Precision Medicine for Childhood Cancers: Role of Epigenetics in Childhood Cancers

The prospect of having a child diagnosed with a cancer is a heart-wrenching experience and one in which subjects the child to painful and longterm consequences. Given the recent explosion of scientific understanding of human carcinogenesis, which involves both genetic and environmental factors playing a role in the development of those cancers, new concepts of “Precision Medicine”, “Personalized Medicine” and “Environmental Medicine” have been generated to mobilized new technologies for the prevention and treatment of childhood cancers. Much of this new thrust has been based on technologies related to “genomics”, or to the major genetic biomarkers that presumably could predict the major “drivers” in the cancer. Without a doubt that there are various genes that can predispose an individual to a given cancer, the roles that “epigenomics” and genetic factors has been widely ignored. This “Commentary” will explore how the multi-step, multi-mechanism process of human carcinogenesis involves the interaction of both the genetic and epigenetic factors during the in utero-perinatal developmental period. Specifically, it will be assumed that the “epigenetic” component of carcinogenesis is the real “driver” of childhood cancers and a specific cellular mechanism will be offered for the Barker hypothesis that happens during in utero development that leads to cancers later in life.