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Biomarkers and clinical interventions.

This section on ‘Biomarkers and clinical interventions’ addresses old and new approaches to clinical preventive intervention. Mammographic density (MD) as an expression of fibroglandular tissue of the breast is considered one of the major risk factors for breast cancer. On the basis of this evidence, great efforts have been made to verify a reliable way to quantitate the phenomenon. In his manuscript, Pearce and Pike [1] review the clinical relevance of different technologies for MD analysis, from mammography to breast magnetic resonance imaging. The authors have also considered other aspects of MD such as the biological bases of the relationship of collagen with breast cell proliferation. However, to understand the role of MD in breast cancer risk, other aspects should be taken into account such as body mass index [2] and, even more interestingly, some common genetic variants associated with breast cancer susceptibility [3]. Gadducci et al. [4] questions how to manage ovarian cancer in high-risk women, from early diagnosis to the prevention site. After reviewing screening programs for early diagnosis based on the serum CA125 assay, concluding that its applicability is not routine, the author reports the experience of multiple biomarker analysis; he concludes that the future for efficient screening programs for subjects who are at a high risk for ovarian carcinoma should be represented by multiplex platform analyses in which proteins mainly involved in normal physiology of the ovaries should be profiled. Could the availability of (a) reliable biomarker(s) also help clinicians to better orientate preventive chemical strategies? Is there still any problem of acceptability of chemoprevention approaches for high-risk subjects? According to Bonanni’s paper [5], the answer is yes. In a study proposing a chemoprevention approach based on aromatase inhibitors for healthy subjects, acceptability was 32% [6]. In the Liber trial, it was even lower [7]. The author comments on the fact that these low acceptability rates for chemoprevention trials contrast with the high acceptance rates seen in studies of chemoprevention of cardiovascular disease. What could be the reasons for this? Perhaps the long duration of cancer chemoprevention trials before obtaining answers? Or an unwillingness by subjects in cancer prevention trials to undergo randomization? Currently there are no answers to these questions, but a dedicated staff and appropriate education of patients are undoubtedly key factors for successful accrual. Optimal selection of therapeutic strategies for each hereditary breast cancer patient continues to evolve. Pathways for intervention to reduce cancer risk in mutation carriers or to decrease risk of recurrence/new cancer in previously diagnosed patients are being developed [8]. Surgical options may be tailored to the magnitude of these problems, but additional studies are needed to evaluate the role of specific surgical approaches. However: the psychological profile of each subject is generally accepted as a major factor in the selection of preventive surgical approaches [9].