Int. J. Environ. Res. Public Health 2014, 11(2), 1479-1499; doi:10.3390/ijerph110201479

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

1,†email, 2,3,4,†,* email, 5,†email, 1,†email, 6,†email, 7,†email, 8,†email, 9,†email, 10,†email, 11,†email, 11,†email and 12,13,†email
Received: 27 November 2013; in revised form: 13 January 2014 / Accepted: 20 January 2014 / Published: 28 January 2014
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords: cancer; cluster investigations; cancer biomarkers; case grouping; leukemia; exposome; infection
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MDPI and ACS Style

Goodman, M.; LaKind, J.S.; Fagliano, J.A.; Lash, T.L.; Wiemels, J.L.; Winn, D.M.; Patel, C.; Eenwyk, J.V.; Kohler, B.A.; Schisterman, E.F.; Albert, P.; Mattison, D.R. Cancer Cluster Investigations: Review of the Past and Proposals for the Future. Int. J. Environ. Res. Public Health 2014, 11, 1479-1499.

AMA Style

Goodman M, LaKind JS, Fagliano JA, Lash TL, Wiemels JL, Winn DM, Patel C, Eenwyk JV, Kohler BA, Schisterman EF, Albert P, Mattison DR. Cancer Cluster Investigations: Review of the Past and Proposals for the Future. International Journal of Environmental Research and Public Health. 2014; 11(2):1479-1499.

Chicago/Turabian Style

Goodman, Michael; LaKind, Judy S.; Fagliano, Jerald A.; Lash, Timothy L.; Wiemels, Joseph L.; Winn, Deborah M.; Patel, Chirag; Eenwyk, Juliet V.; Kohler, Betsy A.; Schisterman, Enrique F.; Albert, Paul; Mattison, Donald R. 2014. "Cancer Cluster Investigations: Review of the Past and Proposals for the Future." Int. J. Environ. Res. Public Health 11, no. 2: 1479-1499.

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