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Chapter 1 - Risk Factors

While the European Code Against Cancer (International Agency for Research on Cancer, 2017) has only 12 proven recommendations for action to reduce risk, a PubMed search for ‘cancer prevention/risk factors’ yields over 130 000 citations. This prompts the question: how, and why, should a busy clinician deal with all this evidence? It is tempting to wait for consensus to be summarised in systematic reviews and meta-analyses. However, these vary in quality, may not be up to date and should not be regarded as a substitute for critical reading of key reference papers. Guidelines and checklists help in making an assessment of the evidence, but it is also important to assess the practical importance of the findings. Many ‘positive’ reports turn out to have little practical impact in the real world. It is the responsibility of all cancer clinicians to give cancer prevention advice, but to be aware of the strengths and limitations of the evidence.


Systematic Reviews: A rigorous method for knowledge synthesis that collects and critically analyses multiple research studies on a specific topic. Defining features of a good quality systematic review are: a clear researchable question, explicit eligibility criteria, comprehensive search for, and selection of, studies, critical appraisal and synthesis of findings.

Abbreviations Further Reading

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