The Canadian Partnership for Tomorrow Project: building a pan-Canadian research platform for disease prevention.
Journal: CMAJ | Pages: 1197-1201 | Date: August 2010 | Authors: Borugian MJ, Robson P, Fortier I, Parker L, McLaughlin J, Knoppers BM, Bédard K, Gallagher RP, Sinclair S, Ferretti V, Whelan H, Hoskin D, Potter JD.
As the proportion of the population over age 65 increases in Western countries, the burden of cancer 1 and other chronic diseases is also increasing. If advances in preventing these diseases are to be realized, better information is needed about their causes and the antecedents of the causes. For example, although it is known that many sporadic cancers are caused by a combination of lifestyle factors, exposure to environmental carcinogens and individual genetic makeup, 2,3 detailed knowledge about the interplay among these factors is lacking.
Much of our current knowledge about the causes of cancer and most relatively rare chronic diseases has come from retrospective case–control studies, in which the characteristics of patients (cases) are compared with those of age- and sex-matched people who do not have the disease (controls). This design has strengths but also a number of weakneses, including potential recall bias and selection bias 4 (Table 1). To address some of these weaknesses, in particular recall bias and the temporal relation between risk factors and outcomes, prospective cohorts are helpful because participants are enrolled before the onset of disease. In studies with a prospective cohort design, large numbers of participants, who generally have not had cancer or any other significant diagnosis, are recruited and followed over a long time, periodically providing updated health and lifestyle information and biologic samples. Layers of data and samples accumulate over time, allowing an exploration of why cancer develops in some people within the cohort but not others. 6 The disadvantages of such a design (Table 1) are cost and time, as it may be a decade or more before major results are obtained. Fortunately, many shorter-term results are also available, such as information on screening attendance and information on the frequency of major risk factors and health states, as well as environmental and individual determinants of these risk factors, all of which are useful for planning various health services. Furthermore, because many diseases can be studied simultaneously, the cost over time per health outcome studied is substantially lower than the cost of case–control studies for a comparable number of participants.