Harvard Report on Cancer Prevention Volume 4: Harvard Cancer Risk Index
- 778 Downloads
Objective: Prediction of cancer risk is a minor component of current health risk appraisals. Perception of individual cancer risk is poor. A Cancer Risk Index was developed to predict individual cancer risk for cancers accounting for 80% of the cancer burden in the United States.
Methods: We used group consensus among researchers at the Harvard Medical School and Harvard School of Public Health to identify risk factors as definite, probable and possible causes of cancer. Risk points were allocated according to the strength of the causal association and summed. Population average risk of cancer and cumulative 10-year risk was obtained from SEER data. Individual ranking relative to the population average was determined. The risk index was evaluated for validity using colon cancer incidence in prospective cohort data.
Results: The Harvard Cancer Risk Index provides a broad classification of cancer risk. Validation against cohort data shows good agreement for colon cancer.
Conclusion: The Harvard Cancer Risk Index offers a simple estimation of personal risk of cancer. It may help inform users of the major risk factors for cancer and identify changes in lifestyle that will reduce their risk. It offers the potential for tailored health-promotion messages.
Unable to display preview. Download preview PDF.
- 1.Kannel WB, McGee D, Gordon T (1976) A general cardiovascular risk profile: the Framingham study. Am J Cardiol 38: 46–51.Google Scholar
- 2.Kannel WB, McGee DL (1987) Composite scoring-methods and predictive validity: insights from the Framingham Study. Health Serv Res 22: 501–535.Google Scholar
- 3.Morrow K, Morris CK, Froelicher VF, et al. (1993) Prediction of cardiovascular death in men undergoing nonivasive evaluation for coronary artery disease. Ann Intern Med 118: 689–695.Google Scholar
- 4.Gail MH, Brinton LA, Byar DP, et al. (1989) Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81: 1879–1886.Google Scholar
- 5.Constantino J, Gail M, Pee D, et al. (1999) Validation studies for models projecting the risk of invasive and total breast cancer incidence. J Natl Cancer Inst 91: 1541–1548.Google Scholar
- 6.Dupont WD, Plummer WD (1996) Understanding the relationship between relative and absolute risk. Cancer 77: 2193–2199.Google Scholar
- 7.Colditz GA, DeJong W, Hunter DJ, Trichopoulos D, Willett WC, eds (1996) Harvard Report on Cancer Prevention. Cancer Causes Control 7(Suppl.): S1–S55.Google Scholar
- 8.Black W, Nease R, Tosteson A (1995) Perception of breast cancer risk and screening effectiveness in women younger than 50 years of age. J Natl Cancer Inst 87: 720–731.Google Scholar
- 9.US Preventive Services Task Force. (1996) Guide to Clinical Preventive Services. Baltimore, MD: Williams & Wilkins.Google Scholar
- 10.US Preventive Services Task Force. Screening for colorectal cancer. (1996) Guide to Clinical Preventive Services, 2nd edn. Baltimore, MD: Williams & Wilkins, pp. 89–103.Google Scholar
- 11.US Preventive Services Task Force. Screening for cervical cancer. (1996) Guide to Clinical Preventive Services, 2nd edn. Baltimore, MD: Williams & Wilkins, pp. 105–117.Google Scholar
- 12.International Agency for Research on Cancer (1987) Overall Evaluations of Carcinogenicity: An Update of IARC Monographs Volumes 1 to 42. Lyon, France: IARC.Google Scholar
- 13.Laupacis A, Sekar N, Stiell I (1997) Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA 277: 488–494.Google Scholar
- 14.Wasson J, Sox H, Ne. R, Goldman L (1985) Clinical prediction rules: application and methodological standards. N Engl J Med 313: 793–799.Google Scholar
- 15.Stiell I, Wells G, Laupacis A (1995) Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injury. BMJ 311: 595–597.Google Scholar
- 16.Calman KC (1996) Cancer: science and society and the communication of risk. BMJ 313: 799–802.Google Scholar
- 17.Calman KC, Royston GHD (1997) Risk language and dialects. BMJ 315: 939–942.Google Scholar
- 18.Bunker J, Houghton J, Baum M (1998) Putting the risk of breast cancer in perspective. BMJ 317: 1307–1309.Google Scholar
- 19.Chu K, Tarone R, Chow W, Hankey B, Ries L (1994) Temporal patterns in colorectal cancer incidence, survival, and mortality from 1950 through 1990. J Natl Cancer Inst 86: 997–1006.Google Scholar
- 20.Steenland K, Thun M (1986) Interaction between tobacco smoking and occupational exposure in the causation of lung cancer. J Occup Med 43: 111–118.Google Scholar
- 21.Berry G, Newhouse ML, Antonis P (1985) Combined effects of asbestos and smoking on mortality from lung cancer and mesothelioma. Br J Ind Med 42: 12–18.Google Scholar
- 22.Rothman K, Keller A (1972) The effect of joint exposure to alcohol and tobacco on risk of cancer of the mouth and pharynx. J Chron Dis 23: 711–716.Google Scholar
- 23.US Department of Health and Human Services (1996) Physical Activity and Health. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.Google Scholar
- 24.Thun M, Peto R, Lopez A, et al. (1997) Alcohol consumption and mortality among middle-aged and elderly US adults. N Engl JMed 337: 1705–1714.Google Scholar
- 25.English DR, Armstrong BK, Kricker A, Fleming C (1997) Sunlight and cancer. Cancer Causes Control 8: 271–283.Google Scholar
- 26.US Department of Health and Human Services (1994) Report of the Surgeon General. Preventing Smoking Among Adolescents. Washington, DC: Centers for Disease Control and Prevention, US DHHS. US Public Health Service.Google Scholar
- 27.Tokunaga M, Land C, Tokuoka S, Nishimori I, Soda M, Akiba S (1994) Incidence of female breast cancer among atomic bomb survivors, 1950-1985. Radiation Res 138: 209–223.Google Scholar
- 28.Brown C, Chu K (1987) Use of multistage models to infer stage affected by carcinogenic exposure: example of lung cancer and cigarette smoking. J Chron Dis 40 (Suppl. 2): 171s–179s.Google Scholar
- 29.US Department of Health and Human Services (1990) The Health Benefits of Smoking Cessation. Washington, DC: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, vol. DHSS Publication No (CDC)90-8416.Google Scholar
- 30.Speizer F, et al. (1999) Prospective study of smoking, antioxidant intake, and lung cancer in middle-aged women. Cancer Causes Control 10: 475-.Google Scholar
- 31.Strecher V, Greenwood T, Wang C, Dumont D (1999) Interactive multimedia and risk communication. Monogr Natl Cancer Inst 25: 134–139.Google Scholar