Impact of Specific Prevention Strategies on Disease Incidence

The age at presentation in a prospective study from the UK demonstrates the number of cases presenting in each 5-year group, from age 30 (Fig. 16.1).

The average age at presentation was 62 with a quarter of cases occurring in men under 50 years of age. The Organisation for Economic Co-operation and Development (OECD) publishes the estimated and projected demographics, broken down by country.36 Their data are based on birth rates, mortality, and immigration. From these they derive the projected data comparing population distribution according to age for the years 2000 and 2050 (Fig. 16.2).

Scenario planning is a means of linking multiple factors to generate a number of potential futures that can be used for strategic planning. It does not represent a forecast, as it provides a range of possible outcomes, or as defined by Porter37 "an internally consistent view of what the future might turn out to be - not a forecast, but one possible future outcome". Scenario planning involves examining relevant parameters, either singly or in combination. This can lead to the formation of clusters of possible futures to assist in strategic planning.

From Fig. 16.2, the magnitude of change for each 5-year group is estimated and predicts how this will influence prevalence of penile cancer in 2050. From this it is possible to formulate a model that assesses the potential interaction of risk factor management and demographics for a whole population. In the first scenario, no action is taken to prevent penile cancer and the model presumes stable incidence of disease. Due to the increasing numbers of men in the older age groups, this projects that the number of men presenting with penile cancer will increase by 47%, with the greater proportion being in older men (Fig. 16.3). The median age at presentation shifts from the 60-64 age group to the 65-69 age group.

1

in 2000

in 2050

1

UNITED KINGDOM

ME

N

1

J

85+

1

80 - 84

1

75 - 79

1

1

70 - 74

1

1

65 - 69

,1

1

60 - 64

1

55 - 59

1 1

50 - 54

1 1

45 - 49

40 - 44

1

35 - 39

30 - 34

1 ,

25 - 29

.11.

20 - 24

I 1 1

15 - 19

10 - 14

1

5 - 9

1

0 - 4

Fig. 16.2 Population distribution among males in the UK. Blue bar represents 2000 data, whereas the other line in the bar represents projected demographics for 2050, as published by the OECD36

Fig. 16.3 Projected increase in incidence of penile cancer in the UK by the year 2050. This model can then be applied in the following two interventional scenarios, circumcision and HPV vaccination
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