Opportunities to Avoid Invasive Cancer by Diagnosis and Interception of Preneoplastic Lesions and Cancer Risk...

Preneoplastic lesions (PNL) represent a state intermediate between normal cells and invasive cancer. Individuals diagnosed with PNL are at increased risk of developing invasive cancer and represent a unique risk group. We estimated the proportion of invasive cancer that could be intercepted at multiple anatomic sites in individuals with PNL.

Using a literature survey of the prevalence, latency, and probability of progression of PNL to invasive cancer, we undertook a sensitivity analysis across proportions of invasive cancer from 5% to 95% that could be intercepted in a cohort of 100,000 individuals that would be avoided if PNL interception was successful. To calculate the number of avoidable invasive cancers, we used data that represent population-based, high-risk, unselected, and selected PNL case series and calculated the sensitivities and specificities of avoidable invasive cancers.

Substantial invasive cancer reductions could be achieved by the interception of PNL that precede pancreas, gastric, bladder, prostate, breast, colorectal, and skin cancers. An intermediate reduction in cancer incidence was observed for lung and oral cancers. Limited impact on the global burden of cancer with the interception of PNL is likely for cervical, liver, and esophageal cancer, as well as myeloma and leukemia. Due to the estimates representing varying populations, the impacts of a specific PNL or cancer cannot be compared with another.

We identified substantial variation in the impact that the interception of PNL would have on the development of invasive cancer.

These results may guide research and implementation of studies intended to maximize the number of invasive cancers that can be avoided by the interception of PNL.