Cancer epidemiology today: Not strengthening the value proposition

Editor’s note: To read a response to this editorial from Amanda I. Phipps, MPH, PhD, see her commentary. To read HemOnc Today’s coverage of the research by Phipps and colleagues, click here.

It is not always easy, for this series of editorials, to come up with a topic that will be relevant to the readership, and that might make a difference in the world of cancer research and treatment.

One of the interesting — and sometimes arduous — roles that my co-Chief Medical Editor, John Sweetenham, MD, and I have taken on is to review vast numbers of articles prior to publication in HemOnc Today.

Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
Derek Raghavan

This is interesting because we have the chance to learn about real progress at an early stage, and arduous because we sometimes have to try to digest some strange studies that have been presented or published, including those with questionable statistics, and occasionally research that simply does not make sense.

Epidemiology studies

One pet peeve of mine is the amount of potentially pointless research that seems to be emerging in the world of oncology, and more recently in cancer epidemiology.

I have known for years — from my periods of service on study sections of the NIH and other granting organizations — that cancer epidemiology seems generally to be well funded, and grants can sometimes be huge. However, I have not always been sure that adequate return on investment has truly existed in recent times.

In the halcyon days of the past — when luminaries like Sir Richard Doll, Malcolm Pike, PhD, and the late Ron Ross,MD, wrote amazing grants that sought to explain oncological conundrums, to clarify the genesis of cancer and to influence our public health approaches to cancer avoidance — the work was meritorious and truly important, and it generated hallmark publications that changed lifestyles and patterns of care.

That is how we learned about the relationship between asbestos and cancer, smoking and cancer, viruses and genital malignancy, and so many other important topics.

That said, it is important to remember that influencing the public in its health behavior patterns — even when the data are extreme and incontrovertible (eg, smoking or asbestos and cancer) — is not that easy, and one always needs to be cognizant of the likely true impact of any epidemiological study.

Alcohol and cancer

These days, I have an emerging concern that runs along the lines of: “What were they thinking?”

This refers both to the numbers of investigators who seem to propose truly pointless — or duplicative — studies, and funding agencies that appear happy to support them.

For example, I recall reading studies in the 1970s that suggested, with many caveats, that alcohol (wine, beer, spirits and even sake) may be associated with the genesis of cancers, and perhaps with altered treatment outcomes. In the intervening 30 years, there have been numerous studies, reviews and meta-analyses that have concluded that there may be some type — either positive or negative — of modest association between alcohol and cancer genesis or treatment outcomes.

In the Jan. 10 edition of HemOnc Today, we reported outcomes of a study by Rivera and colleagues that showed alcohol — and particularly white wine — may increase melanoma risk. This was yet another possible statistical association, drawn from yet another large set of accumulated demographic data.

I asked myself why the investigators sought to carry out yet another alcohol association study, why a funding agency supported it, and why an editor — and reviewers — chose to publish it in a good journal. What is one to do with this information? Based on a modest statistical association, what should one advise the public to actually do?