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. 1986;64(2):311–320.

Evaluating primary prevention programmes against cancer

James A Hanley
PMCID: PMC2490928  PMID: 3488847

Abstract

Based on current knowledge, roughly one third of all cancers worldwide are preventable, and primary prevention is increasingly seen as an important cancer control strategy. Interventions to reduce the exposure to known causes can be effected through legislation or education, or by means of vaccination or chemoprevention. Since primary prevention actions can be costly and will compete for resources needed for other disease control activities, and since there is no guarantee that they will be successful, they should not be introduced haphazardly but on the basis of scientific evaluations. This paper presents the main principles to be followed in designing such evaluations; the illustrations often, of necessity, come from other diseases (particularly cardiovascular disease), where there is considerably more experience. Because the interventions involve changes in lifestyle and behaviour, and because a long time is necessary to observe the ultimate endpoints, controlled intervention studies against cancer present many scientific and logistical difficulties. Some interventions, such as vaccination and chemoprevention (to test suspected protective agents) may be evaluated by traditional clinical trial methodology, using intermediate as well as final (cancer incidence and/or mortality) endpoints. Active, target-directed and preferably controlled health service research studies will definitely be needed to assess community or population interventions based on legislation or education.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Banta H. D., Luce B. R. Assessing the cost-effectiveness of prevention. J Community Health. 1983 Winter;9(2):145–165. doi: 10.1007/BF01349877. [DOI] [PubMed] [Google Scholar]
  2. Cornfield J. Randomization by group: a formal analysis. Am J Epidemiol. 1978 Aug;108(2):100–102. doi: 10.1093/oxfordjournals.aje.a112592. [DOI] [PubMed] [Google Scholar]
  3. Doxiadis S. A., Trihopoulos D. V., Phylactou H. D. Impact of a nationwide anti-smoking campaign. Lancet. 1985 Sep 28;2(8457):712–713. doi: 10.1016/s0140-6736(85)92945-9. [DOI] [PubMed] [Google Scholar]
  4. Egger G., Fitzgerald W., Frape G., Monaem A., Rubinstein P., Tyler C., McKay B. Results of large scale media antismoking campaign in Australia: North Coast "Quit for Life" programme. Br Med J (Clin Res Ed) 1983 Oct 15;287(6399):1125–1128. doi: 10.1136/bmj.287.6399.1125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. FRANCIS T., Jr, KORNS R. F., VOIGHT R. B., BOISEN M., HEMPHILL F. M., NAPIER J. A., TOLCHINSKY E. An evaluation of the 1954 poliomyelitis vaccine trials. Am J Public Health Nations Health. 1955 May;45(5 Pt 2):1–63. [PMC free article] [PubMed] [Google Scholar]
  6. Hoover R. N. Bacillus Calmette-Guérin vaccination and cancer prevention: a critical review of the human experience. Cancer Res. 1976 Feb;36(2 Pt 2):652–654. [PubMed] [Google Scholar]
  7. Horwitz O., Magnus K. Epidemiologic evaluation of chemoprophylaxis against tuberculosis. Am J Epidemiol. 1974 May;99(5):333–342. doi: 10.1093/oxfordjournals.aje.a121618. [DOI] [PubMed] [Google Scholar]
  8. Horwitz R. I., Feinstein A. R. Improved observational method for studying therapeutic efficacy. Suggestive evidence that lidocaine prophylaxis prevents death in acute myocardial infarction. JAMA. 1981 Nov 27;246(21):2455–2459. doi: 10.1001/jama.246.21.2455. [DOI] [PubMed] [Google Scholar]
  9. Mantel N. Synthetic retrospective studies and related topics. Biometrics. 1973 Sep;29(3):479–486. [PubMed] [Google Scholar]
  10. Mehta F. S., Gupta M. B., Pindborg J. J., Bhonsle R. B., Jalnawalla P. N., Sinor P. N. An intervention study of oral cancer and precancer in rural Indian populations: a preliminary report. Bull World Health Organ. 1982;60(3):441–446. [PMC free article] [PubMed] [Google Scholar]
  11. Pal S. C., Deb B. C., Sen Gupta P. G., De S. P., Sircar B. K., Sen D., Sikdar S. N. A controlled field trial of an aluminum phosphate-adsorbed cholera vaccine in Calcutta. Bull World Health Organ. 1980;58(5):741–745. [PMC free article] [PubMed] [Google Scholar]
  12. Parkin D. M., Stjernswärd J., Muir C. S. Estimates of the worldwide frequency of twelve major cancers. Bull World Health Organ. 1984;62(2):163–182. [PMC free article] [PubMed] [Google Scholar]
  13. Rose G. Sick individuals and sick populations. Int J Epidemiol. 1985 Mar;14(1):32–38. doi: 10.1093/ije/14.1.32. [DOI] [PubMed] [Google Scholar]
  14. Rose G. Strategy of prevention: lessons from cardiovascular disease. Br Med J (Clin Res Ed) 1981 Jun 6;282(6279):1847–1851. doi: 10.1136/bmj.282.6279.1847. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Rose G., Tunstall-Pedoe H. D., Heller R. F. UK heart disease prevention project: incidence and mortality results. Lancet. 1983 May 14;1(8333):1062–1066. doi: 10.1016/s0140-6736(83)91907-4. [DOI] [PubMed] [Google Scholar]
  16. Russell M. A., Wilson C., Taylor C., Baker C. D. Effect of general practitioners' advice against smoking. Br Med J. 1979 Jul 28;2(6184):231–235. doi: 10.1136/bmj.2.6184.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Shapiro C., Cook N., Evans D., Willett W., Fajardo I., Koch-Weser D., Bergonzoli G., Bolanos O., Guerrero R., Hennekens C. H. A case-control study of BCG and childhood tuberculosis in Cali, Colombia. Int J Epidemiol. 1985 Sep;14(3):441–446. doi: 10.1093/ije/14.3.441. [DOI] [PubMed] [Google Scholar]
  18. Simon R. Composite randomization designs for clinical trials. Biometrics. 1981 Dec;37(4):723–731. [PubMed] [Google Scholar]
  19. Sondik E. J., Brown B. W., Jr, Silvers A. High risk subjects and the cost of large field trials. J Chronic Dis. 1974 Jul;27(4):177–187. doi: 10.1016/0021-9681(74)90044-7. [DOI] [PubMed] [Google Scholar]
  20. Stampfer M. J., Buring J. E., Willett W., Rosner B., Eberlein K., Hennekens C. H. The 2 x 2 factorial design: its application to a randomized trial of aspirin and carotene in U.S. physicians. Stat Med. 1985 Apr-Jun;4(2):111–116. doi: 10.1002/sim.4780040202. [DOI] [PubMed] [Google Scholar]
  21. Warner K. E. Cigarette smoking in the 1970's: the impact of the antismoking campaign on consumption. Science. 1981 Feb 13;211(4483):729–731. doi: 10.1126/science.7455711. [DOI] [PubMed] [Google Scholar]
  22. Weinstein M. C. Cost-effective priorities for cancer prevention. Science. 1983 Jul 1;221(4605):17–23. doi: 10.1126/science.6407110. [DOI] [PubMed] [Google Scholar]
  23. Whiting-O'Keefe Q. E., Henke C., Simborg D. W. Choosing the correct unit of analysis in Medical Care experiments. Med Care. 1984 Dec;22(12):1101–1114. doi: 10.1097/00005650-198412000-00005. [DOI] [PubMed] [Google Scholar]
  24. Williams P. T., Fortmann S. P., Farquhar J. W., Varady A., Mellen S. A comparison of statistical methods for evaluating risk factor changes in community-based studies: an example from the Stanford Three-Community Study. J Chronic Dis. 1981;34(11):565–571. doi: 10.1016/0021-9681(81)90019-9. [DOI] [PubMed] [Google Scholar]

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