Precursors in cancer epidemiology: aligning definition and function.

A precursor of a disease is a definable pathologic state that progresses directly to disease without a known intermediate step and whose presence substantially increases the likelihood of disease. Precancers, or precursors of cancer, can help provide detail about the dynamic pathogenesis process before clinical disease. Thereby, ascertainment of properly defined precancers can increase precision of estimates and power in epidemiologic and clinical studies. Besides providing targets for direct treatment and improving tools for risk assessment in screening programs, precancers can help establish temporal ordering of cause and effect; can identify relatively homogeneous subsets of cancer that have passed through a given precancer state; and provide a basis for choosing high-risk individuals for detailed longitudinal study. Although the most appropriate definition of the precancer will vary with its function in particular research or clinical applications, the proportion of cancers that progress from the precancer and risk of cancer progressing from the precancer can be important measures of the value of a precancer in translational efforts.