4	 Cofactors for€Cervical Cancer
		18.4.1	 Viral Persistence and€Immune Response
	18.5	 Screening and€Early Detection of€Cervical Cancer
		18.5.1	 HPV Testing
	18.6	 Therapeutic Approach to€Precursor Lesions of€Cervical Cancer
	18.7	 Novel Agents for€Cervical Cancer Prevention
		18.7.1	 Chemopreventive Agents
		18.7.2	 HPV Prophylactic Vaccines
	18.8	 Conclusion
	References
19: Endometrial Cancer Prevention
	19.1	 Epidemiology of€Endometrial Cancer
	19.2	 Endometrial Carcinoma Precursors
		19.2.1	 Atypical Endometrial Hyperplasia
		19.2.2	 Endometrial Intraepithelial Neoplasia
	19.3	 Treatment of€Endometrial Hyperplasia
		19.3.1	 Obesity
	19.4	 Metabolic Syndrome
	19.5	 Weight Loss
		19.5.1	 Bariatric Surgery
	19.6	 Endometrial Screening in€Obese Women
	19.7	 Tamoxifen Use
	19.8	 Genetic Syndromes
		19.8.1	 Lynch Syndrome
		19.8.2	 Cowden Syndrome
	19.9	 Preventive Pharmocologic Interventions
		19.9.1	 Hormone-Based Contraceptives
		19.9.2	 Nonsteroidal Anti-inflammatories (NSAIDs)
		19.9.3	 Metformin
	19.10	 Other Preventive Strategies
	19.11	 Conclusions
	References
20: Epithelial Ovarian Cancer Prevention
	20.1	 Introduction
	20.2	 Histopathology of€Ovarian Cancer
	20.3	 Biology of€Epithelial Ovarian Cancer
	20.4	 Risk Factors for€Epithelial Ovarian Cancer
		20.4.1	 Endometriosis
		20.4.2	 Age
		20.4.3	 Endogenous and€Exogenous Hormones
		20.4.4	 Genetic and€Epigenetic Risk Factors
			20.4.4.1	 Genetic Risk Factors
			20.4.4.2	 Epigenetic Factors
		20.4.5	 Family History
		20.4.6	 Sociodemographic Factors
		20.4.7	 Diet
		20.4.8	 Obesity and€Physical Activity
	20.5	 Early Detection and€Prevention of€Ovarian Cancer
		20.5.1	 CA-125
		20.5.2	 Screening Strategies in€the€Average Risk Population
		20.5.3	 Screening Among Those at Increased Risk of€Ovarian Cancer
		20.5.4	 Proteomics
		20.5.5	 Symptomatology
		20.5.6	 Risk-Reducing Surgery
			20.5.6.1	 Tubal Ligation
			20.5.6.2	 Salpingo-oophorectomy
			20.5.6.3	 Salpingectomy
			20.5.6.4	 Risk-Reducing Salpingectomy or Salpingo-oophorectomy with€Concomitant Hysterectomy
			20.5.6.5	 Residual Risk of€Peritoneal Cancer
	20.6	 Chemoprevention of€Ovarian Cancer
	20.7	 Quality of€Life
	20.8	 Conclusion
	References
21: Cancer Survivorship
	21.1	 Introduction
	21.2	 Prevalence of€Survivorship
	21.3	 Survivorship as€a€Scientific Discipline
	21.4	 Prevention
	21.5	 Smoking Cessation and€Survivorship
	21.6	 Acute Effects of€Cancer Treatment
		21.6.1 Chemotherapy
			21.6.1.1	 Nausea and€Vomiting
			21.6.1.2	 Asthenia
			21.6.1.3	 Anorexia and€Cachexia
			21.6.1.4	 Immunosuppression and€Risk of€Infection
		21.6.2 Surgery
		21.6.3 Radiation Therapy
	21.7	 Long-Term and€Late Effects of€Cancer Treatment
		21.7.1 Generalizations
		21.7.2 Issues Unique to€Certain Cancer Sites
		21.7.3 Special Considerations Related to€Age at Diagnosis
		21.7.4 Special Considerations When Primary Diagnosis and€Treatment Occur in€Childhood
	21.8	 Physiologic Sequelae of€Cancer and€Its Treatment
		21.8.1	 Second Cancers
		21.8.2 Neurocognitive Function
		21.8.3 Gastrointestinal Dysfunction
		21.8.4 Pulmonary Dysfunction
		21.8.5 Cardiac Dysfunction
		21.8.6 Endocrine Dysfunction
		21.8.7 Intestinal Stomas
		21.8.8 Lymphedema
		21.8.9 Pain
		21.8.10 Cosmesis
		21.8.11 Phonation
		21.8.12 Swallowing
		21.8.13 Sexual Dysfunction
		21.8.14 Xerostomia
		21.8.15 Asthenia/Anorexia/Cachexia
		21.8.16 Neuropathy
		21.8.17 Fertility
		21.8.18 Employment and€Financial
		21.8.19 Fatigue
	21.9	 Survivorship Care Planning
	21.10	 Grading of€Late Effects
	21.11	 Advanced Illness
	21.12	 Future Directions
	References