- CCAV —
- clear cell adenocarcinoma of the vagina
- DES —
This interesting series of articles on Opportunities for Cancer Prevention During Early Life brings many ideas for the primary prevention of cancer in childhood, or in adults due to early life events. The economic burden not only of cancer mortality but also of lifelong morbidity among cancer survivors, as shown by Guy et al,1 raises the importance of this critical public health issue. The topics of these articles were developed during online seminars with the pioneers in this area, some of whom authored the articles. They reflect the determinants of health diagrammed so eloquently in Healthy People 2020.2 Broadly, the determinants of health outcomes are biology/genetics, the physical environment, individual behavior, the social environment, and health services. The articles have been grouped according to these categories. For example, the article by Terry and Forman3 focuses on interventions at the individual level, and the article by Massetti et al,4 focuses on interventions aimed at social determinants.
Classically, mutagenesis was the first basic mechanism clearly identified for carcinogenesis, and either inherited mutations or the mutagenesis of agents, such as tobacco and radiation, were the focus. Viral infections also have long been recognized to be involved with certain cancers. Our current models for carcinogenicity recognize that, for most cancers, multiple stages are required to not only initiate the cancer but also to elude biological mechanisms for repairing DNA, immune surveillance, and other natural defenses against cancer. One carcinogen, diethylstilbestrol (DES), did not neatly fit either the mutagen or viral hypotheses,5,6 and we now understand that in addition to inherited or acquired genetic susceptibilities, a basic mechanism for carcinogenesis due to …
Address correspondence to Cynthia F. Bearer, MD, PhD, Division of Neonatology, Department of Pediatrics, University of Maryland, School of Medicine, 110 South Paca St, 8th Floor, Baltimore, MD 21211. E-mail: