Cancer risk is determined by a combination of genetics and environment, according to Regina Santella, professor of Environmental Health Sciences and vice dean of Faculty Affairs and Research. Mailman faculty are active in both arenas. A study of newborns by Frederica Perera at the Columbia Center for Children's Environmental Health, for example, uncovered genetic changes from air pollution known to stack the deck for cancer. And in an ongoing project, Mary Beth Terry, professor of Epidemiology, and Santella are looking at ways to improve existing models for cancer risk, such as the Gail model, which attempts to predict a woman's risk for breast cancer through a questionnaire that assesses risk factors, such as age and reproductive history. As it stands, says Santella, the approach, is only slightly better than flipping a coin. "By adding genetic and epigenetic factors, we can try to improve the model," she says.
When it comes to targeted prevention or treatment around cancer, public health also plays an important role by advocating for equity. Across racial and ethnic groups, there are widening disparities in survival rates for the most treatable cancers, and as the emphasis on precision medicine grows, so does the conversation around its ethics. Genetic studies allow for more personalized care and treatment, but only for those who can afford it.
"You have some people getting fancy gene sequencing and expensive treatments," says Santella. "Others can't afford screenings like mammograms, let alone cancer treatments that can cost hundreds of thousands of dollars."
As Americans join with Vice President Biden to undertake a giant leap toward cancer eradication, count on public health to bring "the right stuff."
Courtesy of the Mailman School of Public Health, UC Berkeley and World Economic Forum in Davos, Switzerland
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