Creating a common language: defining individualized, personalized and precision prevention in public health

Creating a common language: defining individualized, personalized and precision prevention in... Abstract Background Because of the limited success of population-based prevention methods and due to developments in genomic screening, public health professionals and health policy makers are increasingly interested in more individualized prevention strategies. However, the terminology applied in this field is still ambiguous and thus has the potential to create misunderstandings. Methods A narrative literature review was conducted to identify how individualized, personalized and precision prevention are used in research papers and documents. Based on the findings a set of definitions were created that distinguish between these activities in a meaningful way. Results Definitions were found only for precision prevention, not for individualized or personalized prevention. The definitions of individualized, personalized and precision medicine were therefore used to create the definitions for their prevention counterparts. By these definitions, individualized prevention consists of all types of prevention that are individual-based; personalized prevention also consists of at least one form of -omic screening; and precision prevention further includes psychological, behavioral and socioeconomic data for each patient. Conclusions By defining these three key terms for different types of individual-based prevention both researchers and health policy makers can differentiate and use them in their proper context. population-based and preventative services, public health, science Background History of prevention within technocratic public health The importance of prevention in medicine is perhaps first articulated in the Chinese medical text ‘Huangdi Neijing’ (Huang Dee: Nai-Ching) from around 2600 BCE. This text states ‘Superior doctors prevent the disease, mediocre doctors treat the disease before evident, inferior doctors treat the full-blown disease’. More than 2 millennia later, in ancient Greece, Hippocrates categorized various types of acute, chronic, endemic and epidemic illnesses.1 He also noticed how social habits and environmental factors play a major role for the development of a disease and he often recommended diet and exercise for his patients. However, after his death no progress was made to improve his methods regarding medicine or prevention.2 For the next 2 millennia, prevention was effectively synonymous with the battle against infectious diseases—such as leprosy or smallpox. At the beginning of the 18th century, the concept of prevention came under scrutiny again. The Italian physician Bernardino Ramazzini—who, in 1711, wrote that ‘it is much better to prevent than to cure’3—recognized that the occurrence of specific disease is much higher in certain occupations than in others, and that this occupation-related morbidity can be prevented. The introduction of vaccinations in the same century was a milestone in the history of prevention; for the first time it was possible to protect individuals from infectious diseases.4 Due to this new method, the advances in medical science, and the general improvement in living conditions, the chance of dying from an infectious disease started to decline5 and at the end of the 20th century, in developed countries, it became more likely to die from a chronic (non-communicable) disease than from communicable diseases.6 To this day, however, most chronic diseases have no definite cure, but can only be managed. This has led to a situation where a combination of various chronic diseases has become an enormous burden for healthcare systems and societies worldwide. If this trend continues, chronic disease will make up 73% of all deaths and 60% of the global burden of disease by 2020.7 This will have vast economic impacts; in Australia alone the cost due to the loss of labor force caused by chronic conditions will rise from $37.79 billion (2010) to $63.73 billion in 2030.8 The absence of a cure for most chronic diseases highlights the importance of prevention. However, prevention initiatives against chronic diseases have had little or questionable success—apart from a few exceptions, such as the North Karelia Project in Finland for prevention of cardiovascular disease.9 This is in part due to the fact that etiological factors for the various chronic diseases were not—or were only partially—identified. However, with the introduction of genomics, and public health moving to a more individualized approach, this might change in the near future. The emergence of genomic-based prevention The word ‘genomic’ refers both to the sequence and to modifications to the sequence of the genome. The sequence variants, if they are disease risk factors, are fixed in that their contribution to overall risk does not vary over the healthspan or lifespan of the individual. The DNA modifications, if they are disease risk factors, may be variable over the healthspan or lifespan and so, if this variation is detectable in a timely fashion, it is associated with increases and decreases in risk. In order to understand genomics as a relatively new discipline, an international research team composed of experts from various disciplines in 2005 in Bellagio, Italy.10,11 In the 7-day workshop they summarized the achievements and backlog of genome-based research since the Human Genome Project began in 1990.12 The group recognized that genetic prediction has some noteworthy limitations. For example, many diseases are polygenic by nature, making it difficult for genetics to predict the future health status of an individual. Also, for some diseases it is possible to identify the genetic cause, however, with the lack of preventative interventions—such as for Huntington’s disease13—this information does not provide any advantage in preventing the disease from manifesting itself. Despite the existing limitations, genomic-based research can be greatly beneficial for public health. A counter-example of Huntington’s disease is the genomic screening of heterozygous familial hypercholesterolemia (FH), since meaningful preventive action—such as taking statin tablets—can be taken for the individual with this genetic condition.14 Or another example is the identification of the BRCA 1/2 mutations which significantly increases the chance of developing breast cancer.15 Individuals may choose to surgically remove their breast(s) as a preventative measure. Thus, to realize the potential of genomic medicine in general, the Bellagio Group recommended several steps for making use of knowledge integration and the creation of an international public health genomics network.11 A decade has passed since then and—with the exception of cascade screening for familial hypercholesterolemia mentioned previously16,17—genomic-based prevention has still not yet been fully integrated into public health in any nation. One reason for this may be that due to genomic science and technology being oversold,18 new approaches could not substitute the already existing basic public health services which have well-established evidence of effectiveness and cost-effectiveness.19,20 Another may be public health practitioners’ lack of knowledge of how to integrate novel genomic information into their programs.21 Nevertheless, rather than discourage researchers and policy makers from public health genomics, past failures should be perceived as opportunities from which we can all learn to integrate genomics more effectively into public health. Doing so would help to facilitate a debate on how to promote and improve this relatively new approach and thus modernize public health as a whole. Objectives This paper sets out to fulfill three objectives: (i) to identify how the terms individualized, personalized and precision prevention are used in both the grey and white literature thus far, (ii) to create definitions of these terms by using the same wording and by considering how they are related to each other and (iii) to understand how these terms fit into the existing paradigms of preventions within public health. Methods Due to the scope of the search a narrative literature review was conducted. PubMed was used to search for white literature while Google was used to search for grey literature such as reports and government documents. The keywords used were: ‘individualized prevention’, ‘personalized prevention’ and ‘precision prevention’. American and British spellings (i.e. for the suffix ‘-ize’/‘-ise’22,23) were included in the search. Because of the lack of definitions identified in our search, we expanded our investigation to include the following keywords: ‘individualized medicine’, ‘personalized medicine’ and ‘precision medicine’. After identifying all the definitions used for the three types of individual-based medicine, the most widely used were selected. By using these selections and the ones identified in the original search, we constructed our own definitions regarding the three types of individual-based prevention methods which take into consideration already existing notions but are also in sync with their counterparts in medicine. Finally, to see how these new definitions fit existing paradigms in public health, we checked the possible interpretations from the lenses of primary, secondary and tertiary prevention,24 then with universal, selective and indicated prevention,25 and finally with population-based and targeted prevention.26 Results Individualized prevention Although not defined by any white or grey literature, the term ‘individualized prevention’ can be traced back to a 1984 research publication in the field of dental prevention.27 More than a decade later, the same term was used in a paper discussing prevention of HIV transmission.28 The first paper using the term with reference to genomics was published in 2000; the authors described how molecular genetic epidemiological evaluation regarding cancer chemotherapy would be beneficial for individualized prevention and treatment in the near future.29 In recent literature, ‘individualized prevention’ is still used in dental care,30 HIV prevention31 and genomic-based screening,32 but is also used in non-genomic based screening for chronic disease33 and in the field of drug addiction.34 Personalized prevention ‘Personalized prevention’ is another phrase not yet defined anywhere. The first English research article using the term was published in 2000;35 however, the authors only used data regarding age, sex and place of residence of individuals in order to predict the risk of death from pathologies, and did not mention genomics as a potential tool to be incorporated into prevention. Six years passed before an article made the connection between personalized prevention and genomics.36 The authors described that genomic screening for cancer patients could contribute to implementation of personalized prevention. ‘Personalized prevention’ is primarily used in association with genomics,37–39 but is still used in other fields such as medical imaging,40,41 dental care,42 web-based cardiovascular risk assessment43 and alcohol consumption.44 Precision prevention The term ‘precision prevention’ is fairly new, and first appeared in a paper published in 2014. In this editorial article Timothy R. Rebbeck wrote: ‘Precision prevention involves use of biologic, behavioral, socioeconomic and epidemiologic data to devise and implement strategies tailored to reducing cancer incidence and mortality in a specific individual or group of individuals’.45 Two years later Matthew W. Gillman and Ross A. Hammond wrote: ‘What we call precision prevention, on the other hand, has generally involved tailoring behavioral interventions to individuals’ characteristics. Historically, it has operated ‘above the skin’ to overcome psychosocial barriers, emphasize achievable goals, or adapt to families’ differing economic or cultural circumstances’.46 Finally, at the 2016 American Association of Cancer Research (AACR) Annual Meeting, Li Hsu and other experts defined precision prevention as: ‘An in-the-works method to predict risk of colorectal cancer that integrates genetic, lifestyle and environmental risk factors’.47 As we can see, all three descriptions go beyond both individualized and genomic-based screening, while also integrating environmental factors. Adapting the terminology used in medicine Because of the lack of definitions regarding individualized and personalized prevention, the counterpart definitions used in medicine were considered; namely individualized medicine, personalized medicine and—for the sake of completeness—precision medicine. Since prevention is related to medicine, it is important that the definitions of prevention terms align with their counterparts in medicine. Concerning ‘individualized medicine’, only a single definition was found that was used by the German National Academy of Sciences Leopoldina.48 Conversely, ‘personalized medicine’ is used so broadly, that in 2013 Sebastian Schleidgen and his associates wrote a comprehensive article which summarized all the definitions and interpretations of ‘personalized medicine’, and from these created a single definition.49 It is worth mentioning that in their work they perceived ‘individualized medicine’ and ‘personalized medicine’ as synonyms and besides genomic testing, they also included proteomic, metabolomic or molecular diseases pathway screening in their definition. However, in the same year, the European Commission published a document in which they defined ‘personalized medicine’ in a different way.50 This has created a situation where two definitions exist for the same terminology. Regardless, both promote a top-down approach and give little voice or autonomy to public health professionals. Finally, the difference between ‘personalized medicine’ and ‘precision medicine’ is ambiguous.51 Of the four definitions found regarding ‘precision medicine’, three of them recognize that the environment52 and psychosocial characteristics53,54 of the patient should also be incorporated into the term, while one of them ignores these notions entirely.55 After identifying all the possible definitions, we selected those which were deemed most suitable according to their content and wording (Table 1). Table 1 Definitions selected by the authors regarding the various types of individual-based medicine Type of medicine Definition Individualized medicine (IM) Individualized medicine aims to improve the efficacy and quality of treatment through targeted prevention, systematic diagnostics and tailored therapeutic procedures that are oriented to the needs of individual patients or patient groups; at the same time, individualized medicine aims to reduce side effects and increase the cost-effectiveness of treatment over the long term.48 Personalized medicine (PM) Personalized medicine seeks to improve stratification and timing of healthcare by utilizing biological information and biomarkers on the level of molecular disease pathways, genetics, proteomics as well as metabolomics.49 Personalized medicine refers to a medical model using molecular profiling for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention.50 Precision medicine (PrM) Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.52 Type of medicine Definition Individualized medicine (IM) Individualized medicine aims to improve the efficacy and quality of treatment through targeted prevention, systematic diagnostics and tailored therapeutic procedures that are oriented to the needs of individual patients or patient groups; at the same time, individualized medicine aims to reduce side effects and increase the cost-effectiveness of treatment over the long term.48 Personalized medicine (PM) Personalized medicine seeks to improve stratification and timing of healthcare by utilizing biological information and biomarkers on the level of molecular disease pathways, genetics, proteomics as well as metabolomics.49 Personalized medicine refers to a medical model using molecular profiling for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention.50 Precision medicine (PrM) Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.52 Table 1 Definitions selected by the authors regarding the various types of individual-based medicine Type of medicine Definition Individualized medicine (IM) Individualized medicine aims to improve the efficacy and quality of treatment through targeted prevention, systematic diagnostics and tailored therapeutic procedures that are oriented to the needs of individual patients or patient groups; at the same time, individualized medicine aims to reduce side effects and increase the cost-effectiveness of treatment over the long term.48 Personalized medicine (PM) Personalized medicine seeks to improve stratification and timing of healthcare by utilizing biological information and biomarkers on the level of molecular disease pathways, genetics, proteomics as well as metabolomics.49 Personalized medicine refers to a medical model using molecular profiling for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention.50 Precision medicine (PrM) Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.52 Type of medicine Definition Individualized medicine (IM) Individualized medicine aims to improve the efficacy and quality of treatment through targeted prevention, systematic diagnostics and tailored therapeutic procedures that are oriented to the needs of individual patients or patient groups; at the same time, individualized medicine aims to reduce side effects and increase the cost-effectiveness of treatment over the long term.48 Personalized medicine (PM) Personalized medicine seeks to improve stratification and timing of healthcare by utilizing biological information and biomarkers on the level of molecular disease pathways, genetics, proteomics as well as metabolomics.49 Personalized medicine refers to a medical model using molecular profiling for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention.50 Precision medicine (PrM) Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.52 Clarifying the terms After identifying the usage of the various types of prevention and the definitions used in medicine, we have the basis to suggest a consistent set of definitions for individualized, personalized and precision prevention. When formulating the definitions we treated ‘individualized prevention’ and ‘personalized prevention’ separately because we believe it is necessary to have a definition for individual-based prevention that does not include genomic, transcriptomic, proteomic or metabolomic data. Consequently, when arguing for the benefits of introducing, for example, genomic testing into individual-based prevention, we can use two different terms for comparison and therefore avoid terminological confusion. When we disassembled the existing definitions and concepts, we noted that individualized, personalized and precision prevention are not separate terms, but are embedded in each other (Fig. 1). While ‘individualized prevention’ can be used for all kinds of prevention which are individual-based, ‘personalized prevention’ must also include genomic, transcriptomic, proteomic or metabolomic screening, and ‘precision prevention’ has to include environmental factors of the patient, such as psychological and behavioral profile and/or socioeconomic status. Thus, when formulating the definitions we took these into consideration (Table 2). Fig. 1 View largeDownload slide Differences among the various types of individual-based prevention. Fig. 1 View largeDownload slide Differences among the various types of individual-based prevention. Table 2 Definitions defined by the authors regarding the various types of individual-based prevention Type of prevention Definition Individualized prevention (IP) Individualized prevention is a form of prevention in public health, in which health professionals consider the characteristics, lifestyle, family history, anamnesis, risk status and medication of the client when making proposals to maintain or improve the individual’s quality of life. Personalized prevention (PP) Personalized prevention is a form of prevention in public health, which includes the activities of individualized prevention and in which health professionals also consider biological information and biomarkers at the level of molecular disease pathways, genetics, transcriptomics, proteomics and metabolomics of the client when making proposals to maintain or improve the individual’s quality of life. Precision prevention (PrP) Precision prevention is a form of prevention in public health, which includes the activities of personalized prevention and in which health professionals also consider the socioeconomic status or the opportunities offered by psychological and behavioral data of the client when making proposals to maintain or improve the individual’s quality of life. Type of prevention Definition Individualized prevention (IP) Individualized prevention is a form of prevention in public health, in which health professionals consider the characteristics, lifestyle, family history, anamnesis, risk status and medication of the client when making proposals to maintain or improve the individual’s quality of life. Personalized prevention (PP) Personalized prevention is a form of prevention in public health, which includes the activities of individualized prevention and in which health professionals also consider biological information and biomarkers at the level of molecular disease pathways, genetics, transcriptomics, proteomics and metabolomics of the client when making proposals to maintain or improve the individual’s quality of life. Precision prevention (PrP) Precision prevention is a form of prevention in public health, which includes the activities of personalized prevention and in which health professionals also consider the socioeconomic status or the opportunities offered by psychological and behavioral data of the client when making proposals to maintain or improve the individual’s quality of life. Table 2 Definitions defined by the authors regarding the various types of individual-based prevention Type of prevention Definition Individualized prevention (IP) Individualized prevention is a form of prevention in public health, in which health professionals consider the characteristics, lifestyle, family history, anamnesis, risk status and medication of the client when making proposals to maintain or improve the individual’s quality of life. Personalized prevention (PP) Personalized prevention is a form of prevention in public health, which includes the activities of individualized prevention and in which health professionals also consider biological information and biomarkers at the level of molecular disease pathways, genetics, transcriptomics, proteomics and metabolomics of the client when making proposals to maintain or improve the individual’s quality of life. Precision prevention (PrP) Precision prevention is a form of prevention in public health, which includes the activities of personalized prevention and in which health professionals also consider the socioeconomic status or the opportunities offered by psychological and behavioral data of the client when making proposals to maintain or improve the individual’s quality of life. Type of prevention Definition Individualized prevention (IP) Individualized prevention is a form of prevention in public health, in which health professionals consider the characteristics, lifestyle, family history, anamnesis, risk status and medication of the client when making proposals to maintain or improve the individual’s quality of life. Personalized prevention (PP) Personalized prevention is a form of prevention in public health, which includes the activities of individualized prevention and in which health professionals also consider biological information and biomarkers at the level of molecular disease pathways, genetics, transcriptomics, proteomics and metabolomics of the client when making proposals to maintain or improve the individual’s quality of life. Precision prevention (PrP) Precision prevention is a form of prevention in public health, which includes the activities of personalized prevention and in which health professionals also consider the socioeconomic status or the opportunities offered by psychological and behavioral data of the client when making proposals to maintain or improve the individual’s quality of life. Defining the place of the terms in public health To better understand the roles of these activities it is necessary to see how they fit into the existing prevention paradigms in public health. One of the oldest and most commonly used viewpoint of the categories of prevention originates from the 1940s.24 In their work, Hugh Rodman Leavell and Edwin Gurney Clark differentiated between primary, secondary and tertiary prevention, defining primary prevention as activities aiming to prevent disease or injury before they can ever occur; secondary prevention as activities aiming to reduce the impact of a disease or injury that has already occurred; and tertiary prevention as activities aiming to reduce the impact of an ongoing illness or injury that has lasting effects. Our definitions of individualized, personalized and precision prevention are viable within this paradigm, as these prevention types can be applied at any stage across primary, secondary or tertiary prevention. Another approach is to categorize preventions into universal, selective and indicated prevention.25 While universal prevention is a form of prevention that affects the entire population, selective prevention focuses on groups or individuals that have a higher risk of developing a particular disease. Indicated prevention, meanwhile, only focuses on individuals who are identified as being at high risk of developing a disease. In this paradigm, individualized, personalized and precision prevention are part of selective prevention but do not cover it entirely, since selective prevention can be applied to a group as well. Thus, only when combining individualized prevention with stratified prevention56 do we get selective prevention. Finally, by definition, indicated prevention partially overlaps with individualized, personalized and precision prevention. The final prevention paradigm worth mentioning separates prevention into population-based and targeted prevention.26 However, because population-based prevention is identical to universal prevention, and targeted prevention to selective prevention, the same statement can be made as in the previous paragraph. The summary of these categories and how individualized, personalized and precision prevention are located in these are shown in Table 3. Also, for the sake of better understanding how these types of prevention differ from one another, examples are given regarding type 2 diabetes mellitus (T2DM). Table 3 Overlaps and examples of the various types of prevention in public health Type of prevention Examples regarding T2DM Primary prevention Secondary prevention Tertiary prevention Population-based prevention/Universal prevention Using mass media to promote healthy lifestyle such as diet. Carrying out a population wide type 2 diabetes screening program. Carrying out a population wide retinopathy screening program. Introducing a smoking ban in restaurants through legislation. Targeted prevention/selective prevention Stratified prevention Using mass media specifically targeted for obese people to promote healthy lifestyle such diet. Carrying out a type 2 diabetes screening program among all obese people. Carrying out a retinopathy screening program among all people with type 2 diabetes. Individualized prevention By considering the client’s characteristics, lifestyle and medical record the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle and medical record the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle and medical record. Personalized prevention By considering the client’s characteristics, lifestyle, medical record and genome the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle, medical record and genome. Precision prevention By considering the client’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome and by considering the client’s psychological profile and socioeconomic status the GP encouragers the patient to go for a screening for type 2 diabetes. By taking into consideration the patient’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient with type 2 diabetes to cope with the disease. Type of prevention Examples regarding T2DM Primary prevention Secondary prevention Tertiary prevention Population-based prevention/Universal prevention Using mass media to promote healthy lifestyle such as diet. Carrying out a population wide type 2 diabetes screening program. Carrying out a population wide retinopathy screening program. Introducing a smoking ban in restaurants through legislation. Targeted prevention/selective prevention Stratified prevention Using mass media specifically targeted for obese people to promote healthy lifestyle such diet. Carrying out a type 2 diabetes screening program among all obese people. Carrying out a retinopathy screening program among all people with type 2 diabetes. Individualized prevention By considering the client’s characteristics, lifestyle and medical record the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle and medical record the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle and medical record. Personalized prevention By considering the client’s characteristics, lifestyle, medical record and genome the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle, medical record and genome. Precision prevention By considering the client’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome and by considering the client’s psychological profile and socioeconomic status the GP encouragers the patient to go for a screening for type 2 diabetes. By taking into consideration the patient’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient with type 2 diabetes to cope with the disease. Note: Indicated preventions are located within the ‘targeted prevention’ row and ‘secondary prevention’ column. Table 3 Overlaps and examples of the various types of prevention in public health Type of prevention Examples regarding T2DM Primary prevention Secondary prevention Tertiary prevention Population-based prevention/Universal prevention Using mass media to promote healthy lifestyle such as diet. Carrying out a population wide type 2 diabetes screening program. Carrying out a population wide retinopathy screening program. Introducing a smoking ban in restaurants through legislation. Targeted prevention/selective prevention Stratified prevention Using mass media specifically targeted for obese people to promote healthy lifestyle such diet. Carrying out a type 2 diabetes screening program among all obese people. Carrying out a retinopathy screening program among all people with type 2 diabetes. Individualized prevention By considering the client’s characteristics, lifestyle and medical record the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle and medical record the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle and medical record. Personalized prevention By considering the client’s characteristics, lifestyle, medical record and genome the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle, medical record and genome. Precision prevention By considering the client’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome and by considering the client’s psychological profile and socioeconomic status the GP encouragers the patient to go for a screening for type 2 diabetes. By taking into consideration the patient’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient with type 2 diabetes to cope with the disease. Type of prevention Examples regarding T2DM Primary prevention Secondary prevention Tertiary prevention Population-based prevention/Universal prevention Using mass media to promote healthy lifestyle such as diet. Carrying out a population wide type 2 diabetes screening program. Carrying out a population wide retinopathy screening program. Introducing a smoking ban in restaurants through legislation. Targeted prevention/selective prevention Stratified prevention Using mass media specifically targeted for obese people to promote healthy lifestyle such diet. Carrying out a type 2 diabetes screening program among all obese people. Carrying out a retinopathy screening program among all people with type 2 diabetes. Individualized prevention By considering the client’s characteristics, lifestyle and medical record the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle and medical record the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle and medical record. Personalized prevention By considering the client’s characteristics, lifestyle, medical record and genome the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle, medical record and genome. Precision prevention By considering the client’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome and by considering the client’s psychological profile and socioeconomic status the GP encouragers the patient to go for a screening for type 2 diabetes. By taking into consideration the patient’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient with type 2 diabetes to cope with the disease. Note: Indicated preventions are located within the ‘targeted prevention’ row and ‘secondary prevention’ column. Discussion Main findings of this study According to the literature search on the topic of individual-based prevention, we can determine that while there are a few definitions of ‘precision prevention’, both ‘individualized prevention’ and ‘personalized prevention’ are used interchangeably and haphazardly. Essentially, both terms can be used to describe any form of prevention which is not population-based, whether or not genomic-based screening is included. These terms are no longer synonyms, but are embedded into each other. Also, as demonstrated with the example of type 2 diabetes mellitus, they are compatible with existing terminology used in public health. What is already known on this topic Schleidgen and his associates were the ones who first noted that ‘personalized medicine’ is used haphazardly in the scientific literature and created their own definition that takes into account previous usage of this term.43 Although, they have demonstrated the importance of such work, no similar attempts were made regarding the other forms of individual-based medicine or their preventive counterparts. What this study adds This is the first study that investigates how the terms individualized, personalized and precision prevention are used in both grey and white literature. Also, this is the first attempt to standardize these by taking into account their current and past usage, how their counterpart in medicine is used and their relationship to each other. By doing so, we not only introduced new definitions but an entire system on how individual-based prevention should be approached. The goal is for this work to help facilitate debates on how public health as a whole should be modernized. Limitations of this study Because a narrative literature review was conducted and only PubMed was used to search white literature, it is possible that some research papers were not identified that use one of the terms regarding individual-based prevention and medicine. Also, our search only included literature written in English but this was unavoidable because of the scope of our search and language barriers. Also, when interpreting existing definitions and creating our own we did not include experts in this field. This was done on purpose to create a resource accessible to non-experts given the emergence and continued importance this filed will have on medicine and healthcare. Finally, despite our effort to present a set of definitions based on the best arguments possible, without any form of compulsion from government or academic institutions, these are only suggestions and they can, of course, be ignored by researchers and policy makers because there is no international authority to enforce it even if it is accepted. Conclusions Creating a common language in any field of science is a necessity, and individual-based prevention in public health is no exception. By defining the terms individualized, personalized and precision prevention—and by determining their role in public health—we have created the terminological foundation for later work. This foundation can also be used in the debate regarding public health between modernizers and traditionalists. Although, we understand that many within the international research community will wish to use these terms interchangeably or with a different meaning, we hope that our work will highlight the importance of standardization within the field of public health which would help the dissemination of key findings among researchers and health policy makers globally. Acknowledgements The authors would like to thank Tyra Lagerberg for proof-reading the original version of the article. Funding The work is supported by the ‘Gazdaságfejlesztési és Innovációs Operatív Program’ (GINOP) 2.3.2-15-2016-00005 project co-financed by the European Union under the European Regional Development Fund; PRECeDI project (Personalized PREvention of Chronic Diseases) funded by the European Commission in the H2020 Marie Skłodowska-Curie Research and Innovation Staff Exchange program (grant agreement number: 645740). References 1 Garrison FH . An Introduction to the History of Medicine , 4th edn . Philadelphia & London : W.B. Saunders Company , 1929 . 2 Margotta R . The Story of Medicine . New York : Golden Press , 1968 . 3 Gochfeld M . Chronologic history of occupational medicine . J Occup Environ Med 2005 ; 47 ( 2 ): 96 – 114 . Google Scholar CrossRef Search ADS PubMed 4 Bazin H . A brief history of the prevention of infectious diseases by immunisations . Comp Immunol Microbiol Infect Dis 2003 ; 26 ( 5–6 ): 293 – 308 . Google Scholar CrossRef Search ADS PubMed 5 Brachman PS . Infectious diseases—past, present, and future . Int J Epidemiol 2003 ; 32 ( 5 ): 684 – 86 . Google Scholar CrossRef Search ADS PubMed 6 World Health Organization . The Top 10 Causes of Death. http://www.who.int/mediacentre/factsheets/fs310/en/index2.html (April 2017 , date last accessed). 7 Epping-Jordan JE . Integrated approaches to prevention and control of chronic conditions . Kidney Int 2005 ; 68 ( 98 ): S86 – 8 . Google Scholar CrossRef Search ADS 8 Schofield DJ , Shrestha RN , Cunich M et al. . Lost productive life years caused by chronic conditions in Australians aged 45–64 years, 2010–2030 . Med J Aust 2015 ; 203 ( 6 ): 260 . Google Scholar CrossRef Search ADS PubMed 9 Puska P , Mustaniemi H . Incidence and presentation of myocardial-infarction in North-Karelia Finland . Acta Med Scand 1975 ; 197 ( 3 ): 211 – 16 . Google Scholar PubMed 10 Report of an expert workshop held at the Rockefeller Foundation Study and Conference Centre , Bellagio, Italy, 14–20 April 2005 . http://www.phgen.eu/typo3/fileadmin/downloads/bellagio-011807.pdf (April 2017, date last accessed). 11 Burke W , Khoury MJ , Stewart A et al. . The path from genome-based research to population health: development of an international public health genomics network . Genet Med 2006 ; 8 ( 7 ): 451 – 8 . Google Scholar CrossRef Search ADS PubMed 12 Collins FS . Shattuck lecture—medical and societal consequences of the human genome project . New Engl J Med 1999 ; 341 ( 1 ): 28 – 37 . Google Scholar CrossRef Search ADS PubMed 13 Roos RA . Huntington’s disease: a clinical review . Orphanet J Rare Dis 2012 ; 5 : 40 . Google Scholar CrossRef Search ADS 14 Ned RM , Sijbrands EJ . Cascade screening for familial hypercholesterolemia (FH) . PLoS Curr 2011 ; 3 : RRN1238 . Google Scholar PubMed 15 Domchek SM , Friebel TM , Singer CF et al. . Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality . J Am Med Assoc 2010 ; 304 ( 9 ): 967 – 75 . Google Scholar CrossRef Search ADS 16 Ned RM , Sijbrands EJ . Cascade screening for familial hypercholesterolemia (FH) . PLoS Currents 2011 ; 3 : RRN1238 . Google Scholar PubMed 17 Henneman L , McBride CM , Cornel MC et al. . Screening for familial hypercholesterolemia in children: what can we learn from adult screening programs? Healthcare (Basel) 2015 ; 3 ( 4 ): 1018 – 30 . Google Scholar CrossRef Search ADS PubMed 18 Boccia S . Why is personalized medicine relevant to public health? Eur J Public Health 2014 ; 24 ( 3 ): 349 – 50 . Google Scholar CrossRef Search ADS PubMed 19 Boccia S . Personalized health care: the hope beyond the hype . Ital J Public Health 2012 ; 9 ( 4 ): e8688-1 – 2 . 20 Owen L , Pennington B , Fischer A et al. . The cost-effectiveness of public health interventions examined by NICE from 2011 to 2016 . J Public Health (Oxf) 2017 . doi:10.1093/pubmed/fdx119 . 21 Khoury MJ , Bowen MS , Burke W et al. . Current priorities for public health practice in addressing the role of human genomics in improving population health . Am J Prev Med 2011 ; 40 ( 4 ): 486 – 93 . Google Scholar CrossRef Search ADS PubMed 22 Stevenson A , Lindberg CA . New Oxford American Dictionary , 3rd edn . New York : Oxford University Press , 2010 , 1308. Google Scholar CrossRef Search ADS 23 Stevenson A . Oxford Dictionary of English , 3rd edn . New York : Oxford University Press , 2010 , XV. 24 Leavell HR , Clark EG . Preventive Medicine for the Doctor in his Community . New York : McGraw-Hill , 1953 . 25 Gordon RS . An operational classification of disease prevention . Public Health Rep 1983 ; 98 ( 2 ): 107 – 09 . Google Scholar PubMed 26 Zulman DM , Vijan S , Omenn GS et al. . The relative merits of population-based and targeted prevention strategies . Milbank Q 2008 ; 86 ( 4 ): 557 – 80 . Google Scholar CrossRef Search ADS PubMed 27 Hamp SE , Johansson LA , Karlsson R . Clinical effects of preventive regimens for young-people in their early and middle teens in relation to previous experience with dental prevention . Acta Odontol Scand 1984 ; 42 ( 2 ): 99 – 108 . Google Scholar CrossRef Search ADS PubMed 28 Reyes EM , Legg JL . Prevention of HIV transmission . Prim Care 1997 ; 24 ( 3 ): 469 – 77 . Google Scholar PubMed 29 Brockmoller J , Cascorbi I , Henning S et al. . Molecular genetics of cancer susceptibility . Pharmacology 2000 ; 61 ( 3 ): 212 – 27 . Google Scholar CrossRef Search ADS PubMed 30 Riley JL , Gordan VV , Ajmo CT et al. . Dentists’ use of caries risk assessment and individualized caries prevention for their adult patients: findings from The Dental Practice-Based Research Network . Community Dent Oral 2011 ; 39 ( 6 ): 564 – 73 . Google Scholar CrossRef Search ADS 31 Chen YQ , Masse B , Wang L et al. . Statistical considerations for the HPTN 052 Study to evaluate the effectiveness of early versus delayed antiretroviral strategies to prevent the sexual transmission of HIV-1 in serodiscordant couples . Contemp Clin Trials 2012 ; 33 ( 6 ): 1280 – 86 . Google Scholar CrossRef Search ADS PubMed 32 Lu Y , Lu F , Zeng S et al. . Genetics and gastric cancer susceptibility . Int J Clin Exp Med 2015 ; 8 ( 6 ): 8377 – 83 . Google Scholar PubMed 33 Manca DP , Aubrey-Bassler K , Kandola K et al. . Implementing and evaluating a program to facilitate chronic disease prevention and screening in primary care: a mixed methods program evaluation . Implementation Sci 2014 ; 9 : 135 . Google Scholar CrossRef Search ADS 34 Ahn WY , Vassileva J . Machine-learning identifies substance-specific behavioral markers for opiate and stimulant dependence . Drug Alcohol Depen 2016 ; 161 : 247 – 57 . Google Scholar CrossRef Search ADS 35 Giorgi R , Gouvernet J , Jougla E et al. . The use of the personalized estimate of death probabilities for medical decision making . Comput Biomed Res 2000 ; 33 ( 1 ): 75 – 83 . Google Scholar CrossRef Search ADS PubMed 36 Katoh M , Katoh M . Bioinformatics for cancer management in the post-genome era . Technol Cancer Res Treat 2006 ; 5 ( 2 ): 169 – 75 . Google Scholar CrossRef Search ADS PubMed 37 Leonard MM , Camhi S , Huedo-Medina TB et al. . Celiac Disease Genomic, Environmental, Microbiome, and Metabolomic (CDGEMM) study design: approach to the future of personalized prevention of celiac disease . Nutrients 2015 ; 7 ( 11 ): 9325 – 36 . Google Scholar CrossRef Search ADS PubMed 38 Koyanagi YN , Ito H , Oze I et al. . Development of a prediction model and estimation of cumulative risk for upper aerodigestive tract cancer on the basis of the aldehyde dehydrogenase 2 genotype and alcohol consumption in a Japanese population . Eur J Cancer Prev 2017 ; 26 ( 1 ): 38 – 47 . Google Scholar CrossRef Search ADS PubMed 39 Mobasheri A , Henrotin Y . Biomarkers of (osteo)arthritis . Biomarkers 2015 ; 20 ( 8 ): 513 – 18 . Google Scholar CrossRef Search ADS PubMed 40 European Society of Radiology (ESR). Medical imaging in personalised medicine: a white paper of the research committee of the European Society of Radiology (ESR) . Insights Imaging 2015 ; 6 ( 2 ): 141 – 55 . CrossRef Search ADS PubMed 41 Iozzo P . Metabolic imaging in obesity: underlying mechanisms and consequences in the whole body . Ann N Y Acad Sci 2015 ; 1353 : 21 – 40 . Google Scholar CrossRef Search ADS PubMed 42 Kunin AA , Belenova IA , Ippolitov YA et al. . Predictive research methods of enamel and dentine for initial caries detection . EPMA J 2013 ; 4 ( 1 ): 19 . Google Scholar CrossRef Search ADS PubMed 43 van den Brekel-Dijkstra K , Rengers AH , Niessen MAJ et al. . Personalized prevention approach with use of a web-based cardiovascular risk assessment with tailored lifestyle follow-up in primary care practice—a pilot study . Eur J Prev Cardiol 2016 ; 23 ( 5 ): 544 – 51 . Google Scholar CrossRef Search ADS PubMed 44 Vaughn MG , King KM . Premeditation and sensation seeking moderate the reasoned action and social reaction pathways in the prototype/willingness model of alcohol use . Subst Use Misuse 2016 ; 51 ( 6 ): 711 – 21 . Google Scholar CrossRef Search ADS PubMed 45 Rebbeck TR . Precision prevention of cancer . Cancer Epidemiol Biomarkers 2014 ; 23 ( 12 ): 2713 – 15 . Google Scholar CrossRef Search ADS 46 Gillman MW , Hammond RA . Precision treatment and precision prevention integrating ‘below and above the skin’ . Jama Pediatr 2016 ; 170 ( 1 ): 9 – 10 . Google Scholar CrossRef Search ADS PubMed 47 Science Daily . Precision Prevention of Colorectal Cancer. 2016 . https://www.sciencedaily.com/releases/2016/04/160418145504.htm (April 2017, date last accessed). 48 German National Academy of Sciences Leopoldina, acatech – National Academy of Science and Engineering and Union of the German Academies of Sciences and Humanities . Individualised Medicine—Prerequisites and Consequences, Halle (Saale), 2014 . 49 Schleidgen S , Klingler C , Bertram T et al. . What is personalized medicine: sharpening a vague term based on a systematic literature review . Bmc Med Ethics 2013 ; 14 : 55 . Google Scholar CrossRef Search ADS PubMed 50 European Commission . Commission Staff Working Document—Use of ‘-Omics’ Technologies in the Development of Personalised Medicine, Brussles, 2013 . 51 Khoury MJ . The Shift From Personalized Medicine to Precision Medicine and Precision Public Health: Words Matter! https://blogs.cdc.gov/genomics/2016/04/21/shift/ (April 2017 , date last accessed). 52 What is Precision Medicine? National Institutes of Health. https://ghr.nlm.nih.gov/primer/precisionmedicine/definition (April 2017 , date last accessed). 53 Jameson JL , Longo DL . Precision medicine—personalized, problematic, and promising . N Engl J Med 2015 ; 372 ( 4 ): 2229 – 34 . Google Scholar CrossRef Search ADS PubMed 54 Klonoff DC . Precision medicine for managing diabetes . J Diabetes Sci Technol 2015 ; 9 ( 1 ): 3 – 7 . Google Scholar CrossRef Search ADS PubMed 55 Mirnezami R , Nicholson J , Darzi A . Preparing for precision medicine . New Engl J Med 2012 ; 366 ( 6 ): 489 – 91 . Google Scholar CrossRef Search ADS PubMed 56 Burton H , Sagoo GS , Pharoah P et al. . Time to revisit Geoffrey Rose: strategies for prevention in the genomic era? Ital J Public Health 2012 ; 9 ( 4 ): e8665 . © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Public Health Oxford University Press

Creating a common language: defining individualized, personalized and precision prevention in public health

Loading next page...
 
/lp/ou_press/creating-a-common-language-defining-individualized-personalized-and-203hrfdZVp
Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
ISSN
1741-3842
eISSN
1741-3850
D.O.I.
10.1093/pubmed/fdy066
Publisher site
See Article on Publisher Site

Abstract

Abstract Background Because of the limited success of population-based prevention methods and due to developments in genomic screening, public health professionals and health policy makers are increasingly interested in more individualized prevention strategies. However, the terminology applied in this field is still ambiguous and thus has the potential to create misunderstandings. Methods A narrative literature review was conducted to identify how individualized, personalized and precision prevention are used in research papers and documents. Based on the findings a set of definitions were created that distinguish between these activities in a meaningful way. Results Definitions were found only for precision prevention, not for individualized or personalized prevention. The definitions of individualized, personalized and precision medicine were therefore used to create the definitions for their prevention counterparts. By these definitions, individualized prevention consists of all types of prevention that are individual-based; personalized prevention also consists of at least one form of -omic screening; and precision prevention further includes psychological, behavioral and socioeconomic data for each patient. Conclusions By defining these three key terms for different types of individual-based prevention both researchers and health policy makers can differentiate and use them in their proper context. population-based and preventative services, public health, science Background History of prevention within technocratic public health The importance of prevention in medicine is perhaps first articulated in the Chinese medical text ‘Huangdi Neijing’ (Huang Dee: Nai-Ching) from around 2600 BCE. This text states ‘Superior doctors prevent the disease, mediocre doctors treat the disease before evident, inferior doctors treat the full-blown disease’. More than 2 millennia later, in ancient Greece, Hippocrates categorized various types of acute, chronic, endemic and epidemic illnesses.1 He also noticed how social habits and environmental factors play a major role for the development of a disease and he often recommended diet and exercise for his patients. However, after his death no progress was made to improve his methods regarding medicine or prevention.2 For the next 2 millennia, prevention was effectively synonymous with the battle against infectious diseases—such as leprosy or smallpox. At the beginning of the 18th century, the concept of prevention came under scrutiny again. The Italian physician Bernardino Ramazzini—who, in 1711, wrote that ‘it is much better to prevent than to cure’3—recognized that the occurrence of specific disease is much higher in certain occupations than in others, and that this occupation-related morbidity can be prevented. The introduction of vaccinations in the same century was a milestone in the history of prevention; for the first time it was possible to protect individuals from infectious diseases.4 Due to this new method, the advances in medical science, and the general improvement in living conditions, the chance of dying from an infectious disease started to decline5 and at the end of the 20th century, in developed countries, it became more likely to die from a chronic (non-communicable) disease than from communicable diseases.6 To this day, however, most chronic diseases have no definite cure, but can only be managed. This has led to a situation where a combination of various chronic diseases has become an enormous burden for healthcare systems and societies worldwide. If this trend continues, chronic disease will make up 73% of all deaths and 60% of the global burden of disease by 2020.7 This will have vast economic impacts; in Australia alone the cost due to the loss of labor force caused by chronic conditions will rise from $37.79 billion (2010) to $63.73 billion in 2030.8 The absence of a cure for most chronic diseases highlights the importance of prevention. However, prevention initiatives against chronic diseases have had little or questionable success—apart from a few exceptions, such as the North Karelia Project in Finland for prevention of cardiovascular disease.9 This is in part due to the fact that etiological factors for the various chronic diseases were not—or were only partially—identified. However, with the introduction of genomics, and public health moving to a more individualized approach, this might change in the near future. The emergence of genomic-based prevention The word ‘genomic’ refers both to the sequence and to modifications to the sequence of the genome. The sequence variants, if they are disease risk factors, are fixed in that their contribution to overall risk does not vary over the healthspan or lifespan of the individual. The DNA modifications, if they are disease risk factors, may be variable over the healthspan or lifespan and so, if this variation is detectable in a timely fashion, it is associated with increases and decreases in risk. In order to understand genomics as a relatively new discipline, an international research team composed of experts from various disciplines in 2005 in Bellagio, Italy.10,11 In the 7-day workshop they summarized the achievements and backlog of genome-based research since the Human Genome Project began in 1990.12 The group recognized that genetic prediction has some noteworthy limitations. For example, many diseases are polygenic by nature, making it difficult for genetics to predict the future health status of an individual. Also, for some diseases it is possible to identify the genetic cause, however, with the lack of preventative interventions—such as for Huntington’s disease13—this information does not provide any advantage in preventing the disease from manifesting itself. Despite the existing limitations, genomic-based research can be greatly beneficial for public health. A counter-example of Huntington’s disease is the genomic screening of heterozygous familial hypercholesterolemia (FH), since meaningful preventive action—such as taking statin tablets—can be taken for the individual with this genetic condition.14 Or another example is the identification of the BRCA 1/2 mutations which significantly increases the chance of developing breast cancer.15 Individuals may choose to surgically remove their breast(s) as a preventative measure. Thus, to realize the potential of genomic medicine in general, the Bellagio Group recommended several steps for making use of knowledge integration and the creation of an international public health genomics network.11 A decade has passed since then and—with the exception of cascade screening for familial hypercholesterolemia mentioned previously16,17—genomic-based prevention has still not yet been fully integrated into public health in any nation. One reason for this may be that due to genomic science and technology being oversold,18 new approaches could not substitute the already existing basic public health services which have well-established evidence of effectiveness and cost-effectiveness.19,20 Another may be public health practitioners’ lack of knowledge of how to integrate novel genomic information into their programs.21 Nevertheless, rather than discourage researchers and policy makers from public health genomics, past failures should be perceived as opportunities from which we can all learn to integrate genomics more effectively into public health. Doing so would help to facilitate a debate on how to promote and improve this relatively new approach and thus modernize public health as a whole. Objectives This paper sets out to fulfill three objectives: (i) to identify how the terms individualized, personalized and precision prevention are used in both the grey and white literature thus far, (ii) to create definitions of these terms by using the same wording and by considering how they are related to each other and (iii) to understand how these terms fit into the existing paradigms of preventions within public health. Methods Due to the scope of the search a narrative literature review was conducted. PubMed was used to search for white literature while Google was used to search for grey literature such as reports and government documents. The keywords used were: ‘individualized prevention’, ‘personalized prevention’ and ‘precision prevention’. American and British spellings (i.e. for the suffix ‘-ize’/‘-ise’22,23) were included in the search. Because of the lack of definitions identified in our search, we expanded our investigation to include the following keywords: ‘individualized medicine’, ‘personalized medicine’ and ‘precision medicine’. After identifying all the definitions used for the three types of individual-based medicine, the most widely used were selected. By using these selections and the ones identified in the original search, we constructed our own definitions regarding the three types of individual-based prevention methods which take into consideration already existing notions but are also in sync with their counterparts in medicine. Finally, to see how these new definitions fit existing paradigms in public health, we checked the possible interpretations from the lenses of primary, secondary and tertiary prevention,24 then with universal, selective and indicated prevention,25 and finally with population-based and targeted prevention.26 Results Individualized prevention Although not defined by any white or grey literature, the term ‘individualized prevention’ can be traced back to a 1984 research publication in the field of dental prevention.27 More than a decade later, the same term was used in a paper discussing prevention of HIV transmission.28 The first paper using the term with reference to genomics was published in 2000; the authors described how molecular genetic epidemiological evaluation regarding cancer chemotherapy would be beneficial for individualized prevention and treatment in the near future.29 In recent literature, ‘individualized prevention’ is still used in dental care,30 HIV prevention31 and genomic-based screening,32 but is also used in non-genomic based screening for chronic disease33 and in the field of drug addiction.34 Personalized prevention ‘Personalized prevention’ is another phrase not yet defined anywhere. The first English research article using the term was published in 2000;35 however, the authors only used data regarding age, sex and place of residence of individuals in order to predict the risk of death from pathologies, and did not mention genomics as a potential tool to be incorporated into prevention. Six years passed before an article made the connection between personalized prevention and genomics.36 The authors described that genomic screening for cancer patients could contribute to implementation of personalized prevention. ‘Personalized prevention’ is primarily used in association with genomics,37–39 but is still used in other fields such as medical imaging,40,41 dental care,42 web-based cardiovascular risk assessment43 and alcohol consumption.44 Precision prevention The term ‘precision prevention’ is fairly new, and first appeared in a paper published in 2014. In this editorial article Timothy R. Rebbeck wrote: ‘Precision prevention involves use of biologic, behavioral, socioeconomic and epidemiologic data to devise and implement strategies tailored to reducing cancer incidence and mortality in a specific individual or group of individuals’.45 Two years later Matthew W. Gillman and Ross A. Hammond wrote: ‘What we call precision prevention, on the other hand, has generally involved tailoring behavioral interventions to individuals’ characteristics. Historically, it has operated ‘above the skin’ to overcome psychosocial barriers, emphasize achievable goals, or adapt to families’ differing economic or cultural circumstances’.46 Finally, at the 2016 American Association of Cancer Research (AACR) Annual Meeting, Li Hsu and other experts defined precision prevention as: ‘An in-the-works method to predict risk of colorectal cancer that integrates genetic, lifestyle and environmental risk factors’.47 As we can see, all three descriptions go beyond both individualized and genomic-based screening, while also integrating environmental factors. Adapting the terminology used in medicine Because of the lack of definitions regarding individualized and personalized prevention, the counterpart definitions used in medicine were considered; namely individualized medicine, personalized medicine and—for the sake of completeness—precision medicine. Since prevention is related to medicine, it is important that the definitions of prevention terms align with their counterparts in medicine. Concerning ‘individualized medicine’, only a single definition was found that was used by the German National Academy of Sciences Leopoldina.48 Conversely, ‘personalized medicine’ is used so broadly, that in 2013 Sebastian Schleidgen and his associates wrote a comprehensive article which summarized all the definitions and interpretations of ‘personalized medicine’, and from these created a single definition.49 It is worth mentioning that in their work they perceived ‘individualized medicine’ and ‘personalized medicine’ as synonyms and besides genomic testing, they also included proteomic, metabolomic or molecular diseases pathway screening in their definition. However, in the same year, the European Commission published a document in which they defined ‘personalized medicine’ in a different way.50 This has created a situation where two definitions exist for the same terminology. Regardless, both promote a top-down approach and give little voice or autonomy to public health professionals. Finally, the difference between ‘personalized medicine’ and ‘precision medicine’ is ambiguous.51 Of the four definitions found regarding ‘precision medicine’, three of them recognize that the environment52 and psychosocial characteristics53,54 of the patient should also be incorporated into the term, while one of them ignores these notions entirely.55 After identifying all the possible definitions, we selected those which were deemed most suitable according to their content and wording (Table 1). Table 1 Definitions selected by the authors regarding the various types of individual-based medicine Type of medicine Definition Individualized medicine (IM) Individualized medicine aims to improve the efficacy and quality of treatment through targeted prevention, systematic diagnostics and tailored therapeutic procedures that are oriented to the needs of individual patients or patient groups; at the same time, individualized medicine aims to reduce side effects and increase the cost-effectiveness of treatment over the long term.48 Personalized medicine (PM) Personalized medicine seeks to improve stratification and timing of healthcare by utilizing biological information and biomarkers on the level of molecular disease pathways, genetics, proteomics as well as metabolomics.49 Personalized medicine refers to a medical model using molecular profiling for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention.50 Precision medicine (PrM) Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.52 Type of medicine Definition Individualized medicine (IM) Individualized medicine aims to improve the efficacy and quality of treatment through targeted prevention, systematic diagnostics and tailored therapeutic procedures that are oriented to the needs of individual patients or patient groups; at the same time, individualized medicine aims to reduce side effects and increase the cost-effectiveness of treatment over the long term.48 Personalized medicine (PM) Personalized medicine seeks to improve stratification and timing of healthcare by utilizing biological information and biomarkers on the level of molecular disease pathways, genetics, proteomics as well as metabolomics.49 Personalized medicine refers to a medical model using molecular profiling for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention.50 Precision medicine (PrM) Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.52 Table 1 Definitions selected by the authors regarding the various types of individual-based medicine Type of medicine Definition Individualized medicine (IM) Individualized medicine aims to improve the efficacy and quality of treatment through targeted prevention, systematic diagnostics and tailored therapeutic procedures that are oriented to the needs of individual patients or patient groups; at the same time, individualized medicine aims to reduce side effects and increase the cost-effectiveness of treatment over the long term.48 Personalized medicine (PM) Personalized medicine seeks to improve stratification and timing of healthcare by utilizing biological information and biomarkers on the level of molecular disease pathways, genetics, proteomics as well as metabolomics.49 Personalized medicine refers to a medical model using molecular profiling for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention.50 Precision medicine (PrM) Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.52 Type of medicine Definition Individualized medicine (IM) Individualized medicine aims to improve the efficacy and quality of treatment through targeted prevention, systematic diagnostics and tailored therapeutic procedures that are oriented to the needs of individual patients or patient groups; at the same time, individualized medicine aims to reduce side effects and increase the cost-effectiveness of treatment over the long term.48 Personalized medicine (PM) Personalized medicine seeks to improve stratification and timing of healthcare by utilizing biological information and biomarkers on the level of molecular disease pathways, genetics, proteomics as well as metabolomics.49 Personalized medicine refers to a medical model using molecular profiling for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention.50 Precision medicine (PrM) Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.52 Clarifying the terms After identifying the usage of the various types of prevention and the definitions used in medicine, we have the basis to suggest a consistent set of definitions for individualized, personalized and precision prevention. When formulating the definitions we treated ‘individualized prevention’ and ‘personalized prevention’ separately because we believe it is necessary to have a definition for individual-based prevention that does not include genomic, transcriptomic, proteomic or metabolomic data. Consequently, when arguing for the benefits of introducing, for example, genomic testing into individual-based prevention, we can use two different terms for comparison and therefore avoid terminological confusion. When we disassembled the existing definitions and concepts, we noted that individualized, personalized and precision prevention are not separate terms, but are embedded in each other (Fig. 1). While ‘individualized prevention’ can be used for all kinds of prevention which are individual-based, ‘personalized prevention’ must also include genomic, transcriptomic, proteomic or metabolomic screening, and ‘precision prevention’ has to include environmental factors of the patient, such as psychological and behavioral profile and/or socioeconomic status. Thus, when formulating the definitions we took these into consideration (Table 2). Fig. 1 View largeDownload slide Differences among the various types of individual-based prevention. Fig. 1 View largeDownload slide Differences among the various types of individual-based prevention. Table 2 Definitions defined by the authors regarding the various types of individual-based prevention Type of prevention Definition Individualized prevention (IP) Individualized prevention is a form of prevention in public health, in which health professionals consider the characteristics, lifestyle, family history, anamnesis, risk status and medication of the client when making proposals to maintain or improve the individual’s quality of life. Personalized prevention (PP) Personalized prevention is a form of prevention in public health, which includes the activities of individualized prevention and in which health professionals also consider biological information and biomarkers at the level of molecular disease pathways, genetics, transcriptomics, proteomics and metabolomics of the client when making proposals to maintain or improve the individual’s quality of life. Precision prevention (PrP) Precision prevention is a form of prevention in public health, which includes the activities of personalized prevention and in which health professionals also consider the socioeconomic status or the opportunities offered by psychological and behavioral data of the client when making proposals to maintain or improve the individual’s quality of life. Type of prevention Definition Individualized prevention (IP) Individualized prevention is a form of prevention in public health, in which health professionals consider the characteristics, lifestyle, family history, anamnesis, risk status and medication of the client when making proposals to maintain or improve the individual’s quality of life. Personalized prevention (PP) Personalized prevention is a form of prevention in public health, which includes the activities of individualized prevention and in which health professionals also consider biological information and biomarkers at the level of molecular disease pathways, genetics, transcriptomics, proteomics and metabolomics of the client when making proposals to maintain or improve the individual’s quality of life. Precision prevention (PrP) Precision prevention is a form of prevention in public health, which includes the activities of personalized prevention and in which health professionals also consider the socioeconomic status or the opportunities offered by psychological and behavioral data of the client when making proposals to maintain or improve the individual’s quality of life. Table 2 Definitions defined by the authors regarding the various types of individual-based prevention Type of prevention Definition Individualized prevention (IP) Individualized prevention is a form of prevention in public health, in which health professionals consider the characteristics, lifestyle, family history, anamnesis, risk status and medication of the client when making proposals to maintain or improve the individual’s quality of life. Personalized prevention (PP) Personalized prevention is a form of prevention in public health, which includes the activities of individualized prevention and in which health professionals also consider biological information and biomarkers at the level of molecular disease pathways, genetics, transcriptomics, proteomics and metabolomics of the client when making proposals to maintain or improve the individual’s quality of life. Precision prevention (PrP) Precision prevention is a form of prevention in public health, which includes the activities of personalized prevention and in which health professionals also consider the socioeconomic status or the opportunities offered by psychological and behavioral data of the client when making proposals to maintain or improve the individual’s quality of life. Type of prevention Definition Individualized prevention (IP) Individualized prevention is a form of prevention in public health, in which health professionals consider the characteristics, lifestyle, family history, anamnesis, risk status and medication of the client when making proposals to maintain or improve the individual’s quality of life. Personalized prevention (PP) Personalized prevention is a form of prevention in public health, which includes the activities of individualized prevention and in which health professionals also consider biological information and biomarkers at the level of molecular disease pathways, genetics, transcriptomics, proteomics and metabolomics of the client when making proposals to maintain or improve the individual’s quality of life. Precision prevention (PrP) Precision prevention is a form of prevention in public health, which includes the activities of personalized prevention and in which health professionals also consider the socioeconomic status or the opportunities offered by psychological and behavioral data of the client when making proposals to maintain or improve the individual’s quality of life. Defining the place of the terms in public health To better understand the roles of these activities it is necessary to see how they fit into the existing prevention paradigms in public health. One of the oldest and most commonly used viewpoint of the categories of prevention originates from the 1940s.24 In their work, Hugh Rodman Leavell and Edwin Gurney Clark differentiated between primary, secondary and tertiary prevention, defining primary prevention as activities aiming to prevent disease or injury before they can ever occur; secondary prevention as activities aiming to reduce the impact of a disease or injury that has already occurred; and tertiary prevention as activities aiming to reduce the impact of an ongoing illness or injury that has lasting effects. Our definitions of individualized, personalized and precision prevention are viable within this paradigm, as these prevention types can be applied at any stage across primary, secondary or tertiary prevention. Another approach is to categorize preventions into universal, selective and indicated prevention.25 While universal prevention is a form of prevention that affects the entire population, selective prevention focuses on groups or individuals that have a higher risk of developing a particular disease. Indicated prevention, meanwhile, only focuses on individuals who are identified as being at high risk of developing a disease. In this paradigm, individualized, personalized and precision prevention are part of selective prevention but do not cover it entirely, since selective prevention can be applied to a group as well. Thus, only when combining individualized prevention with stratified prevention56 do we get selective prevention. Finally, by definition, indicated prevention partially overlaps with individualized, personalized and precision prevention. The final prevention paradigm worth mentioning separates prevention into population-based and targeted prevention.26 However, because population-based prevention is identical to universal prevention, and targeted prevention to selective prevention, the same statement can be made as in the previous paragraph. The summary of these categories and how individualized, personalized and precision prevention are located in these are shown in Table 3. Also, for the sake of better understanding how these types of prevention differ from one another, examples are given regarding type 2 diabetes mellitus (T2DM). Table 3 Overlaps and examples of the various types of prevention in public health Type of prevention Examples regarding T2DM Primary prevention Secondary prevention Tertiary prevention Population-based prevention/Universal prevention Using mass media to promote healthy lifestyle such as diet. Carrying out a population wide type 2 diabetes screening program. Carrying out a population wide retinopathy screening program. Introducing a smoking ban in restaurants through legislation. Targeted prevention/selective prevention Stratified prevention Using mass media specifically targeted for obese people to promote healthy lifestyle such diet. Carrying out a type 2 diabetes screening program among all obese people. Carrying out a retinopathy screening program among all people with type 2 diabetes. Individualized prevention By considering the client’s characteristics, lifestyle and medical record the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle and medical record the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle and medical record. Personalized prevention By considering the client’s characteristics, lifestyle, medical record and genome the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle, medical record and genome. Precision prevention By considering the client’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome and by considering the client’s psychological profile and socioeconomic status the GP encouragers the patient to go for a screening for type 2 diabetes. By taking into consideration the patient’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient with type 2 diabetes to cope with the disease. Type of prevention Examples regarding T2DM Primary prevention Secondary prevention Tertiary prevention Population-based prevention/Universal prevention Using mass media to promote healthy lifestyle such as diet. Carrying out a population wide type 2 diabetes screening program. Carrying out a population wide retinopathy screening program. Introducing a smoking ban in restaurants through legislation. Targeted prevention/selective prevention Stratified prevention Using mass media specifically targeted for obese people to promote healthy lifestyle such diet. Carrying out a type 2 diabetes screening program among all obese people. Carrying out a retinopathy screening program among all people with type 2 diabetes. Individualized prevention By considering the client’s characteristics, lifestyle and medical record the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle and medical record the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle and medical record. Personalized prevention By considering the client’s characteristics, lifestyle, medical record and genome the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle, medical record and genome. Precision prevention By considering the client’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome and by considering the client’s psychological profile and socioeconomic status the GP encouragers the patient to go for a screening for type 2 diabetes. By taking into consideration the patient’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient with type 2 diabetes to cope with the disease. Note: Indicated preventions are located within the ‘targeted prevention’ row and ‘secondary prevention’ column. Table 3 Overlaps and examples of the various types of prevention in public health Type of prevention Examples regarding T2DM Primary prevention Secondary prevention Tertiary prevention Population-based prevention/Universal prevention Using mass media to promote healthy lifestyle such as diet. Carrying out a population wide type 2 diabetes screening program. Carrying out a population wide retinopathy screening program. Introducing a smoking ban in restaurants through legislation. Targeted prevention/selective prevention Stratified prevention Using mass media specifically targeted for obese people to promote healthy lifestyle such diet. Carrying out a type 2 diabetes screening program among all obese people. Carrying out a retinopathy screening program among all people with type 2 diabetes. Individualized prevention By considering the client’s characteristics, lifestyle and medical record the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle and medical record the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle and medical record. Personalized prevention By considering the client’s characteristics, lifestyle, medical record and genome the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle, medical record and genome. Precision prevention By considering the client’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome and by considering the client’s psychological profile and socioeconomic status the GP encouragers the patient to go for a screening for type 2 diabetes. By taking into consideration the patient’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient with type 2 diabetes to cope with the disease. Type of prevention Examples regarding T2DM Primary prevention Secondary prevention Tertiary prevention Population-based prevention/Universal prevention Using mass media to promote healthy lifestyle such as diet. Carrying out a population wide type 2 diabetes screening program. Carrying out a population wide retinopathy screening program. Introducing a smoking ban in restaurants through legislation. Targeted prevention/selective prevention Stratified prevention Using mass media specifically targeted for obese people to promote healthy lifestyle such diet. Carrying out a type 2 diabetes screening program among all obese people. Carrying out a retinopathy screening program among all people with type 2 diabetes. Individualized prevention By considering the client’s characteristics, lifestyle and medical record the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle and medical record the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle and medical record. Personalized prevention By considering the client’s characteristics, lifestyle, medical record and genome the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome the GP sends the patient to screen for type 2 diabetes. The GP helps the patient with type 2 diabetes to cope with the disease according to the patient’s characteristics, lifestyle, medical record and genome. Precision prevention By considering the client’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient to create a healthy lifestyle. Depending on the client’s characteristics, lifestyle, medical record and genome and by considering the client’s psychological profile and socioeconomic status the GP encouragers the patient to go for a screening for type 2 diabetes. By taking into consideration the patient’s characteristics, lifestyle, medical record, genome, psychological profile and socioeconomic status the GP helps the patient with type 2 diabetes to cope with the disease. Note: Indicated preventions are located within the ‘targeted prevention’ row and ‘secondary prevention’ column. Discussion Main findings of this study According to the literature search on the topic of individual-based prevention, we can determine that while there are a few definitions of ‘precision prevention’, both ‘individualized prevention’ and ‘personalized prevention’ are used interchangeably and haphazardly. Essentially, both terms can be used to describe any form of prevention which is not population-based, whether or not genomic-based screening is included. These terms are no longer synonyms, but are embedded into each other. Also, as demonstrated with the example of type 2 diabetes mellitus, they are compatible with existing terminology used in public health. What is already known on this topic Schleidgen and his associates were the ones who first noted that ‘personalized medicine’ is used haphazardly in the scientific literature and created their own definition that takes into account previous usage of this term.43 Although, they have demonstrated the importance of such work, no similar attempts were made regarding the other forms of individual-based medicine or their preventive counterparts. What this study adds This is the first study that investigates how the terms individualized, personalized and precision prevention are used in both grey and white literature. Also, this is the first attempt to standardize these by taking into account their current and past usage, how their counterpart in medicine is used and their relationship to each other. By doing so, we not only introduced new definitions but an entire system on how individual-based prevention should be approached. The goal is for this work to help facilitate debates on how public health as a whole should be modernized. Limitations of this study Because a narrative literature review was conducted and only PubMed was used to search white literature, it is possible that some research papers were not identified that use one of the terms regarding individual-based prevention and medicine. Also, our search only included literature written in English but this was unavoidable because of the scope of our search and language barriers. Also, when interpreting existing definitions and creating our own we did not include experts in this field. This was done on purpose to create a resource accessible to non-experts given the emergence and continued importance this filed will have on medicine and healthcare. Finally, despite our effort to present a set of definitions based on the best arguments possible, without any form of compulsion from government or academic institutions, these are only suggestions and they can, of course, be ignored by researchers and policy makers because there is no international authority to enforce it even if it is accepted. Conclusions Creating a common language in any field of science is a necessity, and individual-based prevention in public health is no exception. By defining the terms individualized, personalized and precision prevention—and by determining their role in public health—we have created the terminological foundation for later work. This foundation can also be used in the debate regarding public health between modernizers and traditionalists. Although, we understand that many within the international research community will wish to use these terms interchangeably or with a different meaning, we hope that our work will highlight the importance of standardization within the field of public health which would help the dissemination of key findings among researchers and health policy makers globally. Acknowledgements The authors would like to thank Tyra Lagerberg for proof-reading the original version of the article. Funding The work is supported by the ‘Gazdaságfejlesztési és Innovációs Operatív Program’ (GINOP) 2.3.2-15-2016-00005 project co-financed by the European Union under the European Regional Development Fund; PRECeDI project (Personalized PREvention of Chronic Diseases) funded by the European Commission in the H2020 Marie Skłodowska-Curie Research and Innovation Staff Exchange program (grant agreement number: 645740). References 1 Garrison FH . An Introduction to the History of Medicine , 4th edn . Philadelphia & London : W.B. Saunders Company , 1929 . 2 Margotta R . The Story of Medicine . New York : Golden Press , 1968 . 3 Gochfeld M . Chronologic history of occupational medicine . J Occup Environ Med 2005 ; 47 ( 2 ): 96 – 114 . Google Scholar CrossRef Search ADS PubMed 4 Bazin H . A brief history of the prevention of infectious diseases by immunisations . Comp Immunol Microbiol Infect Dis 2003 ; 26 ( 5–6 ): 293 – 308 . Google Scholar CrossRef Search ADS PubMed 5 Brachman PS . Infectious diseases—past, present, and future . Int J Epidemiol 2003 ; 32 ( 5 ): 684 – 86 . Google Scholar CrossRef Search ADS PubMed 6 World Health Organization . The Top 10 Causes of Death. http://www.who.int/mediacentre/factsheets/fs310/en/index2.html (April 2017 , date last accessed). 7 Epping-Jordan JE . Integrated approaches to prevention and control of chronic conditions . Kidney Int 2005 ; 68 ( 98 ): S86 – 8 . Google Scholar CrossRef Search ADS 8 Schofield DJ , Shrestha RN , Cunich M et al. . Lost productive life years caused by chronic conditions in Australians aged 45–64 years, 2010–2030 . Med J Aust 2015 ; 203 ( 6 ): 260 . Google Scholar CrossRef Search ADS PubMed 9 Puska P , Mustaniemi H . Incidence and presentation of myocardial-infarction in North-Karelia Finland . Acta Med Scand 1975 ; 197 ( 3 ): 211 – 16 . Google Scholar PubMed 10 Report of an expert workshop held at the Rockefeller Foundation Study and Conference Centre , Bellagio, Italy, 14–20 April 2005 . http://www.phgen.eu/typo3/fileadmin/downloads/bellagio-011807.pdf (April 2017, date last accessed). 11 Burke W , Khoury MJ , Stewart A et al. . The path from genome-based research to population health: development of an international public health genomics network . Genet Med 2006 ; 8 ( 7 ): 451 – 8 . Google Scholar CrossRef Search ADS PubMed 12 Collins FS . Shattuck lecture—medical and societal consequences of the human genome project . New Engl J Med 1999 ; 341 ( 1 ): 28 – 37 . Google Scholar CrossRef Search ADS PubMed 13 Roos RA . Huntington’s disease: a clinical review . Orphanet J Rare Dis 2012 ; 5 : 40 . Google Scholar CrossRef Search ADS 14 Ned RM , Sijbrands EJ . Cascade screening for familial hypercholesterolemia (FH) . PLoS Curr 2011 ; 3 : RRN1238 . Google Scholar PubMed 15 Domchek SM , Friebel TM , Singer CF et al. . Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality . J Am Med Assoc 2010 ; 304 ( 9 ): 967 – 75 . Google Scholar CrossRef Search ADS 16 Ned RM , Sijbrands EJ . Cascade screening for familial hypercholesterolemia (FH) . PLoS Currents 2011 ; 3 : RRN1238 . Google Scholar PubMed 17 Henneman L , McBride CM , Cornel MC et al. . Screening for familial hypercholesterolemia in children: what can we learn from adult screening programs? Healthcare (Basel) 2015 ; 3 ( 4 ): 1018 – 30 . Google Scholar CrossRef Search ADS PubMed 18 Boccia S . Why is personalized medicine relevant to public health? Eur J Public Health 2014 ; 24 ( 3 ): 349 – 50 . Google Scholar CrossRef Search ADS PubMed 19 Boccia S . Personalized health care: the hope beyond the hype . Ital J Public Health 2012 ; 9 ( 4 ): e8688-1 – 2 . 20 Owen L , Pennington B , Fischer A et al. . The cost-effectiveness of public health interventions examined by NICE from 2011 to 2016 . J Public Health (Oxf) 2017 . doi:10.1093/pubmed/fdx119 . 21 Khoury MJ , Bowen MS , Burke W et al. . Current priorities for public health practice in addressing the role of human genomics in improving population health . Am J Prev Med 2011 ; 40 ( 4 ): 486 – 93 . Google Scholar CrossRef Search ADS PubMed 22 Stevenson A , Lindberg CA . New Oxford American Dictionary , 3rd edn . New York : Oxford University Press , 2010 , 1308. Google Scholar CrossRef Search ADS 23 Stevenson A . Oxford Dictionary of English , 3rd edn . New York : Oxford University Press , 2010 , XV. 24 Leavell HR , Clark EG . Preventive Medicine for the Doctor in his Community . New York : McGraw-Hill , 1953 . 25 Gordon RS . An operational classification of disease prevention . Public Health Rep 1983 ; 98 ( 2 ): 107 – 09 . Google Scholar PubMed 26 Zulman DM , Vijan S , Omenn GS et al. . The relative merits of population-based and targeted prevention strategies . Milbank Q 2008 ; 86 ( 4 ): 557 – 80 . Google Scholar CrossRef Search ADS PubMed 27 Hamp SE , Johansson LA , Karlsson R . Clinical effects of preventive regimens for young-people in their early and middle teens in relation to previous experience with dental prevention . Acta Odontol Scand 1984 ; 42 ( 2 ): 99 – 108 . Google Scholar CrossRef Search ADS PubMed 28 Reyes EM , Legg JL . Prevention of HIV transmission . Prim Care 1997 ; 24 ( 3 ): 469 – 77 . Google Scholar PubMed 29 Brockmoller J , Cascorbi I , Henning S et al. . Molecular genetics of cancer susceptibility . Pharmacology 2000 ; 61 ( 3 ): 212 – 27 . Google Scholar CrossRef Search ADS PubMed 30 Riley JL , Gordan VV , Ajmo CT et al. . Dentists’ use of caries risk assessment and individualized caries prevention for their adult patients: findings from The Dental Practice-Based Research Network . Community Dent Oral 2011 ; 39 ( 6 ): 564 – 73 . Google Scholar CrossRef Search ADS 31 Chen YQ , Masse B , Wang L et al. . Statistical considerations for the HPTN 052 Study to evaluate the effectiveness of early versus delayed antiretroviral strategies to prevent the sexual transmission of HIV-1 in serodiscordant couples . Contemp Clin Trials 2012 ; 33 ( 6 ): 1280 – 86 . Google Scholar CrossRef Search ADS PubMed 32 Lu Y , Lu F , Zeng S et al. . Genetics and gastric cancer susceptibility . Int J Clin Exp Med 2015 ; 8 ( 6 ): 8377 – 83 . Google Scholar PubMed 33 Manca DP , Aubrey-Bassler K , Kandola K et al. . Implementing and evaluating a program to facilitate chronic disease prevention and screening in primary care: a mixed methods program evaluation . Implementation Sci 2014 ; 9 : 135 . Google Scholar CrossRef Search ADS 34 Ahn WY , Vassileva J . Machine-learning identifies substance-specific behavioral markers for opiate and stimulant dependence . Drug Alcohol Depen 2016 ; 161 : 247 – 57 . Google Scholar CrossRef Search ADS 35 Giorgi R , Gouvernet J , Jougla E et al. . The use of the personalized estimate of death probabilities for medical decision making . Comput Biomed Res 2000 ; 33 ( 1 ): 75 – 83 . Google Scholar CrossRef Search ADS PubMed 36 Katoh M , Katoh M . Bioinformatics for cancer management in the post-genome era . Technol Cancer Res Treat 2006 ; 5 ( 2 ): 169 – 75 . Google Scholar CrossRef Search ADS PubMed 37 Leonard MM , Camhi S , Huedo-Medina TB et al. . Celiac Disease Genomic, Environmental, Microbiome, and Metabolomic (CDGEMM) study design: approach to the future of personalized prevention of celiac disease . Nutrients 2015 ; 7 ( 11 ): 9325 – 36 . Google Scholar CrossRef Search ADS PubMed 38 Koyanagi YN , Ito H , Oze I et al. . Development of a prediction model and estimation of cumulative risk for upper aerodigestive tract cancer on the basis of the aldehyde dehydrogenase 2 genotype and alcohol consumption in a Japanese population . Eur J Cancer Prev 2017 ; 26 ( 1 ): 38 – 47 . Google Scholar CrossRef Search ADS PubMed 39 Mobasheri A , Henrotin Y . Biomarkers of (osteo)arthritis . Biomarkers 2015 ; 20 ( 8 ): 513 – 18 . Google Scholar CrossRef Search ADS PubMed 40 European Society of Radiology (ESR). Medical imaging in personalised medicine: a white paper of the research committee of the European Society of Radiology (ESR) . Insights Imaging 2015 ; 6 ( 2 ): 141 – 55 . CrossRef Search ADS PubMed 41 Iozzo P . Metabolic imaging in obesity: underlying mechanisms and consequences in the whole body . Ann N Y Acad Sci 2015 ; 1353 : 21 – 40 . Google Scholar CrossRef Search ADS PubMed 42 Kunin AA , Belenova IA , Ippolitov YA et al. . Predictive research methods of enamel and dentine for initial caries detection . EPMA J 2013 ; 4 ( 1 ): 19 . Google Scholar CrossRef Search ADS PubMed 43 van den Brekel-Dijkstra K , Rengers AH , Niessen MAJ et al. . Personalized prevention approach with use of a web-based cardiovascular risk assessment with tailored lifestyle follow-up in primary care practice—a pilot study . Eur J Prev Cardiol 2016 ; 23 ( 5 ): 544 – 51 . Google Scholar CrossRef Search ADS PubMed 44 Vaughn MG , King KM . Premeditation and sensation seeking moderate the reasoned action and social reaction pathways in the prototype/willingness model of alcohol use . Subst Use Misuse 2016 ; 51 ( 6 ): 711 – 21 . Google Scholar CrossRef Search ADS PubMed 45 Rebbeck TR . Precision prevention of cancer . Cancer Epidemiol Biomarkers 2014 ; 23 ( 12 ): 2713 – 15 . Google Scholar CrossRef Search ADS 46 Gillman MW , Hammond RA . Precision treatment and precision prevention integrating ‘below and above the skin’ . Jama Pediatr 2016 ; 170 ( 1 ): 9 – 10 . Google Scholar CrossRef Search ADS PubMed 47 Science Daily . Precision Prevention of Colorectal Cancer. 2016 . https://www.sciencedaily.com/releases/2016/04/160418145504.htm (April 2017, date last accessed). 48 German National Academy of Sciences Leopoldina, acatech – National Academy of Science and Engineering and Union of the German Academies of Sciences and Humanities . Individualised Medicine—Prerequisites and Consequences, Halle (Saale), 2014 . 49 Schleidgen S , Klingler C , Bertram T et al. . What is personalized medicine: sharpening a vague term based on a systematic literature review . Bmc Med Ethics 2013 ; 14 : 55 . Google Scholar CrossRef Search ADS PubMed 50 European Commission . Commission Staff Working Document—Use of ‘-Omics’ Technologies in the Development of Personalised Medicine, Brussles, 2013 . 51 Khoury MJ . The Shift From Personalized Medicine to Precision Medicine and Precision Public Health: Words Matter! https://blogs.cdc.gov/genomics/2016/04/21/shift/ (April 2017 , date last accessed). 52 What is Precision Medicine? National Institutes of Health. https://ghr.nlm.nih.gov/primer/precisionmedicine/definition (April 2017 , date last accessed). 53 Jameson JL , Longo DL . Precision medicine—personalized, problematic, and promising . N Engl J Med 2015 ; 372 ( 4 ): 2229 – 34 . Google Scholar CrossRef Search ADS PubMed 54 Klonoff DC . Precision medicine for managing diabetes . J Diabetes Sci Technol 2015 ; 9 ( 1 ): 3 – 7 . Google Scholar CrossRef Search ADS PubMed 55 Mirnezami R , Nicholson J , Darzi A . Preparing for precision medicine . New Engl J Med 2012 ; 366 ( 6 ): 489 – 91 . Google Scholar CrossRef Search ADS PubMed 56 Burton H , Sagoo GS , Pharoah P et al. . Time to revisit Geoffrey Rose: strategies for prevention in the genomic era? Ital J Public Health 2012 ; 9 ( 4 ): e8665 . © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

Journal of Public HealthOxford University Press

Published: Apr 20, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off