Closing Remarks: Dr. Michael Thun | Cancer Epidemiology: From Pedigrees to Populations

Closing Remarks: Dr. Michael Thun | Cancer Epidemiology: From Pedigrees to Populations


>>Like all of the other speakers, I feel
incredibly honored and privileged to be able to participate in this meeting and to contribute.
And I’m going to be brief. I really want to discuss just two issues. The first is to underscore
Margaret Spitz’s comments about the inspiration that Joe provides to epidemiologists in the
extramural research community. From a perspective of the American Cancer Society where I worked
for over 20 years, what this involved was inviting me and other senior epidemiologists
to serve on the Board of Scientific Counselors on program reviews, and to get a first-hand
impression of the quality of work that is performed within DCEG across the way. And
the collective energy and experience that I’ve witnessed is inspirational, so I thank
you for that. Second, Joe and David Schottenfeld wish to continue the tradition of the Schottenfeld
and Fraumeni text on cancer epidemiology and prevention, which is widely viewed as the
Bible of the field, and the most coherent picture of the field. And I don’t know whether
we have Stephen Chanock’s — no, we don’t — Stephen Chanock had a picture of books
that Joe had produced, and the big fat ones that was upright was the Cancer Epidemiology
and Prevention, which is now in the 3rd edition since first publication in 1982. And he called
me to ask if I wanted to — I thought there should be a 4th edition and if I would take
the lead in editing that. And when he calls you, it’s an incredible compliment. And I
guess in the moment of excitement and hubris, I signed up for this. So in the last 10 years,
there have been many, many exciting developments in the field. We’ve heard a lot about the
rapid advances in understanding the genetic basis of cancer, pedigrees, large population
studies, and to some extent looking at somatic mutations in tumor tissue. There’s the burgeoning
literature on inflammation, immunologic factors and infectious etiologies. Of course, there’s
the introduction of vaccines for HPV, and there’s the knowledge of the natural history
of HPV transforming screening recommendations for cervical cancer. There’s been a change
in the culture of epidemiology, moving away from small studies increasing into consortia,
pooled analyses, meta analyses. There’s this continuing theme of age at exposure. There’s
the continuing obesity epidemic and obesity-related research, there’s survivorship studies, and
then there’s the consequences of imaging separating real from artifactual trends. There’s also
been amazing progress in prevention in certain areas. There’s the decline in most tobacco-related
cancers among men in high resource countries, and the downturn beginning in women. There’s
the decline in colorectal cancer incidence and mortality because of colorectal screening,
there’s the rise in some obesity-related cancers, which is a great concern, liver and pancreas
in the U.S., and globally, the aging of the populations will cause an enormous increase
in the number of people who develop cancer, even when the age-specific rates are decreasing.
And the largest increase will be in low and middle resourced countries, where you have
huge populations of middle-aged people who are now surviving into the ages where cancer
developed. And also, there is around the world sort of a variable rate of the epidemiologic
transition from the cancers of infectious diseases in low resource countries to the
cancers that we experience in high resource countries. So that brings me to the help I
will need from DCEG researchers and alumni in pulling this off. I realize that this is
not an NCI book, that it’s much broader than that, but NCI researchers certainly have the
greatest loyalty to Joe, and also have a greater opportunity to focus on something that presents
a comprehensive picture of the field than do people who are scrambling for grants. So
Joe, I would like to thank you for the huge influence that you’ve had on me and the inspiration,
and the opportunity to work on what is one part of your amazing legacy. Thank you.

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