Risk-Adjusted Cancer Screening and Prevention (RiskAP): Complementing Screening for Early Disease Detection by a Learning Screening Based on Risk Factors
Breast Care, vol. 17, pp. 208–223
Abstract
Background: 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: 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.
Authors 25
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Affiliation as printed
Center Familial Breast and Ovarian Cancer and Center of Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
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University of Cologne · University Hospital Cologne
Affiliation as printed
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
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Affiliation as printed
Institute of Global Health, University of Geneva, Geneva, Switzerland
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Peter Devilee Aachen
Leiden University · Leiden University Medical Center
Affiliation as printed
Leids Universitair Medisch Zentrum, Universiteit Leiden, Leiden, The Netherlands
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Affiliation as printed
Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
Clinical Trials Unit, University of Southampton, Southampton, UK
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Affiliation as printed
Karolinska Institutet, Stockholm, Sweden
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Vall d'Hebron Institute of Oncology
Affiliation as printed
Vall d'Hebron Instituto de Oncologia (VHIO), Barcelona, Spain
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Università Cattolica del Sacro Cuore · Agostino Gemelli University Polyclinic
Affiliation as printed
Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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
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Friedrich-Alexander-Universität Erlangen-Nürnberg
Affiliation as printed
Friedrich-Alexander-Universität, Erlangen, Germany
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Universitätsmedizin Göttingen · University of Göttingen
Affiliation as printed
Uniklinik Göttingen, Georg-August-Universität Göttingen, Göttingen, Germany
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University of Konstanz · Max Planck Institute for Human Development
Affiliation as printed
Max-Planck-Institut für Bildungsforschung, Universität Konstanz, Konstanz, Germany
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International Hereditary Cancer Center · Pomeranian Medical University
Affiliation as printed
International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
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Affiliation as printed
BRCA-Netzwerk, Bonn, Germany
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Affiliation as printed
Lehrstuhl für Öffentliches Recht, Sozial- und Gesundheitsrecht und Rechtsphilosophie, Ruhr-Universität Bochum, Bochum, Germany
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Affiliation as printed
Center Familial Breast and Ovarian Cancer and Center of Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
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Affiliation as printed
Institut für Krebsepidemiologie, Universität Lübeck, Lübeck, Germany
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The Netherlands Cancer Institute
Affiliation as printed
Departments of Medical Oncology and Molecular Pathology - Netherlands Cancer Institute, Amsterdam, The Netherlands
Departments of Medical Oncology and Molecular Pathology – Netherlands Cancer Institute, Amsterdam, The Netherlands
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University of Cambridge · PHG Foundation
Affiliation as printed
PHG Foundation, University of Cambridge, Cambridge, United Kingdom
PHG Foundation, University of Cambridge, Cambridge, UK
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Affiliation as printed
Department of Oncology, University of Cambridge, Cambridge, United Kingdom
Department of Oncology, University of Cambridge, Cambridge, UK
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Affiliation as printed
Center Familial Breast and Ovarian Cancer and Center of Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
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Affiliation as printed
Center for Life Science & Law, Universität Bonn, Bonn, Germany
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Affiliation as printed
Institut Curie, Paris, France
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Affiliation as printed
UM Utrecht - Julius Center for Health Sciences and Primary Care, Universiteit Utrecht, Utrecht, The Netherlands
UM Utrecht – Julius Center for Health Sciences and Primary Care, Universiteit Utrecht, Utrecht, The Netherlands
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Affiliation as printed
Belgium Cancer Center (BCC), Brussels, Belgium
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University of Cologne · University Hospital Cologne
Affiliation as printed
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
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