Predictive medicine is a new philosophy in the healthcare and novel strategic activity aimed at a potential application of innovative biotechnologies in the prediction of human pathologies, a development of well-timed prevention and individual therapy-planning. Essential components of this approach include well-organised population screening protocols using novel diagnostic biomarkers of disease states, targeted prevention of common human pathologies such as Diabetes mellitus Type 2 and breast cancer, optimal treatment planning and personalised medicine, thereby resulting in substantial improvement of the quality-of-life.
Current healthcare practices essentially rely on emergence of signs and symptoms of human pathologies prior to initiation of interventional modalities. A major limitation of this approach relates to the fact that often the disease process has already taken its toll through manifestation of its complications. As a result, despite high costs associated with care of these individuals, long-term prognosis usually remains poor due to inadequate control of disease manifestations, treatment failure, disease-recurrence and the appearance of severe secondary complications, among others, thereby contributing to relatively low life-quality of the treated persons, high morbidity and mortality. Here we demonstrate some examples on both Diabetes care and Diagnostics and treatment of breast cancer.
The ever increasing number of diabetic patients presents a serious healthcare challenge to most industrialised countries and developing societies with a large population: every 10 seconds, one patient dies of diabetes-related consequences. Diabetic care faces a whole spectrum of problems including the necessity for population screening, targeted preventive measures, ethics, economics and broad dissemination of the issue-related information that still wait for a dramatic improvement in each of them. Currently we already recognise:
Diabetes Mellitus (DM) Type 2, historically characterised as an adult-onset disorder, now comprises approximately one-third of new DM-cases already in the second decade of life. Imbalanced nutrition and widespread ‘fast food’ consumption as well as low body activity in childhood currently result in the increasing prevalence of obesity in young people. Consequently, the mean age at diagnosis of DM Type 2 in young people is 12-14 years. Despite the current progress in individualised insulin therapy, the common onset of DM Type 2 in early adulthood breeds dramatic consequences linked with the early onset of diverse severe complications that are secondary to DM such as retinopathy, nephropathy, silent ischemia and dementia. The recent years have brought new knowledge concerning the predisposition to cancer in diabetics. The large population studies performed indicate an increased risk of liver, pancreas, bladder, digestive and urinary tracts, and endometrium cancer types in DM with some age-specific differences and gender-dependent preferences. Consequently, the costs of diabetes care are growing dramatically. In the USA, the cost burden compared for the years 2002 and 2007 grew from US$ 132 to 174 billion. These statistics do not include intangible costs (e.g. care provided by unpaid caregivers, pain and suffering) or individuals with undiagnosed diabetes or impaired fasting glucose.
Breast cancer is the most common cause of cancer death in female population with an average incidence rate of 10-12 per 100 women. Advanced stages of breast cancer lead to development of metastasis predominantly in lymph nodes, bone, lung, skin, brain and liver. In 2005, breast cancer led to 502,000 deaths (7 per cent of cancer deaths; almost 1 per cent of all deaths) worldwide. During the past three decades, the incidence of breast cancer continually increases worldwide. Although induced population screening by mammography and application of adjuvant therapies keep breast cancer mortality mostly unchanged or even persistently declined over last ten years, currently applied diagnostic approaches, however, are frequently unable to recognise early stages in tumour development that impair the outcome. The approach of breast-MRI is currently the most sensitive diagnostic tool for breast imaging. However, its specificity is limited resulting in a negative impact for surgical management in approximately 9 per cent of cases. Early diagnosis has been demonstrated to be highly beneficial for significantly enhanced therapy efficiency and possibly full recovery in breast cancer.
Predictive medicine is a new philosophy in the healthcare and an attractive subject for currently initiated research activities aimed at a potential application of innovative biotechnologies in the prediction of human pathologies, a development of well-timed prevention and individual therapy-planning. Novel strategies using predictive, preventive & personalised medicine are illustrated in Figure B compared to those of the currently existing healthcare systems in Figure A.
The major premise of the improved strategies is that initially, chronic pathologies are generally triggered at the molecular level followed by pathology-specific molecular events predisposing the potentially affected organs to certain pathologies long before organ damage and symptomatic manifestation of the disease. Therefore, detection of pathology-specific molecular patterns can create a well-founded basis for the predictive approaches desirable in good healthcare. It advocates the application of innovative biotechnologies to predict human pathologies, devise appropriate and timely preventive strategies and individualised treatment planning. As a result, predictive medicine offers great promise for the future practice of medicine. Essential components of this approach include well-organised population screening protocols using novel diagnostic biomarkers of disease states, targeted prevention of common human pathologies, optimal treatment planning and personalised medicine, thereby resulting in substantial improvement of the quality-of-life. This approach also offers the advantage of delivering care at potentially reduced costs to the population at large, and, as a result, addressing social and ethical issues related to access to and affordability of healthcare.
People from various walks of life and socio-economic status are increasingly demanding to be better informed of anticipated changes in their health status as they progress through life. Although not simple, it is now feasible to predict tissue / organ deregulation associated with predisposition to particular pathologies such as premature ageing, neurodegenerative processes, cardiovascular disorders and various cancers. Thus, high-accuracy protein-expression maps of human body fluids open new perspectives for early and even predictive molecular diagnostics of chronic disorders before the usual symptoms appear, and, therefore, allow well-timed prevention. Further, the minimally-invasive approach of expression profiling in blood holds the promise of a revolution in population screening, predictive disease diagnostics and prognostic indicators. An individual’s susceptibility and predisposition to premature ageing and common pathologies such as development of chronic complications in Type 2 diabetes mellitus, breast and prostate cancer can be discerned non-invasively. A broad distribution and a routine clinical utilisation of these advanced technological approaches could enable a significant portion of the population to reach the 100-year age limit yet remaining vibrant in excellent physical and mental health and as actively contributing members of society.
A large group of 60 leading experts from 16 countries has recently prepared the pioneering book on the predictive, preventive & personalised medicine to summarise the most advanced approaches in the branch ‘Predictive Diagnostics and Personalized Treatment: Dream or Reality?’ .
In closing, we hope that the information provided here will stimulate further discussions to address many issues in relation to the future practice of predictive and personalised medicine.
The mission of the ‘European association for predictive, preventive & personalised medicine
The decisive progress in the current healthcare can be achieved only by well-coordinated fulfilment of the following components that are crucial for the practical realisation of this new philosophy in healthcare:
These coordinated measures should be focussed on solving the accumulating problems in healthcare and the increasing, concomitant economical burden that societies face across the globe. The mission of the European Coordinator in this field is performed by the ‘European Association for Predictive, Preventive and Personalised Medicine’ (EPMA).
Following objectives are registered in Brussels by the ‘Statutes’ of the Association:
All EPMA-activities are summarised at www.epmanet.eu. As one can see at this website ‘Patient is in the Focus’ by EPMA, the real application of the innovative technologies for the predictive diagnostics, targeted preventive measures and personalised patient treatment in the European healthcare is the central idea of the Association.
This book is for everyone! On reading this book, you can learn a new philosophy in medicine, novel trends in healthcare and biomedical education. These may help you and your family to define your own way of creating a well chosen life-style. The book provides important information for individuals of various professional and scientific backgrounds. Professionals can consider the general concept of multidisciplinary approaches and learn the mindset of border areas and other scientific branches. A partial list of those who will especially benefit from the information provided in this book is as follows:
Professionals in conventional and molecular diagnostics, biomedicine, biotechnologies, ethics, and economics
