Smoking is still one of the most common causes of cancer.
Smoking is still one of the most common causes of cancer.

Current status and plans

In the following, we describe the current status and plans for prevention measures in the “Model Region Bremen”. The kick-off event took place in July 2022. The current focus is on taking stock (see data collection and evaluation) and piloting initial interventions. At the same time, further interventions are continuously being designed and corresponding applications for third-party funding are being submitted, i.e., it is a dynamic process. Proposals for testing prevention measures in the “Model Region Bremen” can also be submitted at any time.

Examples of interventions and pilots in the area of primary and secondary prevention are briefly described below.

Primary prevention (examples)

  • Physical activity in elementary school: An intervention to promote physical activity in the school setting based on the WHO's “Health Promoting Schools” framework was piloted at various elementary schools in Bremen (ACTIPROS project). Following the successful completion of the pilot study, which was funded by the Federal Ministry of Health (BMG), the current focus is on rolling out the measure and the necessary requirements to do so.
  • Nutrition in schools: The conversion of school catering to the quality standards of the Deutsche Gesellschaft für Ernährung e.V. (German Nutrition Society) is currently evaluated in cooperation with several departments of Bremen politics. In addition, the acceptance of this change by pupils is being investigated (GENAU project).
  • Physical activity and nutrition in the family context: A program called “Healthy Dads, Healthy Kids” was developed in Australia for overweight fathers and their children. The 9-week intervention showed noticeable effects on weight development and on the nutritional and exercise behavior of the participating fathers and children. As part of a project funded by the BMG, the program is currently being adapted in Germany in the “Model Region Bremen” (Healthy Dads, Healthy Kids project). Proof of effectiveness and a comprehensive process evaluation are also being carried out in order to be able to assess the program's faithful implementation, acceptance and aspects of sustainable implementation.
  • Smoking during and after pregnancy: From a life-course perspective, pregnancy and the birth of a child represent favorable opportunities for smoking cessation. As part of a project funded by the German Cancer Aid, an intervention for smoking prevention is being developed on the basis of the “Pro Kind” home visitation program, which is aimed at first-time pregnant women and their families in difficult circumstances. The feasibility of this intervention is being tested in the “Model Region Bremen”.
  • HPV vaccination uptake: In consultation with politicians and health insurance providers and in collaboration with the Robert Koch Institute, interventions are currently being designed to supplement political measures for increasing the HPV vaccination rate in a targeted manner.
  • Prevention recommendations via app: The “EU Mobile App for Cancer Prevention” was developed in an international network to increase the reach of the cancer prevention recommendations of the European Code Against Cancer (ECAC). As part of the BUMPER project, BIPS is leading pilot studies on the use of the app in various EU countries. As a follow-up, the applicability of the app for interventions in the “Model Region Bremen” is currently under investigation.

Secondary prevention (examples)

  • Quality of colonoscopy: Colonoscopy is a very effective tool for the prevention and early detection of colorectal cancer. However, BIPS studies have shown that the quality of the examination varies greatly from doctor to doctor and that this has a significant impact on the preventive effect of colonoscopy. In the context of the Leibniz ScienceCampus Digital Public Health Bremen, we are currently adapting an online training course to improve the quality of a colonoscopies for doctors in Germany. The training, which was developed in the USA and has proven to be very effective there, will be piloted in the “Model Region Bremen”.
  • Risk-adapted cancer screening: The increasing availability of analytical methods for estimating individual cancer risk, such as genetic risk markers (polygenic risk scores), opens up potential new avenues for risk-adapted cancer screening. As far as the practical implementation is concerned, however, many questions remain unanswered. One important aspect, for example, is how well the use of genetic markers to assess cancer risk would be accepted by the population. As part of the NACOP project funded by German Cancer Aid, this question, among others, is being investigated in the “Model Region Bremen”.
  • Special risk groups
  • Relatives of cancer patients: For many cancers, first-degree relatives have a moderately increased risk of developing cancer themselves. This may be partly due to genetic similarities, but also partly to similar lifestyle habits. Relatives of cancer patients often show an increased willingness to change their behavior or take advantage of early detection measures. In the context of the Joint Action (EU4Health Program) PreventNCD, an intervention is currently being developed in the “Model Region Bremen” to contact relatives of cancer patients and provide them with the best possible preventive advice.