Realizing the Potential of Cancer Prevention - The Role of Implementation Science

Abstract

In the past two decades, we and others have estimated that more than half of cancers could have been prevented by applying knowledge that we already have. Tobacco use, inactivity, and obesity are modifiable causes of cancer,^– and evidence now suggests that vaccination against the human papillomavirus, the use of aspirin and selective estrogen-receptor modulators, and participation in screening programs further reduce the risk of specific cancers.^, The effect of these strategies on cancer-related outcomes in the general population is significant. A 62% reduction in lung-cancer mortality is associated with smoking cessation at age 50, and environmental and policy strategies are effective at increasing cessation.^– A 95% reduction in mortality is associated with screening for cervical cancer, a 100% reduction in mortality is associated with vaccination against the human papillomavirus, ^– and a 90% reduction in mortality related to chronic liver disease and liver cancer is associated with vaccination against hepatitis B virus. There is also benefit for those at high risk for cancer. Lung-cancer screening is associated with a 20% reduction in mortality among smokers at high risk, salpingo-oophorectomy reduces the risk of breast and ovarian cancer among women with a BRCA1/2 mutation,^, and treatment with selective estrogen receptor modulators reduces the incidence of breast cancer by 50% among women at high risk.^, Screening, diagnosis, and treatment of hepatitis C virus infection reduces the risk of all-cause mortality by 50% among those with infection. Our ability to prevent cancer has improved significantly.