Role and Limitations of Epidemiology in Establishing a Causal Association Eduardo L
Seminars in Cancer Biology 14 (2004) 413–426 Role and limitations of epidemiology in establishing a causal association Eduardo L. Franco a,∗, Pelayo Correa b, Regina M. Santella c, Xifeng Wu d, Steven N. Goodman e, Gloria M. Petersen f a Departments of Epidemiology and Oncology, McGill University, 546 Pine Avenue West, Montreal, QC, Canada H2W1S6 b Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, LA, USA c Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA d Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA e Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA f Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA Abstract Cancer risk assessment is one of the most visible and controversial endeavors of epidemiology. Epidemiologic approaches are among the most influential of all disciplines that inform policy decisions to reduce cancer risk. The adoption of epidemiologic reasoning to define causal criteria beyond the realm of mechanistic concepts of cause-effect relationships in disease etiology has placed greater reliance on controlled observations of cancer risk as a function of putative exposures in populations. The advent of molecular epidemiology further expanded the field to allow more accurate exposure assessment, improved understanding of intermediate endpoints, and enhanced risk prediction by incorporating the knowledge on genetic susceptibility. We examine herein the role and limitations of epidemiology as a discipline concerned with the identification of carcinogens in the physical, chemical, and biological environment. We reviewed two examples of the application of epidemiologic approaches to aid in the discovery of the causative factors of two very important malignant diseases worldwide, stomach and cervical cancers.
[Show full text]