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The founding of the National Cancer Institute in 1937 was attended by the formation of the National Advisory Council on Cancer. A seminal action by this Council was the funding of the First National Cancer Survey, the first population-based cancer surveillance activity of the federal government. Francis Carter Wood, distinguished cancer researcher and editor of the American Journal of Cancer (predecessor to Cancer Research), was a member of that Council, through which he was a prime mover in the funding of this survey. This action reflected Wood's commitment to population-based cancer surveillance, voiced over more than 2 decades. Such commitment reflected his view that only such data could identify the optimal treatment modality for cancer patients. The implications of this view, with epidemiologic data providing insights on treatment rather than prevention of disease, as the basis for the development of cancer epidemiology are then considered.

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In 1925, the American Public Health Association Committee on Control of Cancer presented the results of its 1924-1925 operations at the association's annual meeting. The Committee evaluated the issue of cancer surveillance, both active and passive, and concluded that the probity of the cancer incidence data, however useful it might be, was outweighed by the likely cost. The reasoning provided by the Committee suggests a sophisticated understanding of many aspects of cancer epidemiology often thought to be a post-World War II development. From the Committee's report, we see that modern cancer epidemiology appears to have started at least as early as the 1920s, and perhaps even earlier.

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The creation of the field of neuroepidemiology was one of the two principal professional achievements of the American College of Epidemiology Fellow Leonard T. Kurland (1921-2001), the other being the establishment of the Rochester Project. In the former, Kurland established the role of the neuroepidemiologists in the development of the corpus of knowledge needed to control and prevent the occurrence of neurological conditions. Two examples of his endeavors in this regard were his work on the Guamanian focus of neurodegenerative diseases and his seminal investigations into the epidemiology of multiple sclerosis. He was also instrumental in the development of the Rochester, Minnesota community as a population laboratory within which epidemiologic investigations could be mounted. This pioneering achievement created a resource used by many generations of epidemiologists and clinicians to examine health and disease in the population.

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During 1911-1914, using the resources of the Metropolitan Life Insurance Company, Louis I. Dublin conducted two national studies into the survival of those surviving episodes of typhoid fever or scarlet fever. He identified an elevated risk of such mortality, associated with specific causes of death, among those having had typhoid fever but not among the scarlet fever survivors. The studies were methodologically sophisticated, resembling those conducted three to four decades later. The studies appear to have been accepted by the medical and public health communities. However, the absence of modern data processing technology and the lack of financial support for such studies by other investigators precluded the further development of modern epidemiology until World War II.

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The development of modern epidemiology, particularly cancer epidemiology, is often seen as a post-World War II phenomenon. However, the First National Cancer Survey, conducted from 1937 to 1939 as part of the newly formed National Cancer Institute's initial activities, provided the first data on the occurrence of cancer in the United States. This project was directed by a young sociologist, Harold Fred Dorn. Through Dorn, many of the methodological innovations in sociology, such as the use of surveys and observational study designs, were incorporated into modern epidemiology. I examine Dorn's training and early career in the context of the First National Cancer Survey as a means of investigating the beginnings of modern epidemiology.

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The pharmaceutical industry developed in the late 19th century as a consequence of both scientific and commercial innovations, such as the development of diphtheria antitoxin and the commercialization of smallpox vaccine. Two tetanus outbreaks in 1901 -- from contaminated diphtheria antitoxin in St. Louis, Missouri, and contaminated smallpox vaccine in Camden, New Jersey -- raised public concern about pharmaceutical safety. In St. Louis, errant manufacturing processes were found to be the source of the outbreak. In Camden, investigation identified contaminated vaccine from one manufacturer as the cause. These investigations, the first known pharmacoepidemiologic studies, were widely reported. They formed the basis for the 1902 Biologics Control Act, which focused on the safety of biologics produced and sold by the pharmaceutical industry and established a precedent of federal regulation of this industry. That power, welcomed by manufacturers to restore the public's trust in their products, was enhanced in the 1906 Food and Drug Act, which created the Food and Drug Administration.

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BACKGROUND: Idiopathic pulmonary arterial hypertension (IPAH) is a progressive disorder that usually culminates in right ventricular failure and death without treatment. OBJECTIVE: To assess mortality trends by race and gender for idiopathic pulmonary arterial hypertension in the United States from 1994-1998. METHODS: The U.S. National Center for Health Statistics data for the years 1994-1998 was reviewed for deaths in which the underlying cause was primary pulmonary hypertension (ICD-9 code 416.0), now known as IPAH. The age, gender, race and state of residence of the deceased were abstracted from the Centers for Disease Control Wonder System (http://wonder.cdc.gov). Average annual age-adjusted region-, race- and gender-specific rates were then calculated. RESULTS: African-American women demonstrated the highest mortality rates for IPAH across all age groups compared to other racial and gender groups. No geographical differences in mortality rates were noted. An increase in mortality rates with advancing age was observed in all racial and gender groups, with the highest mortality rates for IPAH noted in the elderly. DISCUSSION: African Americans with IPAH exhibit a substantially increased mortality compared with Caucasians, particularly African-American women.

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Epidemiology has changed remarkably during its growth in the past quarter century. One of those changes has been the ever-increasing specialization among its practitioners. In this commentary, the author explores the degree to which this phenomenon has shaped the field. A partial explanation for this trend is found in the decline in the availability of training funds not focused on specific disease areas. Although it appears likely that epidemiology can continue to flourish without general epidemiologists, the field will lose some of its ability to quickly respond to emerging public health challenges. The author considers steps necessary for the training and inclusion of general epidemiologists.

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Mortality from pulmonary embolism (PE) has declined in the United States over the past two decades, yet significant racia l disparities persist with the age-adjusted rates for blacks about twice those for whites. Incidence studies to date have not been successful in defining reasons for this disparity, primarily because they have not enrolled sufficient numbers of blacks to allow for racial comparisons. This study overcomes that limitation by using New Jersey hospital discharge data as a surrogate measure for PE incidence. It examines whether differences in access to care, in-hospital case fatality, discharge planning or other factors might help explain the observed patterns. Our results revealed an elevation in the incidence of PE among blacks compared with whites, similar to the contrasts in mortality. In-hospital case fatality did not differ notably between blacks and whites, indicating that treatment in-hospital is an unlikely contributing factor. We found differences in hospital discharge planning and insurance status, suggesting that these factors may play a role. Our results point to the need for longitudinal studies on the natural history of the disease to better identify and hopefully modify the risk factors responsible for the persistent disparity in mortality from PE.

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OBJECTIVE: To examine the demographic and geographic patterns of small bowel cancer incidence in the United States and worldwide. METHODS: Incidence data from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 to 2000 were used to analyze the four histologic types of small bowel cancer, adenocarcinomas, carcinoid tumors, lymphomas, and sarcomas. International comparisons were made using data from Cancer Incidence in Five Continents (CIVIII). Geographic correlations between small bowel and both large bowel and stomach cancer incidence, were performed. RESULTS: Men had higher rates than women for all types of small bowel cancer. Blacks had almost double the incidence of carcinomas and carcinoid tumors compared to whites (10.6 vs. 5.6 per million people; 9.2 vs. 5.4 per million people, respectively). Small bowel cancer incidence has risen, with the greatest increase for carcinoid tumors (21%) and black men (120%). A geographic correlation between small and large bowel cancer incidence, but not small bowel and stomach cancer, were observed. CONCLUSIONS: Small bowel cancer incidence in the U.S. is higher in blacks compared to whites, particularly for carcinomas and carcinoid tumors. Small bowel cancer incidence is rising, particularly in black men. The geographic correlation between large and small bowel cancer suggests shared etiologies.

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The development of the risk management paradigm for the enhancement of post-marketing approval drug safety carries with it the need for external monitoring of the different approaches used by the sponsor. The concept of a Data Monitoring Committee (DMC), widely used in the management of randomized clinical trials, is adapted to provide this monitoring function. The rationale for the post-marketing approval DMC is considered in the context of the risk management paradigm, as well as in the more traditional post-marketing approval surveillance setting. The composition and operation of the post-marketing approval DMC are considered, as well as the process of implementing the committee. Although the adaptation proposed in this article is focused on the paradigm proposed by the United States Food and Drug Administration, it is likely that it will require modification as risk management is adopted (and adapted) by other health regulators.

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El metodo de casos y controles es una herramiento de investigacion que actualmente se utiliza en numerosas aplicaciones. Estas aplicaciones trascienden la investigacion etiologica y pueden centrarse en diversas actividades para resolver problemas en la practica de la salud publica y la medicina. Como metodo, ha llegado a ser un enfoque eficiente, entre otros usos, para investigar epidemias y evaluar intervenciones y programas. Este volumen monografico de Epidemiologic Reviews se ha concebido teniendo en cuenta las necesidades de diversa complejidad de los epidemiologos practicos. Asimismo, constituye un foro de debate e identificacion de algunos de los problemas metodologicos que reclaman atencion

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El metodo de casos y controles es una herramiento de investigacion que actualmente se utiliza en numerosas aplicaciones. Estas aplicaciones trascienden la investigacion etiologica y pueden centrarse en diversas actividades para resolver problemas en la practica de la salud publica y la medicina. Como metodo, ha llegado a ser un enfoque eficiente, entre otros usos, para investigar epidemias y evaluar intervenciones y programas. Este volumen monografico de Epidemiologic Reviews se ha concebido teniendo en cuenta las necesidades de diversa complejidad de los epidemiologos practicos. Asimismo, constituye un foro de debate e identificacion de algunos de los problemas metodologicos que reclaman atencion

Se publico en ingles en Epidemiologic Review 16:1-5, 1994. El BOSP. incluira como serie las traducciones de todos los articulos de esa monografia en la seccion titulada Metodo de Casos y Controles, que se publicara durante varios meses

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