Foreword

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The complete sequencing of the human genome in conjunction with increasingly sophisticated molecular biological techniques have dramatically increased our understanding of the genetic events leading to carcinogenesis. Today, new cancer-related genetic changes seem to be described almost daily and the full potential of genetic profiling of individuals for cancer risk has yet to be realized. Although such profiling will represent an enormous advance, the full therapeutic implications of this technology are only beginning to be understood. For the surgeon, these advances have the potential to not only alter the role of surgery in traditional treatment paradigms but also offer the possibility of prophylactic intervention in at-risk individuals before cancer development. Although this latter approach may eventually be used in individuals at risk for the development of sporadic tumors, today it is generally reserved for prevention in patients with a hereditary disposition to specific cancers. In this issue of Current Problems in Surgery, Dr. Ismail Jatoi from the University of Texas Health Science Center in San Antonio and colleagues from around the country have written a masterful overview on this topic entitled, “The Role of Surgery in Cancer Prevention.” Beginning with a broad overview of cancer genetics, they then discuss the use of surgery for cancer prevention in individuals with hereditary cancers of the breast, stomach, thyroid, and colon. In each case, they review the predisposing genetic changes and the role of genetic testing and counseling. Benefits and risks of such an approach are clearly outlined and surgical options and outcomes are discussed in considerable detail. This thorough review should become an essential resource for all physicians caring for these patients and their families. It establishes a foundation for considering surgical options in other settings as genetic cancer risk profiling becomes a reality.