An Ounce of Prevention

Ben Franklin knew what he was talking about when he advised, “An ounce of prevention is worth a pound of cure.” Though Franklin was generalizing about the superiority of preventing problems rather than trying to fix them after the fact, his 18th century idiom applies quite aptly to modern medicine.

Alas, modern biomedicine is mostly concerned with cures, while progress on prevention falls to those working on hygiene, public health, and sensible dietary habits. But there exists a very effective chemoprevention for one of the most feared of all diagnoses: breast cancer. The preventative agent is tamoxifen, which works by antagonizing the growth-promoting effects of estrogen. In practice, tamoxifen has proven effective in reducing breast cancer incidence for people at increased risk of developing this disease. But it can also cause adverse cardiovascular and metabolic side effects, as well harming the central nervous system.

Now comes a clinical trial with a different small molecule that also proves effective in reducing breast cancer counts. The drug, exemestane, works by inhibiting an enzyme called aromatase, which is in the cellular pathway that leads to the synthesis of estrogen. The best news is that while exemestane is about as effective as tamoxifen, it appears to be less toxic. This could provide serious benefit for millions of women (and a few men) with elevated risk factors for breast cancer and who may wish to do something about it.

A couple of centuries from now we probably won’t be treating cancer with poisons and scalpels, but – as Franklin championed – preventing it from occurring in the first place  by manipulation of cellular chemistry. This report is a solid next step in that direction.

Tom Tritton is President and CEO of CHF.

Drug Togetherness [Periodic Tabloid]
History Live: "Cancer Therapies: Nineteenth Century to Tomorrow" [CHF]

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