Trends in 21st Century Epidemiology: From Scientific Discoveries to Population Health Impact

December 12-13, 2012 - Bethesda, MD


Overview

More than a decade into the 21st century, we are at a major crossroads in our understanding of cancer. Tools of molecular biology, genomics, and other high throughput "omic" technologies are increasingly integrated into epidemiologic investigations. In a 2011 town hall meeting, Dr. Harold Varmus, NCI Director, said, "I expect to see a pretty dramatic revolution in epidemiology... defining cancers by genetic subsets. I expect to see molecular tools brought more forcefully into the realm of cancer diagnosis... talking about ways to discriminate among early lesions and pre-cancerous lesions that may have malignant potential."

Along with these emerging tools come refined social, behavioral, and environmental exposure measurements at the individual, community, and health system levels and the ability to assess gene-gene and gene-environment interactions. There is an increased focus on complex "systems" approaches in understanding the occurrence of cancer and intervening at multiple levels. All this has been influenced by tremendous advances in bioinformatics and information technology, allowing us to collect, analyze, and synthesize information from multiple disciplines at an ever increasing pace.

With these opportunities, however, come the major challenge of dealing with the data deluge and uncovering true causal relationships from the millions and millions of observations that are background noise. At the same time, increased consumer awareness and education has led to enhanced participation and co-ownership of research and research output. Thus, epidemiology now confronts important challenges and opportunities in the study of cancer and other diseases, and must make choices of direction, as it responds to rapid changes in the environment.

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Purpose

On December 12-13, 2012, NCI's Epidemiology and Genomics Research Program (EGRP) sponsored a workshop titled "Trends in 21st Century Epidemiology: From Scientific Discoveries to Population Health Impact" in Bethesda, MD. Researchers and thought leaders presented their perspectives on major facets of the epidemiologic enterprise.

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Agenda and Presentations

During the workshop, a panel of experts with diverse perspectives offered brief assessments of the main challenges and most attractive opportunities for the five areas outlined below. Moderators led discussions among the panelists and workshop participants. Links to the presentations are included in the agenda (below) in the Topic column.

At the end of the meeting, workshop participants held an open discussion to help clarify and prioritize recommendations that will enhance the contribution of epidemiology in the next decade.

View agenda for Wednesday, December 12 and links to presentations
Wednesday, Dec. 12 Topic
12:00 p.m. - 1:00 p.m. Registration
1:00 p.m. - 1:10 p.m. Welcome

Robert T. Croyle, Ph.D.
Division of Cancer Control and Population Sciences (DCCPS), NCI

1:10 p.m. - 1:30 p.m. Charge to Participants [ PDF (1.45 MB), HTML ]

Muin J. Khoury, M.D., Ph.D.
Epidemiology and Genomics Research Program (EGRP), DCCPS, NCI

Session 1: Setting the Stage: The Evolution of Epidemiology and its Applications to Cancer
Moderator: Robert T. Croyle, Ph.D., DCCPS, NCI
1:30 p.m. - 2:00 p.m. Historical Perspectives on the Evolution of Cancer Epidemiology [ PDF (1.53 MB), HTML ]

Robert N. Hoover, M.D., Sc.D.
Division of Cancer Epidemiology and Genetics (DCEG), NCI

2:00 p.m. - 3:00 p.m. Panel and Audience Discussion [ PDF (538 KB), HTML ]
  • What lessons and success stories have we learned from 20th century cancer epidemiology?
  • What are the gaps and provocative questions that epidemiologic research can fill in the next 12 years?

Panelists:
David Hunter, Sc.D., M.P.H.
Harvard University

Timothy Rebbeck, Ph.D.
University of Pennsylvania

Margaret R. Spitz, M.D.
Baylor College of Medicine

Audience and Web Participation
3:00 p.m. - 3:15 p.m. Break
Session 2: The Impact of New Methods and Technologies on Epidemiologic Research
Moderator: Stephen J. Chanock, M.D., DCEG, NCI
3:15 p.m. - 3:45 p.m. Technology-Driven Epidemiology: A Paradigm Shift [ HTML ]

Geoffrey S. Ginsburg, M.D., Ph.D.
Institute for Genome Sciences and Policy, Duke University

3:45 p.m. - 5:00 p.m. Panel and Audience Discussion [ PDF (1 MB), HTML ]
  • Which technologies do you feel are ready for "prime time" in epidemiologic research and for what purpose?
  • What criteria would you use to determine when emerging technologies should be integrated into epidemiologic research?

Panelists:
Zdenko Herceg, Ph.D.
International Agency for Research on Cancer

Thomas A. Sellers, Ph.D., M.P.H.
Moffitt Cancer Center

Michael Snyder, Ph.D.
Stanford University

Georgia D. Tourassi, Ph.D.
Oak Ridge National Laboratory

Audience and Web Participation
6:00 p.m. - 8:00 p.m. Dinner at Local Restaurant
(optional)

View agenda for Thursday, December 13 and links to presentations
Thursday, Dec. 13 Topic
7:30 a.m. - 8:00 a.m. Registration
Session 3: The Evolution of Epidemiologic Cohorts in the Study of Natural History of Cancer and Other Diseases
Moderator: Deborah M. Winn, Ph.D., DCCPS, NCI
8:00 a.m. - 8:30 a.m. What Have We Learned From Epidemiology Cohorts and Where Should We Be Going Next? [ PDF (407 KB), HTML ]

Julie Buring, Sc.D., M.S.
Harvard School of Public Health

8:30 a.m. - 9:30 a.m. Panel and Audience Discussion [ PDF (706 KB), HTML ]
  • What developments are needed to make epidemiologic cohorts a cornerstone of the discovery to practice continuum?
  • How should NCI and NIH facilitate multidisciplinary collaboration to integrate these developments into the research portfolio?

Panelists:
Julie R. Palmer, Sc.D., M.P.H.
Boston University School of Public Health

Lyle Palmer, Ph.D.
Ontario Institute for Cancer Research

Leslie L. Robison, Ph.D. (unable to attend)
St. Jude Cancer Center

Daniela Seminara, Ph.D., M.P.H.
EGRP, DCCPS, NCI

Audience and Web Participation
Session 4: Use of Epidemiologic Research to Advance Clinical and Public Health Practice: Bridging the Evidence Gap with Observational Studies and Randomized Clinical Trials
Moderator: Sheri D. Schully, Ph.D., EGRP, DCCPS, NCI
9:30 a.m. - 10:00 a.m. Epidemiology and Evidence-Based Cancer Prevention [ PDF (458 KB), HTML ]

David F. Ransohoff, M.D.
University of North Carolina at Chapel Hill

10:00 a.m. - 11:00 a.m. Panel and Audience Discussion [ PDF (480 KB), HTML ]
  • How do we fill evidence gaps in care and prevention using epidemiology?
  • What is the role of observational epidemiology in a "data rich" environment where randomized clinical trials may not always be feasible?

Panelists:
Barnett Kramer, M.D., M.P.H.
Division of Cancer Prevention, NCI

Michael Lauer, M.D.
Division of Cardiovascular Sciences, National Heart Lung and Blood Institute (NHLBI)

Jeffrey A. Meyerhardt, M.D., M.P.H.
Harvard Medical School

Olufunmilayo I. Olopade, M.D. F.A.C.P.
University of Chicago

Audience and Web Participation
11:00 a.m. - 11:15 a.m. Break
Session 5: Use of Epidemiology in Knowledge Integration and Meta-Research
Moderator: Muin J. Khoury, M.D., Ph.D., EGRP, DCCPS, NCI
11:15 a.m. - 11:45 a.m. The Role of Epidemiology in Knowledge Integration and Meta-Research [ PDF (1.1 MB), HTML ]

John Ioannidis, M.D., D.Sc
Stanford Prevention Research Center

11:45 a.m. - 12:45 p.m. Panel and Audience Discussion [ PDF (538 KB), HTML ]
  • How can epidemiology help integrate knowledge from basic, clinical and population sciences to accelerate translation from research to practice?

Panelists:
Martin L. Brown, Ph.D.
Applied Research Program, DCCPS, NCI

Katrina Goddard, Ph.D.
Kaiser Permanente Northwest

Robert A. Hiatt, M.D., Ph.D.
University of California San Francisco

Ann Zauber, Ph.D.
Memorial Sloan-Kettering Cancer Center

Audience and Web Participation
12:45 p.m. - 1:15 p.m. Lunch
Session 6: Where Do We Go From Here? 12 Recommendations for Epidemiology in the Next 10-20 Years
Moderator: Patricia Hartge, Sc.D., DCEG, NCI
1:15 p.m. - 2:30 p.m. Working lunch and moderated discussion to come up with 12 broad recommendations for action in the next 10-20 years

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Online Participation

Prior to the workshop, EGRP invited the research community to comment on the topics listed in the agenda via the Cancer Epidemiology Matters Blog.

The meeting offered several ways for the research community to participate online. The proceedings were videocast live from http://videocast.nih.govExternal Web Site Policy. The archived videocasts are available at the links below:

Online participants were invited to share their comments and questions via Twitter (by using the meeting hashtag, #trendsinepi, or @NCIEpiExternal Web Site Policy in their tweets) or email (nciepimatters@mail.nih.gov). Select questions from online participants were then used in the question and answer portions of the workshop sessions. An archive of tweets that include the #trendsinepi hashtagExternal Web Site Policy is also available for viewing.

EGRP continues to encourage the research community to share comments on how to strengthen the future of epidemiology by providing feedback via our Cancer Epidemiology Matters Blog.

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Workshop Recommendations and Summary

Eight overarching thematic recommendations, with proposed corresponding actions for consideration by funding agencies, professional societies, and the research community emerged from the collective intellectual discourse during the workshop. While the recommendations listed below are focused on cancer epidemiology, EGRP believes they apply broadly to the field of epidemiology and will serve as a strong scientific foundation to accelerate translation of scientific discoveries into individual and population health benefits. What follows are brief descriptions of all eight recommendations; a more comprehensive discussion of these recommendations and their foundations can be found in the April 2013 issue of Cancer Epidemiology, and Biomarkers and Prevention.External Web Site Policy

Recommendation #1: Extend the reach of epidemiology to include development and evaluation of clinical and population interventions, implementation, dissemination, and outcomes research.

Recommendation #2: Increase access to data, metadata, and specimens to foster collaboration, ensure reproducibility and replication, and accelerate translation to population health impact.

Recommendation #3: Expand cohort studies across the lifespan and include multiple health outcomes.

Recommendation #4: Develop, evaluate, and use novel technologies to quantify exposures and outcomes on a large scale and assess multiple factors in complex diseases.

Recommendation #5: Develop systematic approaches to manage, analyze, display, and interpret large, complex datasets.

Recommendation #6: Expand knowledge integration to drive research, policy, and practice.

Recommendation #7: Transform epidemiology training by emphasizing team science, multilevel analyses, knowledge integration, and translation.

Recommendation #8: Develop and design rational, cost-effective resources to optimize funding for epidemiology studies, accelerate translation, and maximize health impact.

View full workshop summary. [PDF - 1.8 MB]

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Contacts

Workshop Planning Committee:

EGRP Workshop Advisory Group:

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