Cancer as an endocrine problem

Many of the most common cancers that blight our societies are very rare in other large populations in the world; studies of migrants exclude a simple genetic explanation for these wide geographical variations and imply that environmental exposures are key determinants of the development of these cancers. The most heavily implicated factor is nutrition. There are many other clinical indicators that nutrition, energy balance and metabolic status are perturbed in large numbers of individuals in ‘Westernized’ societies. Many of the tissue morbidities associated with metabolic disturbance are mediated by the consequent hormonal perturbations, and it is likely that these endocrine controls also mediate the effects of nutrition and metabolic status on the development of many clinical cancers. The recent characterization of the genomic landscape of breast and colorectal cancers have established that a few cell signalling pathways are critical for the clinical course of these cancers, in particular cell signalling pathways that are also central to the regulation of cell metabolism. These signalling pathways are normally under hormonal control, and again this evidence suggests that these hormonal controls may determine the context that is permissive for the progression of clinical cancers. This new understanding indicates that many cancers are potentially preventable, and that nutrition, metabolic and endocrine interventions are the most promising strategies for disease prevention.