Prevention of colorectal cancer by combining early detection and chemoprevention

Colorectal cancer is a major cause of cancer-related mortality. Most colorectal cancers arise in precursor lesions over a number of years. The carcinogenetic pathway is modulated by a wide array of genetic and epigenetic factors. Two major approaches to halting carcinogenesis are chemoprevention and early detection. Chemoprevention is an attractive emerging option-advances in understanding the carcinogenetic pathways and progress in evaluating various putative agents are promising. However, several issues regarding efficacy, safety, and acceptability require answers before an ideal agent can come into widespread use. Early detection and removal of precursor lesions show promise in reducing disease burden. Although the concept has been around and has been widely advocated for several years, participation in screening remains low. The ideal test in terms of practicality, accuracy, and safety is still debated. This article reviews the recent literature related to screening and chemoprevention of colorectal cancer. Copyright © 2009 by Current Medicine Group LLC

The Craft of Policy Design: Can It Be More Than Art?

The craft for predicting and evaluating the impacts of policy alternatives has received much of the attention of students of public policy analysis. Relatively little attention has been given to understanding and improving the craft for designing alternative policies. Beyond catalogs of generic policy instruments, two sources provide useful insights into policy design. First, the study of institutional choice as policy design draws attention to the selection of procedures and incentive systems to achieve substantive policy outcomes. Second, the study of the manipulation of the dimensions of policy choice (heresethetics), which provides insight into strategy in political arenas, may help with the broader problem of packaging and presenting policies so that they remain viable during implementation. Copyright 1992 by The Policy Studies Organization.