As scientists continue to make new breakthroughs in cancer treatment, an important field of study is how to prevent more people from receiving a cancer diagnosis in the first place.
Chemoprevention studies the use of medication, vaccines, surgery and other medical interventions that can help reduce the risk of developing cancer, or to keep cancer from recurring.
“We’re thinking about traditional pharmaceuticals and medications, both over-the-counter and prescription, and how they can possibly mitigate cancer risk,” said Dr. Lisa Barroilhet, a gynecologic oncologist who co-leads the UW Carbone Cancer Center’s Chemoprevention Disease-Oriented Team. “We often start with medications, but we also have surgical interventions that can be considered cancer prevention too.”
Barroilhet said much of chemoprevention research focuses on people who are already at higher risk of developing certain cancers, either through hereditary gene alterations or a strong family history of cancer.
“We focus on those patients because we know that the risk of cancer is so much higher than the general population that we’re going to know if an intervention is effective much faster,” Barroilhet said.
Population health scientists are also an important partner in chemoprevention research, creating the foundational data on cancer trends to highlight at-risk populations and what factors could be driving cancer risk.
Barroilhet became interested in chemoprevention research through her specialty as a gynecologic oncologist. She works with patients who have a high risk of ovarian cancer due to a mutation of their BRCA1 or BRCA2 genes. Right now, the preventive treatment is surgical removal of the ovaries, which can be a difficult choice for women who are in their 30s and 40s.
“That’s a big deal to a young person,” she said of ovary removal. “There are legitimate health risks with early menopause, never mind that they might not be able to have the number of kids they want to. These are huge things we’re taking away from healthy patients in the name of cancer prevention, and I just felt that, biologically, there has to be a better way.”
Barroilhet is leading research on the use of an antimalarial medication to promote healthy ovary cell function and hopefully delay the need for a removal surgery. The antimalarial medication blocks a specific part of cellular metabolism that is known to be abnormal in ovarian and other cancer types. Barroilhet hopes to bring this research into clinical testing in the next couple of years.
“I would love to offer my patients an option, even if it’s something they only take for a few years, so they can keep their ovaries longer and get closer to natural menopause,” she said. “I think the health benefits would be tremendous.”
Barroilhet also treats patients who develop cervical and vulvar cancers caused by human papillomavirus (HPV), a sexually-transmitted disease that can cause multiple other cancer types in men and women. There is a successful and safe vaccine against HPV, but Barroilhet notes that vaccination rates among eligible youth in Wisconsin and nationwide are low, so more education and advocacy is needed.
“Vaccines are clearly not enough in this space,” Barroilhet said.
UW Carbone’s chemoprevention research spans a variety of cancer types and includes vaccines to prevent prostate, breast and ovarian cancer development, a study on the use of an antiestrogen drug to prevent recurrence of uterine cancer, and the use of a topical medication to prevent anal cancer in patients with anal dysplasia caused by HPV.
UW Carbone also collaborates with several research institutions and is part of the National Cancer Institute’s Cancer Prevention Clinical Trials Network.
“You name the cancer, and we’re trying to prevent it,” Barroilhet said. “That’s another reason why I really enjoy running chemoprevention clinical trials, I learn so much about other cancers and you can see common pathways, common hypotheses and we can hopefully see some prevention drugs that work for a multitude of cancers.”
