The Social Transformation of American Medicine.

Abstract

before a chemical can initiate the carcinogenic process in such tissues.This might well be an important factor in the very high incidence of liver cancer in many countries in Asia and Africa.Although a close association with exposure to hepatitis B virus is now widely appreciated, there is good evidence that liver cell damage may be quite important.Thus, cellular injury induced by any agent or associated with other diseases such as liver cirrhosis, chronic pancreatitis or chronic cystitis might well play important roles in facilitating the initiation of cancer development in the organs or tissues in which normal cell proliferation is minimal or absent.This shows the type of interplay between known factors that probably plays a role in determining the susceptibility of persons to the carcinogenic conse- quences of exposure to chemical carcinogens.A similar delineation of important modulating factors might be- come possible for later steps in the carcinogenic process, such as those associated with promotion and progression.As physicians, the challenge lies in iden- tifying those specific factors that modulate against initi- ation or subsequent steps in the development of cancer.Their study could well have a major influence in de- vising a rational and acceptable way to prevent some forms of cancer.

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