Diet, nutrition and cancer prevention: where are we going from here?

Since the national declaration of the war on cancer three decades ago, research on carcinogenesis has yielded a tremendous knowledge base on cancer. Cancer cells are the result of multiple genetic defects resulting from exposure to environmental, dietary and infectious agents. Multistep and multistage carcinogenesis may span 20 y or more, a time that provides research and clinical opportunities to suppress this disease in its early and premalignant stages before clinical symptomatic, invasive stages. Where do we go from here? After this year's milestone of gene sequencing accomplishments, further research opportunities arise in pursuing studies on the mechanisms of the acquired capacities of cancer cells, including their limitless replicative potential, sustained angiogenesis and invasion and avoidance of apoptosis. With new DNA chip technology and functional proteomics, complex nutrient-gene interactions may now be investigated. Research on nutrient-gene interactions not only provides pathophysiologic mechanisms of cancer causation and prevention, but also improves the ability to conduct cancer surveillance, crucial in identifying at-risk populations. By combining chemoprevention approaches, from the use of single nutrients to multiple dietary constituents and functional foods, the scope of future cancer prevention strategies will be broadened. Research on eating behavior and changing dietary patterns must be included in any cancer prevention strategy. A new paradigm for diet, nutrition and cancer prevention can be developed using multidisciplinary approaches that include lifestyle and environmental changes, dietary modifications and physical activity consciousness to reduce the burden of cancer not only for high risk individuals but for the general population as well.