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Evidence-based approach to prevention

Suzanne W Fletcher, MD
Robert H Fletcher, MD, MSc
Section Editor
Joann G Elmore, MD, MPH
Deputy Editor
Judith A Melin, MA, MD, FACP


Reproduced and adapted with permission from: Fletcher RH, Fletcher SW, Fletcher GS. Clinical Epidemiology: The Essentials, 5th Edition, Lippincott Williams & Wilkins, Philadelphia 2013. For more information, please visit www.lww.com.

If a patient asks a medical practitioner for help, the doctor does the best he can. He is not responsible for defects in medical knowledge. If, however, the practitioner initiates screening procedures, he is in a very different situation. He should have conclusive evidence that screening can alter the natural history of disease in a significant proportion of those screened.”

Archie Cochrane and Walter Holland, 1971

Most doctors are attracted to medicine because they look forward to curing disease. But all things considered, most people would prefer never to contract a disease in the first place—or, if they cannot avoid an illness, they prefer that it be caught early and stamped out before it causes them any harm. To accomplish this, people without specific complaints undergo interventions to identify and modify risk factors to avoid the onset of disease or to find disease early in its course so that early treatment prevents illness. When these interventions take place in clinical practice, the activity is referred to as preventive care.

Preventive care constitutes a large portion of clinical practice [1]. Clinicians should understand its conceptual basis and content. They should be prepared to answer questions from patients such as, “How much exercise do I need ?” or “I heard that a study showed antioxidants were not helpful in preventing heart disease. What do you think?” or “There was a newspaper ad for a calcium scan. Do you think I should get one?”

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Literature review current through: Oct 2017. | This topic last updated: Sep 15, 2017.
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  1. Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2007. Vital Health Stat 13 2011; :1.
  2. Prevention. Meriam-Webster.com 2011. Available at: http://www.merriam-webster.com/dictionary/prevention (Accessed on January 13, 2012).
  3. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011; 61:212.
  4. National Center for Health Statistics. Health, United States, 2010: With Special Feature on Death and Dying. Health, United States, 2010: With Special Feature on Death and Dying.; Hyattsville, MD 2011.
  5. Roe MT, Ohman EM. A new era in secondary prevention after acute coronary syndrome. N Engl J Med 2012; 366:85.
  6. Harris R, Sawaya GF, Moyer VA, Calonge N. Reconsidering the criteria for evaluating proposed screening programs: reflections from 4 current and former members of the U.S. Preventive services task force. Epidemiol Rev 2011; 33:20.
  7. Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975-2008, National Cancer Institute. Bethesda, MD. Available at: http://seer.cancer.gov/csr/1975_2008/ (Accessed on January 13, 2012).
  8. Chang MH, You SL, Chen CJ, et al. Decreased incidence of hepatocellular carcinoma in hepatitis B vaccinees: a 20-year follow-up study. J Natl Cancer Inst 2009; 101:1348.
  9. Greene SK, Rett M, Weintraub ES, et al. Risk of confirmed Guillain-Barre syndrome following receipt of monovalent inactivated influenza A (H1N1) and seasonal influenza vaccines in the Vaccine Safety Datalink Project, 2009-2010. Am J Epidemiol 2012; 175:1100.
  10. Fiore MC, Jaén CR, Baker TB, et al. Treating tobacco use and dependence: 2008 Update. Rockville, MD: U.S. Department of Health and Human Ser¬vices 2008. Available at: http://www.ncbi.nlm.nih.gov/books/NBK63952/ (Accessed on April 16, 2013).
  11. Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993; 328:1365.
  12. Marcus PM, Bergstralh EJ, Fagerstrom RM, et al. Lung cancer mortality in the Mayo Lung Project: impact of extended follow-up. J Natl Cancer Inst 2000; 92:1308.
  13. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365:395.
  14. Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008; 358:580.
  15. Friedman GD, Collen MF, Fireman BH. Multiphasic Health Checkup Evaluation: a 16-year follow-up. J Chronic Dis 1986; 39:453.
  16. Avins AL, Pressman A, Ackerson L, et al. Placebo adherence and its association with morbidity and mortality in the studies of left ventricular dysfunction. J Gen Intern Med 2010; 25:1275.
  17. Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 1992; 326:653.
  18. Gann PH, Hennekens CH, Stampfer MJ. A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. JAMA 1995; 273:289.
  19. Delongchamps NB, Singh A, Haas GP. The role of prevalence in the diagnosis of prostate cancer. Cancer Control 2006; 13:158.
  20. Carney PA, Miglioretti DL, Yankaskas BC, et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med 2003; 138:168.
  21. Lansdorp-Vogelaar I, Knudsen AB, Brenner H. Cost-effectiveness of colorectal cancer screening. Epidemiol Rev 2011; 33:88.
  22. Berrington de González A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009; 169:2071.
  23. D'Orsi C, Tu SP, Nakano C, et al. Current realities of delivering mammography services in the community: do challenges with staffing and scheduling exist? Radiology 2005; 235:391.
  24. Buys SS, Partridge E, Black A, et al. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA 2011; 305:2295.
  25. Meador CK. The last well person. N Engl J Med 1994; 330:440.
  26. Croswell JM, Baker SG, Marcus PM, et al. Cumulative incidence of false-positive test results in lung cancer screening: a randomized trial. Ann Intern Med 2010; 152:505.
  27. Croswell JM, Kramer BS, Kreimer AR, et al. Cumulative incidence of false-positive results in repeated, multimodal cancer screening. Ann Fam Med 2009; 7:212.
  28. Fowler FJ Jr, Barry MJ, Walker-Corkery B, et al. The impact of a suspicious prostate biopsy on patients' psychological, socio-behavioral, and medical care outcomes. J Gen Intern Med 2006; 21:715.
  29. Schilling FH, Spix C, Berthold F, et al. Neuroblastoma screening at one year of age. N Engl J Med 2002; 346:1047.
  30. Woods WG, Gao RN, Shuster JJ, et al. Screening of infants and mortality due to neuroblastoma. N Engl J Med 2002; 346:1041.
  31. Xiong T, Richardson M, Woodroffe R, et al. Incidental lesions found on CT colonography: their nature and frequency. Br J Radiol 2005; 78:22.
  32. Hubbard RA, Kerlikowske K, Flowers CI, et al. Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography: a cohort study. Ann Intern Med 2011; 155:481.
  33. Mandelblatt JS, Cronin KA, Bailey S, et al. Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern Med 2009; 151:738.
  34. Gillman MW, Daniels SR. Is universal pediatric lipid screening justified? JAMA 2012; 307:259.
  35. Goldie SJ, Kohli M, Grima D, et al. Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl Cancer Inst 2004; 96:604.
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