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The long history of a developing cancer shows that many steps are involved between the first initiated cell and metastatic cancer. For every step, it is conceivable that medication taken by subjects at risk of a particular type of cancer might reduce the incidence of this cancer. Clinical studies are difficult to set up: a great number of healthy subjects would be concerned, the medication would need to be of low or no toxicity, it should be easy to deliver andthe result should be demonstrated by randomised studies.

Some studies have given hope for a chemo-prevention of cancer :

• Administration of tamoxifen (anti-oestrogen) in the prevention of breast carcinoma among healthy women with important familial risks: the results were positive in one major American study (NSABP Breast Cancer Prevention Trial P-1) and negative in two European studies (IBIS-1 study and Royal Marsden Hospital trial)
• Administration of another anti-oestrogen (raloxifen) used for prevention of osteoporosis in post-menopausal women or CORE trial with positive effect in the prevention of endometrial adenocarcinoma (ASCO 2005).
• Administration of an anti-androgen (finasteride) for the prevention of prostate cancer (see the paper in N Engl J Med, 2003, 349, 3, 213)
• Administration of non steroidal anti-inflammatory drugs or aspirin for the prevention of colon carcinoma,
• Multiple disappointing studies with retinoids for the prevention of head and neck cancer.

It is too early to say whether such studies will have an impact on the incidence or the mortality of the cancers for which prevention is carried out.