Colon cancer control in high-risk patients such as those with hereditary polyposis and sporadic colon polyps is of growing importance as therapy modalities alone have not been fully effective in countering either the high incidence or low survival rate of colorectal cancer. The development of chemopreventive agents to prevent intraepithelial neoplasia such as benign adenomas and early neoplastic lesions represents a significant advance in clinical cancer prevention research.79 Clinical trials are the best means to identify the most-promising preventive agents for secondary prevention of colorectal cancer. Development of combination chemoprevention will be essential, just as combination chemotherapy has been so important in the treatment of invasive disease.60 It should be recognized, however, that intervention with nutritional supplements or diet modification alone might not be sufficient for secondary prevention of colorectal cancer. However, intervention by diet modification as recommended to the general population along with chemopreventive agents that have been shown to possess anticancer properties against colon carcinogenesis in preclinical models is an ideal strategy for secondary prevention of colon cancer in these high-risk individuals. One such modification is a series of logically arranged comprehensive studies to elucidate the efficacy of potential chemopreventive agents administered in conjuncture with a diet rich in n-3 PUFAs. This approach is extremely important when promising chemopreventive agents demonstrate significant efficacy but may produce toxic effects at higher doses. Clear delineation of the synergistic effects in laboratory studies will allow rational design of mechanistically driven combination therapies for optimal clinical effects. This is a promising area for future prevention studies in high-risk individuals.
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