53 96
I
believe
the
future
of
screening
strategy
is
hidden
in
DNA. Cancer
is
a multifactorial disease
that
arises
from
the
complex
interplay
between
genetic
and
environmental
factors. Genetic polymorphism
is defined as
the presence of
different
allele
sequences
for
a
single
gene;
it
is
sometimes
linked
to
variations
in
the
expression of
constitutive DNA.
Susceptibility means an
increased
risk
conferred by one or
more polymorphisms (allele
types) of a given gene or genes
that
expose
the
individual,
family,
or
group
of
persons
(ethnic or geographic variations)
to
the genotoxic effects of
environmental
carcinogens.
Differences
in
the
ability
to
activate
carcinogens may
contribute
to host
susceptibility
and may
be
associated with
the
risk
of
BCa
and
RCC.
The
environmental
risk
factors
for
developing
BCa
and
RCC,
such
as
smoking,
are
common,
although
only
a
fraction
of
people
exposed
to
these
risks
eventually
develop
these
diseases.
Genomewide
association
studies
(GWASs) were
recently
performed
for
RCC
and
BCa
[11–15] .The
GWAS
approach
allows
a
search
for
novel
susceptibility
loci
throughout
the
genome
in a hypothesis-freemanner.
In recent years, GWASs
have
emerged
as
a
powerful
approach
in
the
discovery
of
genetics underlying
complex
traits
such
as
cancer.
Diagnostic
tools
based
on DNA
alterations
and
that
can
provide high
specificity
and
sensitivity would
clearly
be
of
enormous benefit
to patients.
Screening
for RCC
and BCa
in
smokers
appears
to
be
too broad
of
a
strategy
in 2014,
and
the appropriate method
is not
to screen only highly exposed
patients
(tobacco)
but
to
screen
only
those
patients
(with
DNA
susceptibility) who are
likely
subsequently
to develop
the
disease.
Until
these
tests
are
available,
smoking
avoidance
and
smoking
cessation
are
the
two most
critical
and
realistic
policies
to
promote
in
2014.
Preventing
BCa
and
RCC
is
certainly
the
most
important
approach
to
reduce
their
incidences
and
patient
mortality.
Therefore,
the
World
Urologic
Oncology
Federation
has
initiated
the
Global
Bladder
Cancer
Prevention
Program
with
the
goal
of
integrating
smoking
cessation
into
urologic
practices
as
a
primary
prevention.
Conflicts
of
interest:
The
author
has
nothing
to
disclose.
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