Faupel-Badger et al. provide a conceptual framework for defining “precancer”, which refers to early-stage tissue abnormalities with molecular and phenotypic alterations that are poised for cancer progression. A consistent definition across organ types is challenging, since not all precancerous lesions develop into cancer. The definition of precancer is evolving due to new technologies, and should include a connection to outcomes, changes in the PME, and integration of spatial omics data. It also must be dynamic, adaptable, and clinically relevant. This interdisciplinary approach could improve early diagnosis, risk stratification, and early intervention strategies.
Contributed by Shishir Pant
ABSTRACT: The term 'precancer' typically refers to an early stage of neoplastic development that is distinguishable from normal tissue owing to molecular and phenotypic alterations, resulting in abnormal cells that are at least partially self-sustaining and function outside of normal cellular cues that constrain cell proliferation and survival. Although such cells are often histologically distinct from both the corresponding normal and invasive cancer cells of the same tissue origin, defining precancer remains a challenge for both the research and clinical communities. Once sufficient molecular and phenotypic changes have occurred in the precancer, the tissue is identified as a 'cancer' by a histopathologist. While even diagnosing cancer can at times be challenging, the determination of invasive cancer is generally less ambiguous and suggests a high likelihood of and potential for metastatic disease. The 'hallmarks of cancer' set out the fundamental organizing principles of malignant transformation but exactly how many of these hallmarks and in what configuration they define precancer has not been clearly and consistently determined. In this Expert Recommendation, we provide a starting point for a conceptual framework for defining precancer, which is based on molecular, pathological, clinical and epidemiological criteria, with the goal of advancing our understanding of the initial changes that occur and opportunities to intervene at the earliest possible time point.
Author Info: (1) Division of Cancer Prevention, National Cancer Institute, NIH, Rockville, MD, USA. (2) Division of Cancer Prevention, National Cancer Institute, NIH, Rockville, MD, USA. (3) Di
Author Info: (1) Division of Cancer Prevention, National Cancer Institute, NIH, Rockville, MD, USA. (2) Division of Cancer Prevention, National Cancer Institute, NIH, Rockville, MD, USA. (3) Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. (4) Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. (5) Department of Medicine, Boston University School of Medicine, Boston, MA, USA. (6) Department of Medicine and Genetics, McDonnell Genome Institute, and Siteman Cancer Center, Washington University in St Louis, Saint Louis, MO, USA. (7) Department of Pathology, Urology and Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. (8) Department of Translational Molecular Pathology, Sheikh Ahmed Center for Pancreatic Cancer Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. (9) Division of Pathology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. (10) Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. (11) Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. (12) Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. (13) Department of Medicine, University of California, La Jolla, San Diego, CA, USA. (14) Department of Gynecological Oncology, Moffitt Cancer Center, Tampa, FL, USA. (15) Patrick G Johnson Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK. (16) Division of Hematology, Mayo Clinic, Rochester, MN, USA. (17) Department of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. (18) Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, MA, USA. (19) Division of Cancer Prevention, National Cancer Institute, NIH, Rockville, MD, USA. srivasts@mail.nih.gov.
