@article{234d4155f2364be2b4c4f0e4d97ef6d2,
title = "Colorectal Cancer Chemoprevention - An Overview of the Science",
abstract = "The development and dissemination of sophisticated detection technologies have recently exposed the high prevalence of preinvasive colorectal neoplasia in the adult U.S. population. Although cancer screening and surveillance provide opportunities for risk stratification, they achieve risk reduction only when coupled with effective interventions. This review surveys the lead compounds for colorectal cancer prevention and the measures by which they may be prioritized for clinical testing. Clinical trials remain the rate-limiting step in agent development, and novel trial designs are needed to hasten agent identification and testing for cancer prevention. Innovative research models include the nesting of prevention end points within cancer treatment trials and within trials testing promising preventive compounds intended for nononcologic indications.",
author = "Hawk, {Ernest T.} and Asad Umar and Viner, {Jaye L.}",
note = "Funding Information: Few studies have examined the association between estrogen-containing compounds and colorectal adenomas, but available data suggest protective effects against this early phase of carcinogenesis. 216–218 The different mechanisms of chemopreventive activity proposed for estrogens include direct or indirect reductions in secondary bile acid production and inhibition of insulin-like growth factor I, which seems to stimulate epithelial proliferation. 219 The Women{\textquoteright}s Health Initiative, partially sponsored by the US National Cancer Institute, is the largest trial of hormone-replacement therapy conducted to date. 41 Although the Women{\textquoteright}s Health Initiative corroborated epidemiological data on the protective effects of estrogen against CRC, in July 2002 the Data Safety and Monitoring Board prematurely halted the placebo-controlled part of the study that compared the use of conjugated equine estrogen plus medroxyprogesterone acetate vs. placebo in 16,608 postmenopausal women with an average follow-up of 5.6 years. This decision was based on an increased overall risk for stroke (stroke hazard ratio [HR], 1.31; 95% CI, 1.02–1.68; ischemic stroke HR, 1.44; 95% CI, 1.09–1.90) 41,218,220 among participants taking conjugated equine estrogen plus medroxyprogesterone acetate. ",
year = "2004",
month = may,
doi = "10.1053/j.gastro.2004.03.002",
language = "English (US)",
volume = "126",
pages = "1423--1447",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "5",
}