Kehm Rebecca D, Llanos Adana A M, McDonald Jasmine A, Tehranifar Parisa, Terry Mary Beth
Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA.
Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY 10033, USA.
Cancers (Basel). 2022 Aug 26;14(17):4122. doi: 10.3390/cancers14174122.
The National Cancer Institute (NCI) has established an online repository of evidence-based cancer control programs (EBCCP) and increasingly calls for the usage of these EBCCPs to reduce the cancer burden. To inventory existing EBCCPs and identify remaining gaps, we summarized NCI's EBCCPs relevant to reducing breast cancer risk with an eye towards interventions that address multiple levels of influence in populations facing breast cancer disparities. For each program, the NCI EBCCP repository provides the following expert panel determined summary metrics: (a) program ratings (1-5 scale, 5 best) of research integrity, intervention impact, and dissemination capability, and (b) RE-AIM framework assessment (0-100%) of program reach, effectiveness, adoption, and implementation. We quantified the number of EBCCPs that met the quality criteria of receiving a score of ≥3 for research integrity, intervention impact, and dissemination capability, and receiving a score of ≥50% for available RE-AIM reach, effectiveness, adoption, and implementation. For breast cancer risk reduction, we assessed the presence and quality of EBCCPs related to physical activity (PA), obesity, alcohol, tobacco control in early life, breastfeeding, and environmental chemical exposures. Our review revealed several major gaps in EBCCPs for reducing the breast cancer burden: (1) there are no EBCCPs for key breast cancer risk factors including alcohol, breastfeeding, and environmental chemical exposures; (2) among the EBCPPs that exist for PA, obesity, and tobacco control in early life, only a small fraction (24%, 17% and 31%, respectively) met all the quality criteria (≥3 EBCCP scores and ≥50% RE-AIM scores) and; (3) of those that met the quality criteria, only two PA interventions, one obesity, and no tobacco control interventions addressed multiple levels of influence and were developed in populations facing breast cancer disparities. Thus, developing, evaluating, and disseminating interventions to address important risk factors and reduce breast cancer disparities are needed.
美国国立癌症研究所（NCI）建立了一个基于证据的癌症控制项目（EBCCP）在线库，并越来越多地呼吁使用这些EBCCP来减轻癌症负担。为了梳理现有EBCCP并找出尚存的差距，我们总结了NCI与降低乳腺癌风险相关的EBCCP，重点关注那些针对面临乳腺癌差异的人群中多层次影响的干预措施。对于每个项目，NCI的EBCCP库提供以下由专家小组确定的汇总指标：（a）项目在研究完整性、干预影响和传播能力方面的评分（1-5分制，5分为最佳），以及（b）项目在覆盖范围、有效性、采用率和实施方面的RE-AIM框架评估（0-100%）。我们对满足以下质量标准的EBCCP数量进行了量化：研究完整性、干预影响和传播能力得分≥3分，以及可用的RE-AIM覆盖范围、有效性、采用率和实施得分≥50%。为了降低乳腺癌风险，我们评估了与体育活动（PA）、肥胖、酒精、早期生活中的烟草控制、母乳喂养以及环境化学物质暴露相关的EBCCP的存在情况和质量。我们的审查揭示了在降低乳腺癌负担的EBCCP方面存在几个主要差距：（1）对于包括酒精、母乳喂养和环境化学物质暴露在内的关键乳腺癌风险因素，没有EBCCP；（2）在现有的针对PA、肥胖和早期生活中的烟草控制的EBCPP中，只有一小部分（分别为24%、17%和31%）满足所有质量标准（EBCCP得分≥3分且RE-AIM得分≥50%）；（3）在满足质量标准的项目中，只有两项PA干预措施、一项肥胖干预措施，没有烟草控制干预措施针对多层次影响，并且是在面临乳腺癌差异的人群中开发的。因此，需要制定、评估和推广干预措施，以解决重要风险因素并减少乳腺癌差异。
