Risk-Adjusted Cancer Screening and Prevention (RiskAP): Complementing Screening for Early Disease Detection by a Learning Screening Based on Risk Factors.

Breast cancer ELSI ethical, legal, social implications Evidence-generating care Risk-adjusted prevention

Journal

Breast care (Basel, Switzerland)
ISSN: 1661-3791
Titre abrégé: Breast Care (Basel)
Pays: Switzerland
ID NLM: 101254060

Informations de publication

Date de publication:
Apr 2022
Historique:
received: 10 02 2021
accepted: 22 03 2021
entrez: 15 6 2022
pubmed: 16 6 2022
medline: 16 6 2022
Statut: ppublish

Résumé

Risk-adjusted cancer screening and prevention is a promising and continuously emerging option for improving cancer prevention. It is driven by increasing knowledge of risk factors and the ability to determine them for individual risk prediction. However, there is a knowledge gap between evidence of increased risk and evidence of the effectiveness and efficiency of clinical preventive interventions based on increased risk. This gap is, in particular, aggravated by the extensive availability of genetic risk factor diagnostics, since the question of appropriate preventive measures immediately arises when an increased risk is identified. However, collecting proof of effective preventive measures, ideally by prospective randomized preventive studies, typically requires very long periods of time, while the knowledge about an increased risk immediately creates a high demand for action. Therefore, we propose a risk-adjusted prevention concept that is based on the best current evidence making needed and appropriate preventive measures available, and which is constantly evaluated through outcome evaluation, and continuously improved based on these results. We further discuss the structural and procedural requirements as well as legal and socioeconomical aspects relevant for the implementation of this concept.

Sections du résumé

Background UNASSIGNED
Risk-adjusted cancer screening and prevention is a promising and continuously emerging option for improving cancer prevention. It is driven by increasing knowledge of risk factors and the ability to determine them for individual risk prediction. However, there is a knowledge gap between evidence of increased risk and evidence of the effectiveness and efficiency of clinical preventive interventions based on increased risk. This gap is, in particular, aggravated by the extensive availability of genetic risk factor diagnostics, since the question of appropriate preventive measures immediately arises when an increased risk is identified. However, collecting proof of effective preventive measures, ideally by prospective randomized preventive studies, typically requires very long periods of time, while the knowledge about an increased risk immediately creates a high demand for action.
Summary UNASSIGNED
Therefore, we propose a risk-adjusted prevention concept that is based on the best current evidence making needed and appropriate preventive measures available, and which is constantly evaluated through outcome evaluation, and continuously improved based on these results. We further discuss the structural and procedural requirements as well as legal and socioeconomical aspects relevant for the implementation of this concept.

Identifiants

DOI: 10.1159/000517182 PMID: 35702492 PMC: PMC9149472
pubmed: 35702492
doi: 10.1159/000517182
pii: brc-0017-0208
pmc: PMC9149472
doi:

Types de publication

Journal Article Review

Langues

eng

Pagination

208-223

Informations de copyright

Copyright © 2021 by S. Karger AG, Basel.

Déclaration de conflit d'intérêts

The authors have no conflicts of interest to declare.

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Auteurs

Rita K Schmutzler (RK)

Center Familial Breast and Ovarian Cancer and Center of Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany.

Björn Schmitz-Luhn (B)

Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, and Research Unit Ethics, University Hospital of Cologne, Cologne, Germany.

Bettina Borisch (B)

Institute of Global Health, University of Geneva, Geneva, Switzerland.

Peter Devilee (P)

Leids Universitair Medisch Zentrum, Universiteit Leiden, Leiden, The Netherlands.

Diana Eccles (D)

Clinical Trials Unit, University of Southampton, Southampton, United Kingdom.

Per Hall (P)

Karolinska Institutet, Stockholm, Sweden.

Judith Balmaña (J)

Vall d'Hebron Instituto de Oncologia (VHIO), Barcelona, Spain.

Stefania Boccia (S)

Sezione di Igiene, Instituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Peter Dabrock (P)

Friedrich-Alexander-Universität, Erlangen, Germany.

Günter Emons (G)

Uniklinik Göttingen, Georg-August-Universität Göttingen, Göttingen, Germany.

Wolfgang Gaissmaier (W)

Max-Planck-Institut für Bildungsforschung, Universität Konstanz, Konstanz, Germany.

Jacek Gronwald (J)

International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland.

Stefanie Houwaart (S)

BRCA-Netzwerk, Bonn, Germany.

Stefan Huster (S)

Lehrstuhl für Öffentliches Recht, Sozial- und Gesundheitsrecht und Rechtsphilosophie, Ruhr-Universität Bochum, Bochum, Germany.

Karin Kast (K)

Center Familial Breast and Ovarian Cancer and Center of Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany.

Alexander Katalinic (A)

Institut für Krebsepidemiologie, Universität Lübeck, Lübeck, Germany.

Sabine C Linn (SC)

Departments of Medical Oncology and Molecular Pathology - Netherlands Cancer Institute, Amsterdam, The Netherlands.

Sowmiya Moorthie (S)

PHG Foundation, University of Cambridge, Cambridge, United Kingdom.

Paul Pharoah (P)

Department of Oncology, University of Cambridge, Cambridge, United Kingdom.

Kerstin Rhiem (K)

Center Familial Breast and Ovarian Cancer and Center of Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany.

Tade Spranger (T)

Center for Life Science & Law, Universität Bonn, Bonn, Germany.

Dominique Stoppa-Lyonnet (D)

Institut Curie, Paris, France.

Johannes Jozef Marten van Delden (JJM)

UM Utrecht - Julius Center for Health Sciences and Primary Care, Universiteit Utrecht, Utrecht, The Netherlands.

Marc van den Bulcke (M)

Belgium Cancer Center (BCC), Brussels, Belgium.

Christiane Woopen (C)

Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, and Research Unit Ethics, University Hospital of Cologne, Cologne, Germany.

Classifications MeSH