lunes, 11 de noviembre de 2013

Transforming Epidemiology for 21st Century Medicine and Public Health

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Transforming Epidemiology for 21st Century Medicine and Public Health

Transforming Epidemiology for 21st Century Medicine and Public Health

  1. Sheri D. Schully1
+ Author Affiliations
  1. Authors' Affiliations: 1Division of Cancer Control and Population Sciences, 2Division of Cancer Epidemiology and Genetics, and 3Division of Cancer Prevention, National Cancer Institute, and 4Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, NIH, Bethesda, Maryland; 5Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia; 6Stanford Prevention Research Center, Department of Medicine, Department of Health Research and Policy, Stanford University School of Medicine, and Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California; 7Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas; 8Division of Medicine, Brigham and Women's Hospital; 9Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School; 10Department of Epidemiology and Nutrition, Harvard School of Public Health; 11Slone Epidemiology Center, Boston University, Boston, Massachusetts; 12Center for Health Research, Kaiser Permanente, Portland, Oregon; 13Center for Genomic Medicine, Institute for Genome Sciences and Policy, Duke University School of Medicine, Durham, North Carolina; 14International Agency for Research on Cancer, Lyon, France; 15Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California; 16Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago Medicine, Chicago, Illinois; 17Office of the Director, Moffit Cancer Center, Tampa, Florida; 18Departments of Epidemiology and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 19Department of Biostatistics and Epidemiology and Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; 20Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee; and 21Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
  1. Corresponding Author:
    Muin J. Khoury, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333. Phone: 404-498-0001; Fax: 404-498-0140; E-mail: muk1@CDC.GOV


In 2012, the National Cancer Institute (NCI) engaged the scientific community to provide a vision for cancer epidemiology in the 21st century. 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. The themes are (i) extending the reach of epidemiology beyond discovery and etiologic research to include multilevel analysis, intervention evaluation, implementation, and outcomes research; (ii) transforming the practice of epidemiology by moving toward more access and sharing of protocols, data, metadata, and specimens to foster collaboration, to ensure reproducibility and replication, and accelerate translation; (iii) expanding cohort studies to collect exposure, clinical, and other information across the life course and examining multiple health-related endpoints; (iv) developing and validating reliable methods and technologies to quantify exposures and outcomes on a massive scale, and to assess concomitantly the role of multiple factors in complex diseases; (v) integrating “big data” science into the practice of epidemiology; (vi) expanding knowledge integration to drive research, policy, and practice; (vii) transforming training of 21st century epidemiologists to address interdisciplinary and translational research; and (viii) optimizing the use of resources and infrastructure for epidemiologic studies. These recommendations can transform cancer epidemiology and the field of epidemiology, in general, by enhancing transparency, interdisciplinary collaboration, and strategic applications of new technologies. They should lay a strong scientific foundation for accelerated translation of scientific discoveries into individual and population health benefits. Cancer Epidemiol Biomarkers Prev; 22(4); 508–16. ©2013 AACR.
For decades, epidemiology has provided a scientific foundation for public health and disease prevention (1). Epidemiology has contributed to major scientific discoveries such as the relationship between cigarette smoking and common diseases (2). Yet, the observational nature of much of epidemiologic research has attracted criticism including “excess expense, repudiated findings, studies that offer small incremental knowledge, inability to innovate at reasonable cost, and failure to identify research questions with the greatest merit” (3).
In the past few years, translational research (4) has sought to accelerate the movement of scientific discoveries into practice and improved health outcomes. However, the main focus of translational research remains, by and large, on basic science to clinical applications (bench to bedside). Epidemiology and other population sciences can be integrated into a full translational framework that spans scientific discoveries through improved population health (4). Within this framework, Lam and colleagues have identified 4 drivers that are increasingly shaping the field of epidemiology: interdisciplinary collaboration, multilevel analysis, emergence of innovative technologies, and knowledge integration from basic, clinical, and population sciences (5). Epidemiology can be a key translational discipline for addressing questions of current great societal importance, such as the economics of health services, the aging of our population, the growing burden of common chronic diseases, the persistence of health disparities, and global health. The translational impact of epidemiology similarly must be achieved in an era of greater consumer awareness, open access to health, and other types of information and enhanced communications, via the web, mobile technologies, and social media.
In 2012, the National Cancer Institute (NCI) initiated a conversation aiming to shape the future of cancer epidemiology and to establish priorities for action (6). Web-based blog posts, several commentaries (5–11), online dialogue using social media (@NCIEpi #trendsinepi on Twitter), and an interdisciplinary workshop (12) informed the proposals presented herein. Table 1 outlines 8 broad recommendations with proposed actions targeted to funding agencies, professional societies, and the research community. Many of these actions already feature prominently in epidemiologic research but a more systematic approach will be needed to increase the impact of epidemiology in the 21st century. Although the recommendations presented here are focused on cancer epidemiology, we believe they apply to the whole field of epidemiology.

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