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Personalizing Cancer Prevention

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Air date: Wednesday, April 16, 2008, 3:00:00 PM
Time displayed is Eastern Time, Washington DC Local
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Category: WALS - Wednesday Afternoon Lectures
Runtime: 01:00:37
Description: Imagine this: you receive a call from a close friend, who needs your professional advice. As a holiday gift from her family, she has had her whole genome sequenced by a commercial service. The results show that she carries genetic variants that increase her risks of breast cancer and heart disease. What should she do with this information? She is 43 years old and childless, and has no family history of heart disease. However her paternal aunt was diagnosed with breast cancer at age 57 years.

Such increasingly likely scenarios introduce a host of issues for which epidemiologists and clinicians are unprepared. In this talk I will discuss some of the paradoxes and problems in personalizing the prevention of cancer and other chronic diseases. For example, how will individuals handle the information they receive? What are the emotional consequences of learning that you are at increased risk of a life-threatening disease? How can patients and their physicians understand and balance the risks and benefits of any given preventive strategy? What epidemiologic data are needed to help them?

From a public health perspective, one might ask how individual risk prediction might be used to decrease the disease burden of a population. The attraction of personalized prevention is based on the premise that individuals have a broad spectrum of risks for a given disease, and that most of the disease burden is borne by a small subset of identifiable “high-risk” individuals. According to this premise, identifying the high-risk individuals would enable us to focus screening and chemo-prevention on those for whom it would be most effective.

Is the premise valid? Some have argued against it, noting examples in which individuals deemed “high-risk” account for only a small fraction of a given disease. Even if valid, the premise involves the paradox that many individuals must undergo a given preventive strategy so that a handful can receive the benefit.

I will illustrate these issues with examples from our current attempts to prevent breast and prostate cancer.

Alice S. Whittemore is Professor of Epidemiology and Biostatistics in the Department of Health Research and Policy (HRP) at Stanford. She has published extensively on the epidemiology of site-specific cancers, and on statistical methods for the design and analysis of epidemiological studies. Her current research focuses on the genetic epidemiology of cancers of the breast, ovary, and prostate. During the period 1991-2001 she was a recipient of an Outstanding Investigator Grant from NCI to develop improved methods for the design and conduct of epidemiologic studies. This work has earned her the Eighth American Association for Cancer Research-American Cancer Society Award for Research Excellence in Cancer Epidemiology and Prevention, the Janet L. Norwood Award, and the Florence Nightingale Award for outstanding achievement by a woman in the statistical sciences.

Dr. Whittemore is a member of the Institute of Medicine, a Fellow of the American Association for the Advancement of Science, a Fellow of the American Statistical Association, and a member of the American Epidemiological Society. She has served on the Board of Scientific Counselors of NCI, the Board of Scientific Advisors to NCI, and the Board of Scientific Counselors of the National Institute for Environmental Health Sciences (NIEHS). She also has served as President of the International Biometric Society (Western North American Region) and as a member of the Prostate Health Council of the American Foundation for Urologic Diseases.

http://med.stanford.edu/profiles/cancer/faculty/Alice_Whittemore

The NIH Director's Wednesday Afternoon Lecture Series includes weekly scientific talks by some of the top researchers in the biomedical sciences worldwide.
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NLM Title: Personalizing cancer prevention [electronic resource] / Alice S. Whittemore.
Series: NIH Robert S. Gordon, Jr. lecture
Author: Whittemore, Alice.
National Institutes of Health (U.S.)
Publisher:
Other Title(s): NIH Robert S. Gordon, Jr. lecture
Abstract: (CIT): In this talk I will discuss some of the paradoxes and problems in personalizing the prevention of cancer and other chronic diseases. For example, how will individuals handle the information they receive? What are the emotional consequences of learning that you are at increased risk of a life-threatening disease? How can patients and their physicians understand and balance the risks and benefits of any given preventive strategy? What epidemiologic data are needed to help them? From a public health perspective, one might ask how individual risk prediction might be used to decrease the disease burden of a population. The attraction of personalized prevention is based on the premise that individuals have a broad spectrum of risks for a given disease, and that most of the disease burden is borne by a small subset of identifiable "high-risk" individuals. According to this premise, identifying the high-risk individuals would enable us to focus screening and chemo-prevention on those for whom it would be most effective. Is the premise valid? Some have argued against it, noting examples in which individuals deemed "high-risk" account for only a small fraction of a given disease. Even if valid, the premise involves the paradox that many individuals must undergo a given preventive strategy so that a handful can receive the benefit. I will illustrate these issues with examples from our current attempts to prevent breast and prostate cancer.
Subjects: Genetic Predisposition to Disease
Neoplasms--epidemiology
Neoplasms--prevention & control
Neoplasms--psychology
Risk Assessment
Publication Types: Lectures
Webcasts
Download: To download this event, select one of the available bitrates:
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NLM Classification: QZ 200
NLM ID: 101473090
CIT Live ID: 6219
Permanent link: http://videocast.nih.gov/launch.asp?14436

 

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