The multidimensional role of cancer epidemiology in cancer prevention: discovery science and beyond.

A four-dimensional framework describes the role of cancer epidemiology in cancer prevention beyond discovery science.

• The four dimensions are: (1) hazard identification, (2) risk assessment, (3) understanding natural history, and (4) evaluating biological targets for prevention.
• The authors note that 'the role of cancer epidemiology in these next steps and in other aspects of cancer prevention is perhaps less well appreciated.'
• The framework provides 'a systematic approach to define research questions and interpret results in the context of cancer prevention.'
• The approaches required vary depending on the type of prevention strategy being pursued.

Primary and secondary prevention strategies require different epidemiological dimensions from the proposed framework.

• Primary prevention will usually require hazard identification and risk assessment and/or burden estimation.
• Secondary prevention will require studies of the natural history of disease.
• The framework accommodates different study designs depending on the prevention strategy type.
• Novel methods play a role in the success of each of the four epidemiological dimensions.

Five illustrative examples were used to demonstrate the multidimensional framework in practice.

• The five examples selected were: occupational radiation exposure, menopausal hormone therapy, per- and polyfluoroalkyl substances (PFAS), obesity, and lung computed tomography (CT) screening.
• These examples span both primary prevention (e.g., occupational radiation, PFAS, obesity, menopausal hormone therapy) and secondary prevention (e.g., lung CT screening) contexts.
• The examples were chosen to show how different dimensions of the framework apply across varied exposure types and cancer prevention strategies.
• The examples illustrate how epidemiological research continues after initial hazard identification to inform actionable prevention.

The translation of epidemiological findings into cancer prevention typically requires further epidemiological research beyond initial hazard identification.

• The authors state that 'after this identification, the translation of those findings into cancer prevention typically requires further epidemiological research.'
• The pivotal role of epidemiology in identifying causes of cancer is described as 'well recognized,' but subsequent translational roles are less appreciated.
• Further research is needed to move from identifying causes to actually reducing cancer incidence and mortality in affected populations.

The field of cancer epidemiology requires broader measures of success than traditionally applied.

• Traditional measures of success include discovery of causes and estimates of population attributable fractions.
• Broader measures should extend 'through to reductions of harmful exposures and eventually lowering cancer incidence and mortality in the affected populations.'
• This broader view requires reconceptualizing how the field defines and evaluates its own impact.
• The authors argue this expanded view is necessary given the multidimensional role epidemiology plays across the cancer prevention continuum.