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

Welcome and Charge

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Muin J. Khoury, M.D., Ph.D.
EGRP, DCCPS, NCI


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[Image] showing front page of a commentary published online in Cancer Epidemiology Biomarkers & Prevention on June 4, 2012 titled "Frontiers in Cancer Epidemiology: A Challenge to the Research Community from the Epidemiology and Genomics Research Program at the National Cancer Institute" by Muin J. Khoury et al. Also shown is a screen shot of a post on the Cancer Epidemiology Matters Blog titled "Stimulating Fresh Thinking in 21st Century Cancer Epidemiology."

Excerpt from Khoury et al., CEBP July 2012; 21(7): 999-1001 used with permission of American Association of Cancer Research.


Slide 3 of 29: Brief Timeline of Cancer Epidemiology: 1937 - 1979

[Image] showing timeline for dates between 1937, when NCI was established, and 1979, with some of the research accomplishments during this time period, such as the link between asbestos and lung cancer, warning labels added to cigarette labels, and DES linked to vaginal adenocarcinoma.

Adapted from Greenwald P and Dunn BK. Cancer Res 2009; 69(6): 2151-8.


Slide 4 of 29: Brief Timeline of Cancer Epidemiology: 1980 - 1989

[Image] showing timeline for dates between 1980 and 1989, with some of the research accomplishments during this time period, such as hepatitis B vaccine shown to prevent liver cancer, HPV DNA identified in cervical biopsies, H. pylori linked to gastric cancer, and the Gail model used to calculate breast cancer risk.

Adapted from Greenwald P and Dunn BK. Cancer Res 2009; 69(6): 2151-8.


Slide 5 of 29: Brief Timeline of Cancer Epidemiology: 1990 - 1999

[Image] showing timeline for dates between 1990 and 1999, with some of the research accomplishments during this time period, such as Li-Fraumeni and Lynch Syndromes, ATBC and CARET trials show association between dietary vitamins and cancer, BRCA1 and BRCA2 increases risk of breast and ovarian cancer, WCRF/AICR recommendation for diet, BMI, obesity, and physical activity to reduce cancer risk, and tamoxifen reduces breast cancer in ER+ women.

Adapted from Greenwald P and Dunn BK. Cancer Res 2009; 69(6): 2151-8.


Slide 6 of 29: Brief Timeline of Cancer Epidemiology: 2000 - 2009

[Image] showing timeline for dates between 2000 and 2009, with some of the research accomplishments during this time period, such as human genome project completed, HRT increases breast cancer risk, GWAS studies launched, HPV vaccine approved to prevent four forms of HPV, and NIH's GEI program launched.

Greenwald P and Dunn BK. Cancer Res 2009; 69(6): 2151-8.


Slide 7 of 29: Brief Timeline of Cancer Epidemiology: 2010 - 2019

[Image] showing timeline for dates between 2010 and 2019. An early achievement during this time period includes EGRP funding its first exome sequencing study and the Trends in 21st Century Epidemiology workshop. There is an image of the Mayan calendar embedded in the timeline for December 21, 2012 and the statement that "Unless the Mayans were right, we need to think about the future of epidemiology and how we get there."

Greenwald P and Dunn BK. Cancer Res 2009; 69(6): 2151-8.


Slide 8 of 29: The Study of Distribution and Determinants of Disease Occurrence and Outcomes in Populations

Epidemiology comes in different flavors

  • By Outcomes: Cancer, Cardiovascular, Diabetes, Birth Defects...
  • By Risk Factors: Infectious, Genetic, Nutritional, Environmental, Social...
  • By Life Stages: Reproductive, Perinatal, Pediatric, Geriatric...
  • By Context: Descriptive, Analytic, Clinical, Public Health...
  • By Methodologies: Observational, Experimental (RCT)...
  • By Phase of Translation: from Discovery to Population Health

Slide 9 of 29: Four Drivers of Epidemiology in the Context of Translational Research

Lam TK et al. "Drivers" of translational cancer epidemiology in the 21st century: needs and opportunities. Cancer Epidemiol Biomarkers Prev. 2013 Jan [Epub ahead of print]

[Image] showing the inter-relationship between collaboration, technology, knowledge integration, and multi-level analysis and how they, in concert, drive the translation from discoveries to promising interventions to healthcare to public health practice, and ultimately population health impact within the research translation continuum. T0 refers to discovery, T1 refers to characterization, T2 is evaluation, T3 is implementation and health services, and T4 is outcomes research.


Slide 10 of 29: Collaboration: Trends in Funded Research

[Image] showing a graph of the number of EGRP-funded consortia and cohorts between 1992-2011. For cohorts, fewer than 10 were funded in 1992 and that increased gradually to a little over 20 cohorts in 2011. No consortia were funded in 1991, but that number rose steeply to its highest point (2010?) of just under 120 cohorts. The number of consortia funded by EGRP decreased in 2011 to around 70.

Source: Epidemiology and Genomics Research Program (EGRP), http://epi.grants.cancer.gov/
*Prior to 1997, EGRP did not exist, so some grants funded by other NCI Divisions/Programs


Slide 11 of 29: Multi-level Analysis: The Example of Obesity

[Image] representing multi-level analysis depicting three layers. The bottom layer includes a metabolic network, protein-protein interactions, and a regulatory network. The middle layer represents a disease network (e.g. obesity, diabetes, asthma, etc), and the top layer is a social network (e.g. social links, family ties, and physical proximity).

From NEJM, Barabási, Network Medicine - From Obesity to the "Diseasome," 357 (4), 404-7. Copyright © (2007) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.


Slide 12 of 29: Multi-level Analysis: Trends in Published Research

[Image] showing multiple layers representing individual (biologic, risk factors, and sociodemographics), interactions (GxE, etc.), provider and social supports, community, state and national health environment.

  • A quick look at 300 random publications from 2000, 2005, and 2010 reveals very few multi-level analyses in the cancer epidemiology literature beyond GxE at the individual level.

Slide 13 of 29: Multi-level Analysis: Trends in G - G and G - E in Genetic Epidemiology Studies

[Image] showing a graph of the number of publications for gene x gene, gene x environment, and pharmacogenetics from 1997 to 2011. There were similar numbers of publications for gene x environment and pharmacogenetics between 1997 to 2007 and then the pharmacogenetics publications doubled between 2007 and 2011 to about 350 and the gene x environment publications plateaued before beginning to decrease. The number of gene x gene publications increased from 0 in 1999 to a peak of about 600 ten years later.

Source: HuGE Navigator, http://hugenavigator.net/HuGENavigator/startPagePubLit.doExternal Web Site Policy


Slide 14 of 29: Technology: Trends in Published Research (1 of 3)

[Image] showing a graph of the number of publications related to classic "omic" cancer studies between 1992 and 2011. One line on the graph represents genetic publications and the other represents gene expression publications. There were about 2,000 gene expression publications in 1992 and a little more than 3,000 genetic publications in 1992. The increase in publications for each was similar, but slightly greater for gene expression publications. There were roughly 13,000 of each category of publications by 2011.

Source: PubMed search excluded reviews, meta-analyses, systematic reviews and filtered on cancer and humans


Slide 15 of 29: Technology: Trends in Published Research (2 of 3)

[Image] showing a graph of the number of publications related to emerging "omics" cancer studies between 1992-2011. Lines on the graph represent methylation, histone, chromatin condensation, mitochondrial DNA, microRNA, metabolomics, telomere, and proteomic research. There were no more than 100 publications for any of these categories in 1992. Throughout this time period, the greatest number of publication existed for methylation studies (about 1,800 by 2011). Beginning around 2006, there was a sharp increase in the number of microRNA publications, rising from less than 100 to more than 1,600 in 2011. All other categories showed a steady, modest increase in the number of publications (< 600 publications in 2011).

Source: PubMed search excluded reviews, meta-analyses, systematic reviews and filtered on cancer and humans


Slide 16 of 29: Technology: Trends in Published Research (3 of 3)

[Image] showing a graph of the number of publications related to usage of accelerometer as objective measure of physical activity between 1992-2011. The graph includes a line representing epidemiology publications from 1991 to 2011 and cancer publications from 2006 to 2011. Between 2001 and 2006, there were no more than 10 publications for each of these two categories. By 2011, there were around 55 epidemiology publications and a little more than 20 cancer-specific publications.

Source: PubMed search excluded reviews, meta-analyses, systematic reviews and filtered on cancer and humans

Related Reference: Verma M, Khoury MJ, Ioannidis JPA. Cancer Epidemiol Biomarkers Prev. (in press)


Slide 17 of 29: Knowledge Integration: Trends in Published Research

[Image] showing a graph of the publications in the field of cancer epidemiology between 1992 and 2011. The graph shows the number of publications categorized as a review, systematic review, or meta-analysis. In 1991, there were fewer than 50 publications each in the category of systematic review or analysis publications, and well over 350 review articles. In 2011, review articles numbered around 650. There were slightly more than 400 systematic reviews, and almost 300 meta-analyses.

Source: PubMed search excluded trials and treatment studies and filtered on cancer and humans

Reference: Ioannidis JP, Schully S, Lam TK, Khoury MJ. CEBP. Oct 23, 2012 [epub ahead of print]


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Welcome to the Era of "Omic" and "Big Data" Epidemiology!

Which Brand of Epidemiology will Show up in the 21st Century?

Incidentalomic Epidemiology vs. Translational Epidemiology


Slide 19 of 29: Translational Epidemiology

  • Khoury MJ, Gwinn M, Ioannides JPA. The emergence of translational epidemiology: from scientific discovery to population health impact. Am J Epidemiol. 2010 September 1; 172 (5): 517-24.
  • Koplan JP, Thacker SB, Lezin NA. Epidemiology in the 21st century: calculation, communication, and intervention. Am J Public Health. 1999 August; 89 (8): 1153-55.

Slide 20 of 29: Welcome to 12-12-12

Our big objective: come up with 12 recommendations for action to influence the field of epidemiology in the next 12 years


Slide 21 of 29: Session 1: The Evolution of Epidemiology and its Applications to Cancer

  • "Historical perspectives on the evolution of cancer epidemiology" by Bob Hoover
  • Panel's questions:
    1. What lessons and success stories have we learned from 20th century cancer epidemiology?
    2. What are the major scientific questions that cancer epidemiology should address in the next decade to impact public health?

Slide 22 of 29: Session 2: The Impact of New Methods and Technologies on Epidemiologic research

  • "Technology-driven epidemiology: a paradigm shift" by Geoff Gingsburg
  • Panel's questions:
    1. Which technologies do you feel are ready for "prime time" in epidemiologic research and for what purpose?
    2. What criteria would you use to determine when emerging technologies should be integrated into epidemiologic research?

Slide 23 of 29: Session 3: The Evolution of Epidemiologic Cohorts in the Study of Natural History of Cancer and Other Diseases

  • What have we learned from epidemiology cohorts and where should we be going next?" by Julie Buring
  • Panel's questions:
    1. What developments are needed to make epidemiologic cohorts a cornerstone of the discovery to practice continuum?
    2. How should NCI and NIH facilitate multidisciplinary collaboration to integrate these developments into the research portfolio?

Slide 24 of 29: Session 4: Use of Epidemiology to Advance Clinical and Public Health Practice

  • "Epidemiology and evidence-based research along the cancer care continuum" by David Ransohoff
  • Panel's questions:
    1. What are new ways in which epidemiology can be used to fill evidence gaps between discoveries and population health impact?
    2. How can observational epidemiology make the greatest scientific contributions in understanding cancer-related risk factors that cannot be studied through randomized clinical trials?

Slide 25 of 29: Session 5: Use of Epidemiology in Knowledge Integration and Meta-Research

  • "The role of epidemiology in knowledge integration and meta research" by John Ioannidis
  • Panel's question:
    1. How can epidemiology help integrate knowledge from basic, clinical and population sciences to accelerate translation from research to practice?

Slide 26 of 29: Session 6: Where do We Go From Here?

General Discussion Moderated by Patricia Hartge

  • Objective: 12 Recommendations for Action for Epidemiology in the Next 12 Years

Slide 27 of 29: Engaging the Scientific Community

  • The digital conversation started via our blog 6 months ago
  • This meeting is being webcast to the community at large (smile for the camera)
  • We will also be monitoring an email box and Twitter feed for questions from the community at large
  • We will continue the dialogue after 12/13/12

Slide 28 of 29: Your Charge!

  • Engage, participate, invigorate!
  • Think provocatively and creatively about the future of cancer epidemiology and how the discipline needs to evolve with a changing landscape
  • Engage online and tweet about the meeting
  • Engage others and continue the conversation after you leave tomorrow

Slide 29 of 29: A Big Thank You

Planning Committee:

  • Bob Hoover
  • Muin Khoury
  • Tim Rebbeck
  • Sheri Schully

EGRP Scientific Team:

  • Mahesh Divi
  • Joanne Elena
  • Tram Kim Lam
  • Stefanie Nelson
  • Joseph Su

EGRP Communications Team:

  • Christie Kaefer
  • Dacia Beard
  • Audrey Babkirk

EGRP Fellows:

  • Christine Chang
  • Paul Ebohon

CMP:

  • Trinh Lieu

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