triterpenoids that are now in clinical trials, as well as for the new ones that Honda continues to develop. (See several multimedia with additional details about this longtime collaboration.)

Sporn is hopeful, too, but also admits to profound frustration. Now 73, he's been preaching the gospel of chemoprevention and receiving praise for his ideas for more than 30 years. In fact, he's even been called the "father of chemoprevention" for having coined the term "chemoprevention" in the 1970s. Yet neither medicine nor society in general has fully embraced chemoprevention.

"In recent years," says Leaf, "particularly in the last year, [Sporn] has gotten more and more frustrated with what he sees as the continuing growth of the problem, the cost of [cancer] drugs for treatment, and the lack of investment in the only model that can work. And by the way, this is a model that has worked in cardiovascular disease."

Since 1996, when Sporn wrote an article about the war on cancer for Lancet, he has been calling for the oncology community to follow the lead of the cardiovascular community.

Sporn is hopeful, too, but also admits to profound frustration. Now 73, he's been preaching the gospel of chemoprevention and receiving praise for his ideas for more than 30 years. In fact, he's even been called the "father of chemoprevention."

Cardiovascular deaths have plummeted over the past 30 years, largely because of an emphasis on prevention, Sporn argues. High blood pressure and high cholesterol are now universally accepted as precursors to cardiovascular disease and thus as warranting treatment with powerful and potentially dangerous drugs, such as statins. Even some of the most commonly used medications can have serious side effects. Aspirin, for example, can cause bleeding in the stomach and brain, kidney failure, and some kinds of strokes, according to the Food and Drug

Administration. But people take it because its beneficial effects outweigh the small risk of those side effects.

"We should ask why the oncology community and the public at large have been so resistant to" taking a chemopreventive approach with cancer, Sporn wrote. Why not develop drugs to treat the molecular and cellular changes that occur in tissues before a tumor develops?

"We're so obsessed," says Leaf, "with the sins of commission—of giving someone a drug and having one in a thousand, or one in 10,000, have a reaction that's terrible—that it blinds us, or prevents us from acting in the only way that we can, which is to try to prevent cancer development in large numbers of people."

Earlier this year, Leaf was chatting with Sporn about this very problem. "Everybody talks about risk-benefit," Sporn remembers Leaf

Since 1996, Sporn has been calling for the oncology community to follow the lead of the cardiovascular community. Cardiovascular deaths have plummeted over the past 30 years, largely because of an emphasis on prevention, Sporn argues.

telling him, but "that's posing the question the wrong way. It's not a risk versus benefit situation; it's a risk versus risk situation."

Sporn liked that idea so much that he used it in his AACR talk. "The real risk for the prospective cancer patient may be to do nothing," Sporn told the audience. If you have a strong family history of breast or colon cancer, for example, your risk may be exceptionally high. "So you must measure the risks of using chemoprevention," said Sporn, against "the risk of doing nothing."