1. Precancer Workshop Sponsored by Division of Cancer Biology, NCI and Department of Pathology, George Washington University Medical School November 8-9, 2004 Overview – Jules Berman, Ph.D., M.D., Cancer Diagnosis Program, NCI

2. Precancers are the morphologically identifiable lesions that precede invasive cancers. __ agree __ disagree

3. In theory, the identification and elimination of precancers would lead to the eradication of most human cancers. __ agree __ disagree

4. Most clinicians and health provider organizations already have a good understanding of what lesions are precancers and what lesions are not precancers. __ agree __ disagree

5. Most researchers have a pretty good idea of the biologic properties that distinguish precancers from fully developed cancers. __ agree __ disagree

6. Precancers do not exist as entitities separable from cancers. The lesions that are called precancers are really just small or early cancers that have not yet invaded or metastasized. __ agree __ disagree

7. Precancers exist but most of the lesions people label as precancers are spontaneously regressing foci, and not truly precancerous. __ agree __ disagree

8. Another term for precancer is intraepithelial neoplasia. Therefore, the concept of precancers is narrow, applying only to some epithelial tumors. __ agree __ disagree

9. The term "precancer" includes different biological classes of lesions. For instance, adenomas, myelodysplasias, microscopic intraepithelial neoplasias, and diffuse atypical hyperplasias are all very different classes of precancers. __ agree __ disagree

10. There is no need to develop a comprehensive precancer classification. It’s already been done by the WHO. __ agree __ disagree

11. It is not generally worthwhile to screen for precancers because the small subset of precancers that will progress to cancer can't be distinguished from the non-progressing lesions. __ agree __ disagree

12. Prophylactic chemotherapy makes no sense for precancers. Nobody will accept chemotherapy for a tumor that they don’t yet have. __ agree __ disagree

13. It is not worthwhile trying to develop surgical methods to excise precancers. There are too many of them and most are not easily detectable or amenable to surgical treatment. __ agree __ disagree

14. The precancers are not suitable lesions for research. They are so small that it is impossible to obtain enough tissue for useful experimental studies. __ agree __ disagree

15. There are currently no useful mouse models for human precancers. Mice are short- lived animals with an accelerated carcinogenesis pathway that does not typically involve an identifiable precancer lesion. __ agree __ disagree

16. At this time, there is no regulatory infrastructure that will permit us to develop treatment protocols for the precancers. __ agree __ disagree

17. When you eliminate a precancer, you’re preventing the occurrence of a cancer. Therefore, methods of treating precancers fall under the general area of cancer prevention, not cancer treatment __ agree __ disagree

18. If you treat a precancer with medicine or surgery, you are treating a neoplastic condition, and this research falls in the general area of cancer treatment, not cancer prevention. __ agree __ disagree

19. The National Cancer Institute already supports precancer research and provides funds commensurate with the importance of the field. __ agree __ disagree

20. The purpose of Workshop Establish Precancer as a distinct area of scientific research with its own set of: 1. basic biologic principles 2. fundamental research questions 3. translational research objectives and has proven ability to reduce the number of cancer deaths.