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

机译：癌症群研究：回顾过去和未来的建议

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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.
机译：非传染性疾病的住宅群引起了公众持续的关注，有时甚至引起争议。有关公民向公共卫生机构报告的许多分类都伴随着对调查将发现疾病原因的期望。尽管有关聚类研究的目标，方法和结论在科学文献和大众媒体中进行了辩论，但是对报告的聚类的研究很少能提供有关疾病病因的明确答案。此外，对于病因复杂且潜伏期长的疾病（例如大多数癌症），研究内在困难是固有的。无论如何，整群调查仍然是地方，州和联邦公共卫生机构的重要职能。限制类群研究发现疾病原因的能力的挑战包括：需要考虑较长的潜伏期，大多数分析的统计能力低，类群边界和关注人群的不确定性定义以及迁入和迁出。举行了一个多学科研讨会，讨论研究癌症群的创新和/或探索不足的方法。描述了几种潜在的富有成果的道路，包括重建居住历史的现代方法，改进的分析空间数据的方法，改进的电子数据源的利用，利用致癌作用的生物标记物的进展，将病例分组的新概念，癌症的传染病因学研究以及“组学”方法。

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