Cancer Cluster Investigations: Review of the Past and Proposals for the Future

• Type of Material: Article
• Authors: Michael Goodman, Emory University; Judy S. LaKind, LaKind Associates LLC; Jerald A. Fagliano, New Jersey Department of Health; Timothy Lash, Emory University; Joseph L. Wiemels, University of California San Francisco; Deborah M. Winn, National Institutes of Health; Chirag Patel, Stanford University; Juliet Van Eenwyk, Washington State Department of Health; Betsy A. Kohler, North American Association of Central Cancer Registries; Enrique F. Schisterman, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Paul Albert, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Donald R. Mattison, University of Ottawa
• Language: English
• Date: 2014-02-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2014 by the authors; licensee MDPI, Basel, Switzerland.
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.3390/ijerph110201479
• Title of Journal or Parent Work: International Journal of Environmental Research and Public Health
• ISSN: 1661-7827
• Volume: 11
• Issue: 2
• Start Page: 1479
• End Page: 1499
• Grant/Funding Information: Chirag Patel is supported by the following grant: NHLBI T32HL007034.; Joseph Wiemels is supported by the following grants: NIEHS/EPA P01ES018172, NCI R01CA155461, NIEHS R01ES09137.; This workshop was supported by a grant from the Research Foundation for Health and Environmental Effects (RFHEE).; Michael Goodman receives salary support from the National Cancer Institute’s contract N01 PC35135.
• Keywords: ACUTE MYELOID-LEUKEMIA; Environmental Sciences; LAST 20 YEARS; exposome; ACUTE LYMPHOBLASTIC-LEUKEMIA; leukemia; AMYOTROPHIC-LATERAL-SCLEROSIS; Environmental Sciences & Ecology; cancer; case grouping; CHILDHOOD LEUKEMIA; Life Sciences & Biomedicine; infection; BREAST-CANCER; Science & Technology; FOR-DISEASE-CONTROL; cluster investigations; INVESTIGATIONS TELL US; RARE DISEASES; ENVIRONMENTAL SCIENCES; cancer biomarkers; MULTIPLE-SCLEROSIS; Public, Environmental & Occupational Health
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Residential clusters of non-communicable diseases are a source of enduring public concern, and at times, controversy. Many clusters reported to public health agencies by concerned citizens are accompanied by expectations that investigations will uncover a cause of disease. While goals, methods and conclusions of cluster studies are debated in the scientific literature and popular press, investigations of reported residential clusters rarely provide definitive answers about disease etiology. Further, it is inherently difficult to study a cluster for diseases with complex etiology and long latency (e.g., most cancers). Regardless, cluster investigations remain an important function of local, state and federal public health agencies. Challenges limiting the ability of cluster investigations to uncover causes for disease include the need to consider long latency, low statistical power of most analyses, uncertain definitions of cluster boundaries and population of interest, and in- and out-migration. A multi-disciplinary Workshop was held to discuss innovative and/or under-explored approaches to investigate cancer clusters. Several potentially fruitful paths forward are described, including modern methods of reconstructing residential history, improved approaches to analyzing spatial data, improved utilization of electronic data sources, advances using biomarkers of carcinogenesis, novel concepts for grouping cases, investigations of infectious etiology of cancer, and "omics" approaches.