The multi-dimensional role of cancer epidemiology in cancer prevention: discovery science and beyond

The pivotal role of epidemiology in the identification of the causes of cancer is well recognised. However, after this identification the translation of those findings into cancer prevention typically requires further epidemiological research. The role of cancer epidemiology in these next steps and other aspects of cancer prevention, is perhaps, less well appreciated. Here we describe a framework for the multi-dimensional role of cancer epidemiology in cancer prevention including: 1) hazard identification 2) risk assessment 3) understanding natural history and 4) evaluating biological targets for prevention. The approaches required will vary depending on the type of prevention strategy. For example, primary prevention will usually require hazard identification and risk assessment and/or burden estimation, whereas secondary prevention will require studies of the natural history of disease. We describe the types of epidemiological study designs that are used to address these four dimensions and the role of novel methods in their success. We illustrate this with five examples: occupational radiation exposure, menopausal hormone therapy, per- and polyfluoroalkyl substances, obesity and lung CT screening. These examples show how the framework provides a systematic approach to define research questions and interpret results in the context of cancer prevention. This broader view of the field of cancer epidemiology also requires broader measures of success that go beyond the discovery of causes and estimates of population attributable fractions, through to reductions of harmful exposures and eventually lowering of cancer incidence and mortality in the affected populations.