The biological side of randomness. A starting point to rethink causation of diseases and prevention as a strategy

It's time to rethink prevention as a strategy to fight diseases? In this opinion I'll try to question preventive medicine as a strategy starting from the evidences on the randomness of disease, as suggested by recent and very questioned data on variation in cancer risk among different tissues. To understand the scope of this refutation we must remember that the preventive strategy was developed since the introduction of the concept of risk factor, that date back to the Framingham Heart Study (FHS) started in 1948. Indeed, prior to the FHS, doctors were still engaged in the study of causation by following the established paradigm of aetiology, and had not yet focused on the concept of multifactorial diseases and prevention or prophylaxis of risk factors was not yet a paradigm in medicine. After having metabolised these new concepts and made prevention of risk factors the main strategy to fight multifactorial diseases for years, today, in a Western world that is aging, we are facing a new challenge since prevention seems to be no longer enough to cope with diseases such as cancer and, possibly, we need new strategies that we still have not. And this why? Possibly because the randomness appears ever more like the engine that drives the physical universe even if, for living organisms, we must admit several deterministic or, at least, very reproducible events since they are able to actively interact with the environment.