Population-based cancer control: where is the greatest benefit from proven strategies to 'regain' years of life lost prematurely?
OBJECTIVE
To apply a 'health gain' approach to population-based cancer control.


METHODS
We calculated the potential years of life otherwise lost prematurely which could be 'regained' through implementation of cancer control programs for which Level I or Level II evidence already exists for population outcomes.


RESULTS
More potential years of life lost (PYLLs) would be 'regained' by enforcing a 'smoke-free' Australia than by any other possible scenario based on proven effectiveness. Even achievable scenarios for tobacco control (17% or 20% prevalence) would 'regain' more PYLL than either mammographic screening according to national policy or faecal occult blood testing (FOBT) of both men and women over 50 years for colorectal cancer.


CONCLUSIONS
As few commentators remain optimistic that more money will be allocated to health, strategic thinking for health gain needs to re-appraise resource allocation for population-based cancer control in Australia.


CONCLUSIONS
We recommend wider debate in response to our finding that, on the basis of best available evidence, the greatest potential for health gain lies less in cancer screening than fully funded tobacco control.
Ward
J E
JE
Needs Assessment & Health Outcomes Unit, Central Sydney Area Health Service, Newtown, NSW. jward@nah.rpa.cs.nsw.gov.au
Young
J M
JM
Jelfs
P
P
D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005260:Female; D006285:Health Planning; D006801:Humans; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008327:Mammography; D008875:Middle Aged; D008962:Models, Theoretical; D009369:Neoplasms / Q000517:prevention & control*; D009780:Occult Blood; D015995:Prevalence; D012306:Risk; D016540:Smoking Cessation