American Journal of Epidemiology Vol. 155, No. 4 : 385-386
Copyright © 2002 by The Johns Hopkins University School of Hygiene and Public Health
BOOK REVIEWS |
Fundamentals of Cancer Epidemiology
Department of Health Research and Policy Stanford University School of Medicine Stanford, CA 94305
I have been waiting for a book just like this! I do not think I am the only one that has felt a need for a textbook suitable for a graduate-level didactic course in cancer epidemiology. This void may seem rather odd considering that cancer epidemiology has a longer history than most other areas of epidemiology and that virtually all the graduate programs in epidemiology offer a course in cancer epidemiology. Even molecular epidemiology, one of the newest breeds, has several books that can be used as course textbooks (1
–3). Of course, there is an authoritative book edited by Schottenfeld and Fraumeni (4); indeed, I have found some chapters, particularly those on methodological and conceptual topics, suitable as background readings for the course I teach. However, the Schottenfeld and Fraumeni book seems a little too overwhelming and expensive as a required textbook for a first course, especially for the students who do not plan to specialize in cancer epidemiology but wish to sample the field. Apparently, Philip Nasca and Harris Pastides felt the same need and attempted to fill the void by writing a book on their own along with three contributors (Lisa Chasan-Taber, James McSharry, and Wei Zheng).
This book, as noted in the foreword by Michel Ibrahim, is intentionally not organized according to site-specific cancers. Instead, the book consists of 16 chapters divided into two parts: part I (chapters 1–7) with chapters on descriptive epidemiology, basic terminology, biology of normal and cancer cells, experimental studies, biomarkers, and genetic factors; and part II (chapters 8–16) with chapters on selected risk factors (occupation, tobacco, alcohol, radiation, viruses, immunity, endogenous and exogenous hormones, and diet). It may be debatable whether a discussion of genetic factors (chapter 7) belongs in part I that covers the basic methodological issues or part II that concerns risk factors. However, this placement causes little harm as the division of the two parts is only mentioned in the preface and the chapter on genetic factors is placed (strategically?) at the end of part I.
I share the authors' view about how the topics should be selected for a first course in cancer epidemiology and thus am in strong favor of the way the chapters are organized in this book. I believe it is more educational to put an emphasis on the concepts and methodological issues that are essential to the design and conduct of rigorous epidemiologic research (e.g., measurement error and timing of relevant exposure) than to go over a list of established, probable, and controversial risk factors for each cancer type. While our understanding of specific risk factor-cancer associations is constantly updated and revised as new study findings are reported, certain basic principles behind cancer epidemiologic research remain little changed. Furthermore, the same exposure could increase the risk of one cancer type while decreasing the risk of another, and we should be reminded of the need and importance of weighing risks against benefits when we apply epidemiologic findings to cancer control through primary prevention. Surveys of selected site-specific cancers, which are helpful in learning the pathogenesis of specific organs and devising secondary prevention strategies (e.g., population screening and identification of high-risk persons), could be added to the course syllabus at the discretion of individual instructors.
Other nice features of the book include a brief overview and discussion questions for each chapter, the latter of which reflects the fact that this book was written primarily as a textbook for an introductory course. Two appendices (a list of informative Web sites and a glossary of technical terms) provide helpful resources as quick references.
Recognizing the authors' intent to keep the book concise, I still wish some additional topics were covered in this book. Those include multistep carcinogenesis models (from both biologic and mathematical/statistical viewpoints), cancer screening, and chemoprevention. The two chapters on the biology of normal and cancer cells cover mostly molecular aspects with little discussion at the cellular and histologic levels. Some of the histopathologic changes relevant to carcinogenesis are explained in the chapter on basic terminology, but perhaps the importance of preneoplasia in carcinogenesis, which has important implications for etiologic research as well as cancer prevention, deserves more attention. The chapter on infectious agents as causes of cancer is limited to viruses; I prefer that other types of microorganisms (e.g., bacteria and parasites) also be discussed, at least briefly, to provide a more balanced overview of that class of risk factors.
I noticed some misrepresentations of technical details in the book. For example, the definition of "component causes" (p. 18) seems to misquote what Rothman (5) meant. In addition, it is not correct to state that the International Classification of Diseases (ICD) codes for many cancers have not changed substantially from the Seventh through the 10th revisions (p. 35), as the codes in the 10th Revision (6) are very different from those in the Ninth Revision. Some key references that the text refers to are omitted in the bibliography (e.g., the work by Landrigan and Markowitz on the estimated fraction of cancer risk attributable to workplace exposures quoted on p. 125). As for the attribution of cancer risk to various classes of risk factors, discussed on p. 11 by referring to the classic article by Doll and Peto (7), the reader should be cautioned that the sum of estimated attributable fractions could exceed 100 percent.
I agree with the authors that the book, when used as a course textbook, should be supplemented by instructor-prepared course notes and selected readings from the literature. Students would also benefit from case studies and class discussions to examine why various studies presumably addressing the same research question produce inconsistent findings in more depth than a brief review of relevant literature in this book could do. Nevertheless, this book will certainly reduce the burden of the course instructor for collecting and editing relevant material from various sources and provide the student with a better sense of cohesiveness in the array of subjects covered in an introductory course on cancer epidemiology.
NOTES
By Philip C. Nasca and Harris Pastides
ISBN 0-8342-1776-7, Aspen Publishers, Inc., Gaithersburg, Maryland (Telephone: 800-234-1660, Fax: 301-417-7650, E-mail: labram@aspenpubl.com), 2001, 368 pp., Hardcover $68.00
References
- Toniolo P, Boffetta P, Shuker DEG, et al, eds. Application of biomarkers in cancer epidemiology. Workshop report. IARC Sci Publ 1997;(142):1–18.
- Schulte PA, Perera FP. Molecular epidemiology. Principles and practices. San Diego, CA: Academic Press, Inc, 1993.
- Hulka BS, Wilcosky TC, Griffith JD. Biological markers in epidemiology. New York, NY: Oxford University Press, 1990.
- Schottenfeld D, Fraumeni JF Jr, eds. Cancer epidemiology and prevention. 2nd ed. New York, NY: Oxford University Press, 1996.
- Rothman KJ. Modern epidemiology. 1st ed. Boston, MA: Little, Brown and Company, 1986.
- World Health Organization. International statistical classification of diseases and related health problems. 10th Revision. Geneva, Switzerland: World Health Organization, 1992.
- Doll R, Peto R. The causes of cancer. Quantitative estimates of avoidable risks of cancer in the United States today. New York, NY: Oxford University Press, 1981.
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