The limitations of case-control studies in the detection of environmental carcinogens.

The ability of the case-control study to detect human carcinogens has been investigated theoretically for varying fractions of the population exposed to hazards carrying different relative risks. The method is shown to be useful for the investigation of factors to which exposure is widespread (for example, common foods or beverages) but it is of limited use for the study of uncommon types of exposure, such as those associated with occupation. The case-control study is unable to detect very small relative risks (less than 1.5) even where exposure is widespread and large numbers of cases of cancer are occurring in the population. The principal limitation of the method is the maximum number of cases which can be recruited and analysed. It will only be through large-scale collaborative multicentre or international studies that important risk factors will be detected.