Cancer: the big questions to address in coming years.

Molecular epidemiology was introduced in the study of cancer in the early 1980s, with the expectation that it
would help overcome some important limitations of epidemiology and facilitate cancer prevention. Since then, it has become clear that the great majority of cancers are in theory preventable because the factors that determine their incidence are largely exogenous or “environmental” including exposures related to lifestyle (diet and smoking), occupation, and pollutants in the air, water, and food supply. This awareness has lent greater urgency to the search for more powerful early-warning systems to identify causal environmental agents and flag risks well before the malignant process is entrenched. The first generation of biomarkers has contributed important understanding of mechanisms, risk, and susceptibility as they relate largely to genotoxic carcinogens. The newer generation of biomarkers, including epigenomics, genomics, and proteomics, can vastly strengthen efforts to identify carcinogenic risks, design interventions, and reshape public health policy to be more preventative. However, the systematic validation of these newer “omic” biomarkers is urgently needed, as is the development of automated high throughput methods capable of measuring the so-called “exposome”—the diversity of exposures acting on the individual through lifestyle, occupation, or the ambient environment—with the same detail and precision as genomics. Another important future direction in molecular epidemiology is longitudinal, life-course, and multigenerational research on the role of early-life (prenatal and early postnatal) environmental exposures in childhood and adult cancer. Since its founding in 1991, Cancer Epidemiology, Biomarkers & Prevention has been at the forefront of the field, publishing key papers on biomarker validation and their application to molecular epidemiologic studies on the causes, early detection, and prevention of cancer.

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