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

Session 1 Panel and Audience Discussion

Slide 1 of 7

  • Questions:
    • 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?
  • Moderator: Robert T. Croyle, Ph.D., DCCPS, NCI
  • 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

Slide 2 of 7

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

Slide 3 of 7: Where is the US National Cohort? - For Cancer It Exists!

[Table] showing data for the US Initial Cancer Cohort Consortium (BPC3), the US Enlarged Cohort Consortium (pancreas, glioma), and the US Caucasian and African-American Cancer Consortia. Data includes cohort size (male, female, and total), years (base year, last year, and follow-up), minorities (AA and other), and whether blood was collected. This available data gives information on whether the cohort/consortium is NCI funded (Infrastructure), exposure data, and diversity.

Source: NCI Cohort Consortium, 2012 Hartge

Slide 4 of 7

Timothy Rebbeck, Ph.D.
University of Pennsylvania

Slide 5 of 7

[Image] of Multi-level model adapted from Warnecke 2008. Figure shows the factors influencing cancer. Fundamental causes include social conditions and policies (culture, racism, sexism, poverty, discrimination, public policies), and institutions (health care system, families, community-based organizaions, legal system, media, political system). Social organization influences include neighborhoods (collective efficacy, access, social cohesion, segregation, neighborhood disadvantage, neighborhood stability), and social relationships (social networks, social support, social influences, social engagement). Individual risk factors include age, SES, education, obesity, tobacco use, acculturation, diet, and race. Factors involved in biological/genetic pathways include metabolic processes and genetic mechanisms.

Source: Adapted from Warnecke et al. Am J Public Health. 2008 September; 98(9): 1608-1615.

[Image] on the left side shows transition of epidemiology in the 20th century and the 21st century. Twenty first century epidemiology was largely focused on social epidemiology, with consideration for environmental epidemiology and molecular/genetic epidemiology. Epidemiology in the 21st century will consider all the factors simultaneously to practice multilevel epidemiology.

Slide 6 of 7

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

Slide 7 of 7

What are the "big", "understudied", "neglected" or "provocative" questions?



  • How to uncover heritability of lung cancer?
  • What are functional consequences of variants?
  • G-E interactions? Role of nicotine dependence?
  • Can we refine risk prediction?


  • What have we learned about obesity genetics?
  • Is association reversible if obesity is treated?
  • What is role of brown adipose tissue?
  • How does colon microbiome affect body fat?

Integrative Epidemiology - The time for "big science" cohesive; apply new technologies; interdisciplinary collaborative studies

Lung Ca Genetic Susceptibility

  • Replication studies
  • Fine-mapping, resequencing
  • WES, WGS
  • Functional genomics
  • Intermediate phenotypes - COPD
  • Extreme phenotypes
  • Risk assessment models

Mechanisms of Obesity/Cancer link

  • Advanced phenotype measurements
  • Novel imaging
  • Extreme phenotypes
  • Bariatric surgery - metabolomics
  • Regulators of BAT determination
  • Pre-clinical models
  • Gut microbiome


Who to screen?

Obesity prevention/Rx

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