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An Empirical Analysis of Precision Previvorship: Are Familial and High-Risk Cancer Preventive Programs Evidence Based?

Published:October 19, 2021DOI:https://doi.org/10.1016/j.amjmed.2021.09.003
      Over the last decade, some academic medical centers have launched new cancer screening or preventive programs, often appealing to individuals with family history or known elevated genetic risk. Preventive and screening services are offered for a breadth of tumor types, including pancreatic, hematologic, breast, and lung cancers. Standard services available are cancer prevention counseling, prophylactic surgery, personalized genomic risk profiling, removal of precancerous growths, ongoing surveillance, access to clinical trials, and exercise and nutrition plans.
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      References

        • Prasad V
        Perspective: the precision-oncology illusion.
        Nature. 2016; 537: S63
      1. The University of Kansas Cancer Center. Previvors beat cancer before it starts with genetic testing. Available at: https://www.kucancercenter.org/news-room/blog/2019/10/previvors-genetic-testing. Accessed April 29, 2021.

        • Newman TB
        • Kohn MA
        Evidence-Based Diagnosis: an Introduction to Clinical Epidemiology.
        Cambridge University Press, Cambridge2020
        • Schwartz LM
        • Woloshin S
        • Fowler Jr, FJ
        • Welch HG
        Enthusiasm for cancer screening in the United States.
        JAMA. 2004; 291: 71-78
      2. American Cancer Society. Cancer facts & figures 2021. Available at:https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2021.html. Accessed April 4, 2021.

        • Patel CJ
        • Burford B
        • Ioannidis JP
        Assessment of vibration of effects due to model specification can demonstrate the instability of observational associations.
        J Clin Epidemiol. 2015; 68: 1046-1058
      3. U.S. News & World Report. Best hospitals for cancer. Available at: https://health.usnews.com/best-hospitals/rankings/cancer. Accessed March 15, 2021.

        • Smith R
        A POEM a week for the BMJ.
        BMJ. 2002; 325: 983
        • Del Paggio JC
        • Berry JS
        • Hopman WM
        • et al.
        Evolution of the randomized clinical trial in the era of precision oncology.
        JAMA Oncol. 2021; 7: 728-734
        • de Grooth HJ
        • Parienti JJ
        • Oudemans-van Straaten HM
        Should we rely on trials with disease- rather than patient-oriented endpoints?.
        Intensive Care Med. 2018; 44: 464-466
        • Haslam A
        • Hey SP
        • Gill J
        • Prasad V
        A systematic review of trial-level meta-analyses measuring the strength of association between surrogate end-points and overall survival in oncology.
        Eur J Cancer. 2019; 106: 196-211
        • Prasad V
        Powering cancer screening for overall mortality.
        Ecancermedicalscience. 2013; 7: ed27
        • Black WC
        • Haggstrom DA
        • Welch HG
        All-cause mortality in randomized trials of cancer screening.
        J Natl Cancer Inst. 2002; 94: 167-173
        • Korenstein D
        • Mamoor M
        • Bach PB
        Preventive services offered in executive physicals at top-ranked hospitals.
        JAMA. 2019; 322: 1101-1103
      4. U.S. Preventive Services Taskforce. Recommendation topics. Available at: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics. Accessed April 15, 2021.

      5. Prevention is better than cure.
        in: Knowles E The Oxford Dictionary of Phrase and Fable. Oxford University Press, New York2005 (Available at:) (Accessed April 10, 2021)
      6. Nature Portfolio: Disease prevention. Nature.Available at: https://www.nature.com/subjects/disease-prevention. Accessed April 12, 2021.

      7. World Health Organization (WHO) Regional Office for the Eastern Mediterranean (EMRO). Health promotion and disease prevention through population-based interventions, including action to address social determinants and health inequity. Available at:http://www.emro.who.int/about-who/public-health-functions/health-promotion-disease-prevention.html. Accessed April 12, 2021.

        • Hodes JF
        • Oakley CI
        • O'Keefe JH
        • et al.
        Alzheimer's "prevention" vs. "risk reduction": transcending semantics for clinical practice.
        Front Neurol. 2019; 9: 1179
        • Fisher B
        • Costantino JP
        • Wickerham DL
        • et al.
        Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study.
        J Natl Cancer Inst. 1998; 90: 1371-1388
        • Thompson IM
        • Goodman PJ
        • Tangen CM
        • et al.
        The influence of finasteride on the development of prostate cancer.
        N Engl J Med. 2003; 349: 215-224https://doi.org/10.1056/NEJMoa030660