Precision prevention and early detection: framework for a new clinical cancer control pathway

Stage at diagnosis remains the strongest determinant of cancer survival, yet only 13% of cancers are detected through guideline-based screening, and 20-50% first present in an emergency department. Precision prevention and early detection (PPED) tailors cancer control by asking who is at elevated risk of developing cancer, what preventive intervention is appropriate, when should intervention be applied and at what intensity, and how and where preventive services should be delivered. De-escalation of preventive interventions in low-risk individuals is as important as preventive care escalation in high-risk individuals. The hereditary cancer syndromes demonstrate that this logic works when cancer risk is sufficiently enriched. Although the science must continue to mature, the health-system infrastructure and workforce required to sustain longitudinal prevention planning are a defining cancer control challenge in the next decade.