Abstract
Background: Cancer is the second leading cause of death worldwide next to cardiovascular diseases. Despite the advancement in screening, early diagnosis, and development in treatment technology in last several decades, cancer incidence overall, particularly that of gastrointestinal (GI) cancers, is far from being controlled, and is expected to increase worldwide. Summary: Although numerous preclinical and population-based clinical studies have already made important progress in restraining the overall cancer incidence and mortality, the full potential of preventive strategy is still far from being realized, and remains at an early stage. There are several major challenges regarding this issue, and one of the crucial challenges is to maintain the balance between risks and benefits. As a result of past investments, primary prevention nowadays include the integration of various activities such as lifestyle changes to reduce risk, screening to detect early lesions, vaccines and preventive therapies aimed to actively interrupt the carcinogenic pathway. Long-term aspirin use seems to have the largest potential effect on the general population on cancer incidence and mortality overall, especially GI cancers. Helicobacter pylori eradication reduces the risk for gastric cancer and is advocated regardless of the symptoms and stage of disease. Metformin and statins are promising in cancer prevention in patients with type 2 diabetes. Vitamin D supplementation is promising in the prevention of colorectal adenoma recurrence. Key Message: However, additional studies are warranted to establish the potential of various agents and to identify more specific and highly targeted new agents for chemoprevention in digestive oncology.
References
1.
Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, Brenner H, et al.; Global Burden of Disease Cancer Collaboration. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 Cancer Groups, 1990 to 2015. A systematic analysis for the Global Burden of Disease Study. JAMA Oncol. 2017 Apr 1; 3(4): 524-548.
2.
Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, et al.; GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct; 388(10053): 1659–724.
3.
Peery AF, Crockett SD, Barritt AS, Dellon ES, Eluri S, Gangarosa LM, Jensen ET, Lund JL, Pasricha S,Runge T, Schmidt M, Shaheen NJ, Sandler RS. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015 Dec; 149(7): 1731–1741.e3.
4.
National Cancer Institute. Surveillance, Epidemiology, and End Results program (SEER) Cancer Statistics Review (CSR) 1975–2015 [cited 2018 April 16].
5.
Sporn MB. Approaches to prevention of epithelial cancer during the preneoplastic period. Cancer Res. 1976 Jul; 36(7 PT 2): 2699–702.
6.
Chun KS, Kim EH, Lee S, Hahm KB. Chemoprevention of gastrointestinal cancer: the reality and the dream. Gut Liver. 2013 Mar; 7(2): 137–49.
7.
Bisgaard ML, Fenger K, Bülow S, Niebuhr E, Mohr J. Familial adenomatous polyposis (FAP): frequency, penetrance, and mutation rate. Hum Mutat. 1994; 3(2): 121–5.
8.
Guillem JG, Wood WC, Moley JF, Berchuck A, Karlan BY, Mutch DG, et al.; ASCO; SSO. ASCO/SSO review of current role of risk-reducing surgery in common hereditary cancer syndromes. J Clin Oncol. 2006 Oct; 24(28): 4642–60.
9.
Chang MH, You SL, Chen CJ, Liu CJ, Lai MW, Wu TC, et al.; Taiwan Hepatoma Study Group. Long-term effects of hepatitis B immunization of infants in preventing liver cancer. Gastroenterology. 2016 Sep; 151(3): 472–480.e1.
10.
Cuzick J. Preventive therapy for cancer. Lancet Oncol. 2017; 18:e472–82.
11.
American Cancer Society. Cancer facts and figures 2018. Atlanta: American Cancer Society 2018. .
12.
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003 Apr; 348(17): 1625–38.
13.
Trock B, Lanza E, Greenwald P. Dietary fiber, vegetables, and colon cancer: critical review and meta-analyses of the epidemiologic evidence. J Natl Cancer Inst. 1990 Apr; 82(8): 650–61.
14.
Park Y, Hunter DJ, Spiegelman D, Bergkvist L, Berrino F, van den Brandt PA, et al. Dietary fiber intake and risk of colorectal cancer: a pooled analysis of prospective cohort studies. JAMA. 2005 Dec; 294(22): 2849–57.
15.
Gaard M, Tretli S, Løken EB. Dietary factors and risk of colon cancer: a prospective study of 50,535 young Norwegian men and women. Eur J Cancer Prev. 1996 Dec; 5(6): 445–54.
16.
Norat T, Bingham S, Ferrari P, Slimani N, Jenab M, Mazuir M, et al. Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. J Natl Cancer Inst. 2005 Jun; 97(12): 906–16.
17.
Gerhardsson de Verdier M, Hagman U, Peters RK, Steineck G, Overvik E. Meat, cooking methods and colorectal cancer: a case-referent study in Stockholm. Int J Cancer. 1991 Oct; 49(4): 520–5.
18.
Keum NN, Bao Y, Smith-Warner SA, Orav J, Wu K, Fuchs CS, Giovannucci EL. Association of physical activity by type and intensity with digestive system cancer risk. JAMA Oncol. 2016 Sep 1; 2(9): 1146–53.
19.
Wang XQ, Terry PD, Yan H. Review of salt consumption and stomach cancer risk: epidemiological and biological evidence. World J Gastroenterol. 2009 May; 15(18): 2204–13.
20.
Chan AT, Giovannucci EL. Primary prevention of colorectal cancer. Gastroenterology. 2010 Jun; 138(6): 2029–2043.e10.
21.
Friedenreich CM, Orenstein MR. Physical activity and cancer prevention: etiologic evidence and biological mechanisms. J Nutr. 2002 Nov; 132(11 Suppl): 3456S–64S.
22.
World Cancer Research Fund/American Institute for Cancer Research. Continuous update project report. Food, nutrition, physical activity, and the prevention of colorectal cancer. [cited 2015 Sept 13]. Available from: http://wcrf.org/.
23.
Samad AK, Taylor RS, Marshall T, Chapman MA. A meta-analysis of the association of physical activity with reduced risk of colorectal cancer. Colorectal Dis. 2005 May; 7(3): 204–13.
24.
Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Krstic G, Wetterslev J, et al. Vitamin D supplementation for prevention of cancer in adults. Cochrane Database Syst Rev. 2014 Jun; 6(6):CD007469.
25.
Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA. 2007 Feb; 297(8): 842–57.
26.
Steinbach G, Lynch PM, Phillips RK, Wallace MH, Hawk E, Gordon GB, et al. The effect of celecoxib, a cyclooxygenase-2 inhibitor, in familial adenomatous polyposis. N Engl J Med. 2000 Jun; 342(26): 1946–52.
27.
Henney JE. Celecoxib indicated for FAP. JAMA. 2000; 283(9): 1131.
28.
Food and drug administration. Withdrawal of approval of familial adenomatous polyposis (FAP) indication for Celebrix (Pfizer, Inc.). Fed Regist. 2012; 34052.
29.
Veettil SK, Lim KG, Ching SM, Saokaew S, Phisalprapa P, Chaiyakunapruk N. Effects of aspirin and non-aspirin nonsteroidal anti-inflammatory drugs on the incidence of recurrent colorectal adenomas: a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials. BMC Cancer. 2017 Nov; 17(1): 763.
30.
Baron JA, Cole BF, Sandler RS, Haile RW, Ahnen D, Bresalier R, et al. A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med. 2003 Mar; 348(10): 891–9.
31.
Benamouzig R, Deyra J, Martin A, Girard B, Jullian E, Piednoir B, et al. Daily soluble aspirin and prevention of colorectal adenoma recurrence: one-year results of the APACC trial. Gastroenterology. 2003 Aug; 125(2): 328–36.
32.
Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E, Keresztes R, et al. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med. 2003 Mar; 348(10): 883–90.
33.
Antithrombotic Trialists’ (ATT) Collaboration. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney P, Meade T, Patrono C, Roncaglioni MC, Zanchetti A. Aspirin in the primary and secondary prevention of -vascular disease: collaborative meta-analysis of -individual participant data from randomised trials. Lancet. 2009 May 30; 373(9678): -1849–60.
34.
Dehmer SP, Maciosek MV, Flottemesch TJ, LaFrance AB, Whitlock EP. Aspirin for the primary prevention of cardiovascular disease and colorectal cancer: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2016 Jun; 164(12): 777–86.
35.
Bibbins-Domingo K; U.S. Preventive Services Task Force. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016 Jun; 164(12): 836–45.
36.
Chan AT, Ladabaum U. Where do we stand with aspirin for the prevention of colorectal cancer? The USPSTF recommendations. Gastroenterology. 2016 Jan; 150(1): 14–8.
37.
Flossmann E, Rothwell PM; British Doctors Aspirin Trial and the UK-TIA Aspirin Trial. Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomised and observational studies. Lancet. 2007 May; 369(9573): 1603–13.
38.
Chan AT. COX-2 expression in adenoma: an imperfect marker for chemoprevention. Gut. 2010 May; 59(5): 568–9.
39.
Benamouzig R, Uzzan B, Martin A, Deyra J, Little J, Girard B, et al.; APACC Study Group. Cyclooxygenase-2 expression and recurrence of colorectal adenomas: effect of aspirin chemoprevention. Gut. 2010 May; 59(5): 622–9.
40.
Dubois RN. Review article: cyclooxygenase—a target for colon cancer prevention. Aliment Pharmacol Ther. 2000 Apr; 14 Suppl 1: 64–7.
41.
Eberhart CE, Coffey RJ, Radhika A, Giardiello FM, Ferrenbach S, DuBois RN. Up-regulation of cyclooxygenase 2 gene expression in human colorectal adenomas and adenocarcinomas. Gastroenterology. 1994 Oct; 107(4): 1183–8.
42.
Ogino S, Chan AT, Fuchs CS, Giovannucci E. Molecular pathological epidemiology of colorectal neoplasia: an emerging transdisciplinary and interdisciplinary field. Gut. 2011 Mar; 60(3): 397–411.
43.
Kopp E, Ghosh S. Inhibition of NF-kappa B by sodium salicylate and aspirin. Science. 1994 Aug; 265(5174): 956–9.
44.
Schwenger P, Bellosta P, Vietor I, Basilico C, Skolnik EY, Vilcek J. Sodium salicylate induces apoptosis via p38 mitogen-activated protein kinase but inhibits tumor necrosis factor-induced c-Jun N-terminal kinase/stress-activated protein kinase activation. Proc Natl Acad Sci USA. 1997 Apr; 94(7): 2869–73.
45.
Martinez ME, O’Brien TG, Fultz KE, Babbar N, Yerushalmi H, Qu N, et al. Pronounced reduction in adenoma recurrence associated with aspirin use and a polymorphism in the ornithine decarboxylase gene. Proc Natl Acad Sci USA. 2003 Jun; 100(13): 7859–64.
46.
Gala MK, Chan AT. Molecular pathways: aspirin and Wnt signaling-a molecularly targeted approach to cancer prevention and treatment. Clin Cancer Res. 2015 Apr; 21(7): 1543–8.
47.
Drew DA, Cao Y, Chan AT. Aspirin and colorectal cancer: the promise of precision chemoprevention. Nat Rev Cancer. 2016 Mar; 16(3): 173–86.
48.
Rothwell PM, Wilson M, Elwin CE, Norrving B, Algra A, Warlow CP, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet. 2010 Nov; 376(9754): 1741–50.
49.
Emilsson L, Holme Ø, Bretthauer M, Cook NR, Buring JE, Løberg M, et al. Systematic review with meta-analysis: the comparative effectiveness of aspirin vs. screening for colorectal cancer prevention. Aliment Pharmacol Ther. 2017 Jan; 45(2): 193–204.
50.
Nishihara R, Lochhead P, Kuchiba A, Jung S, Yamauchi M, Liao X, et al. Aspirin use and risk of colorectal cancer according to BRAF mutation status. JAMA. 2013 Jun; 309(24): 2563–71.
51.
Armaghany T, Wilson JD, Chu Q, Mills G. Genetic alterations in colorectal cancer. Gastrointest Cancer Res. 2012 Jan; 5(1): 19–27.
52.
Nan H, Hutter CM, Lin Y, Jacobs EJ, Ulrich CM, White E, et al.; CCFR; GECCO. -Association of aspirin and NSAID use with risk of colorectal cancer according to genetic variants. JAMA. 2015 Mar; 313(11): 1133–42.
53.
Hill MJ, Morson BC, Bussey HJ. Aetiology of adenoma—carcinoma sequence in large bowel. Lancet. 1978 Feb; 1(8058): 245–7.
54.
Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet. 2011 Jan; 377(9759): 31–41.
55.
Cao Y, Nishihara R, Wu K, Wang M, Ogino S, Willett WC, et al. Population-wide impact of long-term use of aspirin and the risk for cancer. JAMA Oncol. 2016 Jun; 2(6): 762–9.
56.
Ye X, Fu J, Yang Y, Gao Y, Liu L, Chen S. Frequency-risk and duration-risk relationships between aspirin use and gastric cancer: a systematic review and meta-analysis. PLoS One. 2013 Jul; 8(7):e71522.
57.
Cuzick J, Thorat MA, Bosetti C, Brown PH, Burn J, Cook NR, et al. Estimates of benefits and harms of prophylactic use of aspirin in the general population. Ann Oncol. 2015 Jan; 26(1): 47–57.
58.
Elwood PC, Morgan G, Galante J, Chia JW, Dolwani S, Graziano JM, et al. Systematic review and meta-analysis of randomised trials to ascertain fatal gastrointestinal bleeding events attributable to preventive low-dose aspirin: no evidence of increased risk. PLoS One. 2016 Nov; 11(11): e0166166.
59.
Spence AD, Busby J, Johnston BT, Baron JA, Hughes CM, Coleman HG, et al. Low-dose aspirin use does not increase survival in 2 independent population-based cohorts of patients with esophageal or gastric cancer. Gastroenterology. 2018 Mar; 154(4): 849–860.e1.
60.
Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. European Helicobacter and Microbiota Study Group and Consensus panel. Management of Helicobacter pylori infection–the Maastricht V/Florence Consensus Report. Gut. 2017 Jan; 66(1): 6–30.
61.
Song H, Ekheden IG, Zheng Z, Ericsson J, Nyrén O, Ye W. Incidence of gastric cancer among patients with gastric precancerous lesions: observational cohort study in a low risk Western population. BMJ. 2015 Jul; 351: h3867.
62.
Nakamura S, Sugiyama T, Matsumoto T, Iijima K, Ono S, Tajika M, et al.; JAPAN GAST Study Group. Long-term clinical outcome of gastric MALT lymphoma after eradication of Helicobacter pylori: a multicentre cohort follow-up study of 420 patients in Japan. Gut. 2012 Apr; 61(4): 507–13.
63.
IARC Working Group Reports. Helicobacter pylori eradication as a strategy for preventing gastric cancer. World Health Organization. 2014: 8.
64.
Ford AC, Forman D, Hunt RH, Yuan Y, Moayyedi P. Helicobavter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ. 2014; 348:g3174.
65.
Choi IJ, Kook MC, Kim YI, Cho SJ, Lee JY, Kim CG, et al. Helicobacter pylori therapy for the prevention of metachronous gastric cancer. N Engl J Med. 2018 Mar; 378(12): 1085–95.
66.
Akinyemiju T, Abera S, Ahmed M, Alam N, Alemayohu MA, Allen C, et al.; Global Burden of Disease Liver Cancer Collaboration. The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level. JAMA Oncol. 2017 Dec; 3(12): 1683–91.
67.
Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul JL, et al.; European Association for the Study of the Liver. Electronic address: [email protected]; European Association for the Study of the Liver. European Association for the Study of the liver. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol. 2018 Jul; 69(1): 182–236.
68.
European Association for the Study of the liver. EASL Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017 Aug; 67(2): 370-398.
69.
Pawlotsky JM, Negro F, Aghemo A, Berenguer M, Dalgard O, Dusheiko G, et al.; European Association for the Study of the Liver. Electronic address: [email protected]; European Association for the Study of the Liver. European Association for the Study of the liver. EASL Recommendations of treatment of hepatitis C 2018. J Hepatol. 2018 Aug; 69(2): 461–511.
70.
European Union HCV Collaborators. Hepatitis C virus prevalence and level of intervention required to achive the WHO targets for elimination of intervention required to achieve the WHO targets for elimination in the European Union by 2030: a modelling study. Lancet Gastroenterol Hepatol. 2017; 2: 325–36.
71.
Evans JM, Donnelly LA, Emslie-Smith AM, Alessi DR, Morris AD. Metformin and reduced risk of cancer in diabetic patients. BMJ. 2005 Jun; 330(7503): 1304–5.
72.
Currie CJ, Poole CD, Gale EA. The influence of glucose-lowering therapies on cancer risk in type 2 diabetes. Diabetologia. 2009 Sep; 52(9): 1766–77.
73.
Decensi A, Puntoni M, Goodwin P, Cazzaniga M, Gennari A, Bonanni B, et al. Metformin and cancer risk in diabetic patients: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2010 Nov; 3(11): 1451–61.
74.
Zhang ZJ, Zheng ZJ, Shi R, Su Q, Jiang Q, Kip KE. Metformin for liver cancer prevention in patients with type 2 diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012 Jul; 97(7): 2347–53.
75.
Yuhara H, Steinmaus C, Cohen SE, Corley DA, Tei Y, Buffler PA. Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol. 2011 Nov; 106(11): 1911–21.
76.
Chang YT, Tsai HL, Kung YT, Yeh YS, Huang CW, Ma CJ, et al. Dose-dependent relationship between metformin and colorectal cancer occurrence among patients with type 2 diabetes-a Nationwide cohort study. Transl Oncol. 2018 Apr; 11(2): 535–41.
77.
Beaty MM, Lee EY, Glauert HP. Influence of dietary calcium and vitamin D on colon epithelial cell proliferation and 1,2-dimethylhydrazine-induced colon carcinogenesis in rats fed high fat diets. J Nutr. 1993 Jan; 123(1): 144–52.
78.
Díaz GD, Paraskeva C, Thomas MG, Binderup L, Hague A. Apoptosis is induced by the active metabolite of vitamin D3 and its analogue EB1089 in colorectal adenoma and carcinoma cells: possible implications for prevention and therapy. Cancer Res. 2000 Apr; 60(8): 2304–12.
79.
Fleet JC, DeSmet M, Johnson R, Li Y. Vitamin D and cancer: a review of molecular mechanisms. Biochem J. 2012 Jan; 441(1): 61–76.
80.
Grau MV, Baron JA, Sandler RS, HaileRW, BeachML, ChurchTR, Heber D. Vitamin D, calcium supplementation, and colorectal adenomas: results of a randomized trial. J Natl Cancer Inst. 2003 Dec 3; 95(23): 1765-71
81.
Wei MY, Garland CF, Gorham ED, Mohr SB, Giovannucci E. Vitamin D and prevention of colorectal adenoma: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2008 Nov; 17(11): 2958–69.
82.
Garland CF, Garland FC, Gorham ED, Lipkin M, Newmark H, Mohr SB, et al. The role of vitamin D in cancer prevention. Am J Public Health. 2006 Feb; 96(2): 252–61.
83.
Aggarwal BB, Bhardwaj A, Aggarwal RS, Seeram NP, Shishodia S, Takada Y. Role of resveratrol in prevention and therapy of cancer: preclinical and clinical studies. Anticancer Res. 2004 Sep-Oct; 24 5A: 2783–840.
84.
Chiu HF, Ho SC, Chang CC, Wu TN, Yang CY. Statins are associated with a reduced risk of gastric cancer: a population-based case-control study. Am J Gastroenterol. 2011 Dec; 106(12): 2098–103.
85.
Chiu HF, Ho SC, Chen CC, Yang CY. Statin use and the risk of liver cancer: a population-based case–control study. Am J Gastroenterol. 2011 May; 106(5): 894–8.
86.
Poynter JN, Gruber SB, Higgins PD, Almog R, Bonner JD, Rennert HS, et al. Statins and the risk of colorectal cancer. N Engl J Med. 2005 May; 352(21): 2184–92.
87.
Nguyen DM, Richardson P, El-Serag HB. Medications (NSAIDs, statins, proton pump inhibitors) and the risk of esophageal adenocarcinoma in patients with Barrett’s esophagus. Gastroenterology. 2010 Jun; 138(7): 2260–6.
88.
Brusselaers N, Engstrand L, Lagergren J. Maintenance proton pump inhibition therapy and risk of oesophageal cancer. Cancer Epidemiol. 2018 Apr; 53: 172–7.
89.
Brusselaers N, Wahlin K, Engstrand L, Lagergren J. Maintenance therapy with proton pump inhibitors and risk of gastric cancer: a nationwide population-based cohort study in Sweden. BMJ Open. 2017 Oct; 7(10):e017739.
90.
Cheung KS, Chan EW, Wong AY, Chen L, Wong IC, Leung WK. Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study. Gut. 2018 Jan; 67(1): 28–35.
© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
