Future research perspectives on environment and health: the requirement for a more expansive concept of translational cancer research

Abstract

The last two decades have seen exciting advances in understanding the human genome, aided by the development of powerful analytical laboratory tools. These advances have enabled genome-wide association studies to link specific genetic variants with an altered risk of cancer. Unfortunately there has not been an analogous refinement of tools on such a comprehensive scale to permit an equally thorough investigation of environmental factors, yet it is known that these play a major role in cancer etiology. This limitation led to the suggested need for an exposome to match the genome. Major advances both in understanding mechanisms of carcinogenesis as well as in the technology to investigate these underlying steps in the disease process offer the potential to redress this imbalance between exposome and genome. This is all the more important in order to fully exploit the large prospective cohort studies with biological specimens now being established to investigate the environmental and genetic basis of common chronic diseases. Currently translational cancer research is understood to equate to a "bench to bedside" process, focused on improved clinical management of cancer. Unfortunately, alone, this is an inadequate response to the growing burden of cancer worldwide. Priority also needs to be placed on understanding the causes of cancer, its prevention and, critically, how to implement promising interventions into health care structures. The need therefore is to translate basic science to the population in parallel to the translation into the clinic. This "two-way" translational cancer research encourages the common soil of basic science to be applied both to the prevention of cancer and to its treatment. In this way the notable advances in relation to carcinogenesis will yield a richer benefit to society through balanced initiatives to understand the causes and prevention of cancer in addition to more effective treatment and care of those people developing the disease.

Figure 1

Two-way translational cancer research