A researcher wants to study whether a biomarker measured at baseline predicts breast cancer within an existing cohort of 50,000 women, but measuring the biomarker in every woman would be too expensive. The most appropriate design that uses stored samples from only a fraction of the cohort is:

• A Classic case-control study
• B Cross-sectional study
• C Ecological study
• D Nested case-control study ✓

Explanation

In a nested case-control study, cases are incident events arising within the cohort during follow-up, and controls are sampled from cohort members at risk at the time each case occurs. Exposure data come from specimens collected before disease onset, so temporality is preserved while cost falls dramatically compared with assaying the entire cohort. A classic case-control study recruits outside the cohort and loses this prospective exposure advantage.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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