This book presents a logical system of critical appraisal, to allow readers to evaluate studies and to carry out their own studies more effectively. This system emphasizes the central importance of cause and effect relationships. Its great strength is that it is applicable to a wide range of issues, and both to intervention trials and observational studies. This system unifies the often different approaches used in epidemiology, health services research, clinical trials, and evidence-based medicine, starting from a logical consideration of cause and effect. The author's approach to the issues of study design, selection of subjects, bias, confounding, and the place of statistical methods has been praised for its clarity and interest. Systematic reviews, meta-analysis, and the applications of this logic to evidence-based medicine, knowledge-based health care, and health practice and policy are discussed. Current and often controversial examples are used, including screening for prostate cancer, publication bias in psychiatry, public health issues in developing countries, and conflicts between observational studies and randomized trials. Statistical issues are explained clearly without complex mathematics, and the most useful methods are summarized in the appendix. The final chapters give six applications of the critical appraisal of major studies: randomized trials of medical treatment and prevention, a prospective and a retrospective cohort study, a small matched case-control study, and a large case-control study. In these chapters, sections of the original papers are reproduced and the original studies placed in context by a summary of current developments.

Our series Cancer Prevention - Cancer Control continues to address the causes and prevention of cancer. In this volume, Hill, Elwood, and English bring together a rich resource summarizing the state of science underpinning the primary prevention of skin cancer. While skin cancer causes an increasing burden, particularly in populations of European origin, our understanding of the role of sun exposure together with the genetic components of skin cancer continues to grow. Given the emphasis on evidence-based medicine and public health prevention efforts, it is noteworthy that, although we can all access the same evidence base, countries around the world have had remarkably different responses to the application of this knowledge to prevent skin cancer. The outstanding contribution of the Australian public health community to the scientific understanding of skin cancer etiology and the translation of this knowledge into national prevention efforts uniquely positions the editors to compile this volume focused on the primary prevention of skin cancer. In so doing they draw on an international team of authors to present a "state of the science" summary of skin cancer prevention and to identify those areas where uncertainty remains. To achieve successful prevention of cancer we must translate our scientific knowledge base into effective prevention programs. This book offers the reader keen insights into the depth of our understanding of etiologic pathways for skin cancer. This etiologic science base is complemented by rigorous prevention science placing emphasis on the social context for effective and sustained prevention efforts.

Significant progress has been made in recent years in understanding the origins of cutaneous maligant melanoma. Knowledge of the relationship between solar radiation and melanoma has changed and it now appears that both the character and timing of exposure may be more important than total cumulative dose in accounting for risk. The melanoma-sunlight model may prove an instructive heuristic exercise for environmental epidemiology, as we currently tend to restrict ourselves to a search for uniform total dose--response relationships between cancers and suspected environmental carcinogens. The study of the relationship between acquired melanocytic nevi and melanoma has led to useful new information about predictors of melanoma risk, and in addition has opened new perspectives on the development of nevi in children. Definition of the factors for nevus development in children may lead to the possibility of primary prevention programs for melanoma in younger generations of children. Recent new evidence suggests that certain occupational groups may be at elevated risk of melanoma. A great deal of work is going into the study of ways of screening high risk populations in order to detect melanoma at its earliest stages when current treatment protocols are most effective. The visibility of lesions on the skin challenges classical definitions of early detection and screening in epidemiology.

Our series Cancer Prevention - Cancer Control continues to address the causes and prevention of cancer. In this volume, Hill, Elwood, and English bring together a rich resource summarizing the state of science underpinning the primary prevention of skin cancer. While skin cancer causes an increasing burden, particularly in populations of European origin, our understanding of the role of sun exposure together with the genetic components of skin cancer continues to grow. Given the emphasis on evidence-based medicine and public health prevention efforts, it is noteworthy that, although we can all access the same evidence base, countries around the world have had remarkably different responses to the application of this knowledge to prevent skin cancer. The outstanding contribution of the Australian public health community to the scientific understanding of skin cancer etiology and the translation of this knowledge into national prevention efforts uniquely positions the editors to compile this volume focused on the primary prevention of skin cancer. In so doing they draw on an international team of authors to present a "state of the science" summary of skin cancer prevention and to identify those areas where uncertainty remains. To achieve successful prevention of cancer we must translate our scientific knowledge base into effective prevention programs. This book offers the reader keen insights into the depth of our understanding of etiologic pathways for skin cancer. This etiologic science base is complemented by rigorous prevention science placing emphasis on the social context for effective and sustained prevention efforts.