A key element of the future will be the rapid emergence of new technologies, some of which may have important impacts on several aspects of cancer prevention, diagnosis and treatment. Remarkable strides have been made in a number of technology fields but their application to cancer medicine will take another decade or so. It was thought to be of interest , nevertheless, to indicate how new methodologies might begin to influence the areas of cancer detailed in this Code.

The most readily applicable new technologies are in imaging, molecular typing of tissues , and intelligent drug design.

It is possible that spiral CT examination of the lungs of smokers might be shown to dramatically improve early detection of resectable lung tumours. On the other hand it is quite unlikely that
sophisticated second generation nuclear magnetic resonance imaging or positron emission tomography scanning will be routinely applied to populations, even those at high risk Rather they could be useful in characterising suspicious lesions and, of course in delineating primary tumours and suspect metastases. Virtual colonoscopy, on the other hand, may prove to be a valuable way to screen for bowel cancer, as may stool examination, not for blood but for the presence of mutated genes in sloughed cells.

Unravelling of the molecular constitution of tissues is already a reality, though not in any routine application. Thus tumour cells in small numbers can be arrayed by gene and protein Chip technology to reveal a molecular signature, specific to that tumour. Perturbed patterns of gene and protein expression have already been used to re-classify tumours, and to correlate with eventual prognosis. Certain drug treatments and radiation regimes have been correctly predicted to be ineffective in the environment of specific genetic mutations. And, of course, a couple of specific examples exist where targeted therapeutics, antibodies ( such as trastuzumab against her2-neu moieties) and small molecules (such as imatinib against bcr-abl kinases) have become effective treatments. In these and some other instances, gene and protein technology has been used to monitor treatment, providing extremely precise molecular endpoints.

Molecular examination of normal cells in a cancer patient may also give a guide to the metabolic fate of a range of medicines . Using this information a number of drugs may be discarded as inappropriate for that person. The era of truly tailor-made treatment may not be far off.

The new technologies mentioned above may provide opportunities for development of new diagnostics e.g. for virus-associated malignancies; they may be helpful in analysis of large population-based sets of tissues and offer new insights into mechanisms of interaction between environmental factors, e.g. dietary components, and genotype; and they may be helpful in selection of high risk volunteers for specific tailored chemoprevention trials. All told, the future appears to be full of bright promise in Cancer Control.