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Can We Really Derive Etiology from Human-based Studies?¹

Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, New York 14214

This paper discusses the need for and limitations of human-based studies of diet and cancer. Four problems of such studies remain especially acute: assessment and monitoring of dietary practice; assessment of compliance in diet change studies; validation of dietary questionnaires; and the use of intermediate biological end points. These limit human-based studies' utilization of recent advances in the cellular and molecular biology of cancer. Those researchers who emphasize human-based studies cannot proceed without acknowledgment of and interface with these advances, which promise more precise definition of both exposure and disease and may facilitate evaluation of associations of dietary practice and carcinogenesis in the context of human-based studies. To take advantage of these advances will require critical attention to the causal mechanisms by which intermediate biological end points link dietary exposures with cancer risk.

¹ Presented at the American Cancer Society Research Workshop on Cancer and Nutrition, July 13 and 14, 1992, Atlanta, GA. This work was supported by Grant PDT-434 from the American Cancer Society.

² To whom requests for reprints should be addressed, at Department of Social and Preventive Medicine, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, 270 Farber Hall, 3435 Main Street, Buffalo, NY 14214-3000.