Table 1.

Combined benefits of evidence-based interventions for leading cancers

CancerIntervention (Ix)
MedicalBehavioralSocialPolicyIx targetEvidenceMagnitude of preventive benefit
LungSerial CTLong-term smokersRCT (16)20% reduction in mortality (16)
USPSTF recommendation (17)
Smoking cessation medsSmoking cessation interventionsAdolescent & adultsMultiple cohort studies, case–control studies, and population data (14, 92, 93)Cessation in adolescent 90+ % reduction mortality
Surgeon GeneralCessation at age 50
Reports (SGR) 1990 (94, 95)62% reduction mortality (14)
Tobacco treatment guidelines (15)
Smoke-free policiesAllSGR (96)Impact on lung cancer cannot be estimated based on present data
Tobacco raxesAllSGRv201410 % increase in cigarette prices decreased smoking prevalence by 3.7% (98)
WHO (97)
Graphic warning labelsAllComparison of Canada to United StatesReduction in smoking rates by 2.9% to 4.68% (relative reduction of 12%–19%; ref. 99)
Comprehensive advertising bansAllComprehensive bans in European Commission countriesBans of advertising reduced smoking prevalence by 6% (100)
CRCScreeningAge 50+ & high riskRCTs of screening methods + prospective observational studies (101–105)30% to 50% reduction in incidence and mortality (101–105)
USPPSTF (5)
AspirinRandomized trials (106, 107)30% reduction incidence and mortality (108)
Systematic review meta-analysis (108)
USPSTF in process 2016
Smoking cessation medsSmoking cessation IxSmoke-free policiesAllCohort studies (109)Impact on CRC cannot be estimated based on present data
Surgeon General's Report, 2014
Tobacco treatment guidelines (15)
Tobacco taxes
Wt management/loss IxSchool/workAllEpidemiologic evidence on burden due to obesity (110)11% CRC incidence attributable to overweight and obesity (110)
Environment/clinicalRCT weight loss strategies
PA IxsUrban designAll13% CRC incidence (110)
Food & beverageAllSugar-sweetened beverages increase weight gain (111); processed/red meat increases risk (112)Combined impact on CRC cannot be estimated based on present data
BreastScreeningAge 50+ & high riskModeling screening, treatment, and mortality (21, 22)30% reduction in mortality (21, 22)
Salpingo- oophorectomyFamily history Breast CancerSynthesis of observational data50% reduction in incidence (23)
NCCN practice guideline (23, 24)
SERMHigh riskRCT evidence (25, 26, 113)50% reduction in incidence (25, 26, 113)
ASCO practice guideline (52)
Weight managementWeight management/loss InterventionsSchool/work environmentAll10% to 20% reduction in postmenopausal breast cancer incidence (33)
Physical activity interventionsUrban designAllCannot be estimated based on present data
Alcohol counselingTaxation on alcohol (WHO recommendation, not disease specific)WHO recommendations to limit alcohol intake through taxation, accessImpact on breast cancer cannot be estimated based on present data
Food & beverageAll5 a day trial increased consumption community/worksites (114)Impact on breast cancer cannot be estimated based on present data
CervicalScreeningAllIARC multi-site case control study (27)95+% reduction in mortality (27)
VaccineAllRCT for efficacy against infection (30, 115)∼100% reduction in incidence and mortality
Population evaluation for health benefits (28–30)
Sm cessation medsSm cessation IxSmoke-free policiesSee lung aboveImpact on cervical cancer cannot be estimated based on present data
Tobacco taxesSee lung aboveImpact on cervical cancer cannot be estimated based on present data
LiverVaccineUniversal vaccinationAllPopulation reduction post vaccination (116)∼100% reduction in incidence and mortality
Wt management/Loss InterventionsSchool/work environmentOverweight and obese >60% adult populationMortality among ACS cohort members (117)24% to 50% reduction in mortality though avoiding overweight and obesity (117)
AlcoholTaxation on alcohol (WHO rec, not disease specific)AllWHO recommendations to limit alcohol intake through taxation, accessImpact on liver cancer cannot be estimated based on present data