Biological, psychological & social domains interact at multiple levels (genes, human & environment microbiomes, stress, behavior, broad SES & environment) outlined by the biopsychosocial ecological model (BPSEM). The BPSEM specifies pathways aligned with the AoU pillars of biology, lifestyle, & environment. Simultaneous examination of the interacting domains and levels of the BPSEM is now computationally possible and... more »
Existing evidence does not adequately evaluate the effects with consideration of the patients’ past history of tobacco use and the tobacco use during and after cancer treatment. The toxicity and expense of many cancer therapies warrant a better understanding of how concurrent tobacco use undermines efficacy or increases morbidity.
Cancer patients who smoke cigarettes have increased treatment toxicity and poorer prognosis compared to former or never smokers. Only 50-70% of patients who smoke at the time of diagnosis initially quit and many later relapse to smoking. Research is needed to better understand how tobacco users who are diagnosed with cancer perceive the risks of tobacco use and the benefits of cessation, and to explore factors that support... more »
Studies have shown that individuals with autoimmune diseases and other immune disorders are at increased the risk of developing lymphoma later in life, but the biological mechanisms are unclear. Better characterization of the risk, specific lymphoma subtypes involved, and the impact of treatment along with an understanding of disease mechanisms is critical for prevention of lymphoma in this highly susceptible population.... more »
Although prostate cancer is the most common cancer among men in the U.S., many men have indolent tumors that are unlikely to cause death in a man’s lifetime. Determining which prostate tumors are likely to lead to death is of critical clinical importance to prevent unnecessary treatment and unwanted side-effects. Understanding factors related to disease etiology and progression and developing risk models is essential... more »
Prostate cancer has long been suspected to include an infectious etiology, although no agent has been identified. It is possible that one specific virus or bacterium is not significant, but rather the characteristics of the entire microbiota to which the prostate is exposed (e.g., the abundance and diversity of all microorganisms). This may be capturable by examining the seminal fluid microbiome.
In order to continue to move the field of cancer research forward, it will be imperative to collect detailed data on the molecular characterization of the tumors for All of Us participants who are diagnosed with cancer. Without these data (which cancer registries lack in completeness), cancer research within All of Us will be hampered. Stratification by these details will be extremely valuable for valid cancer studies... more »
The built environment is only one contextual exposure of interest to investigators who study these factors in relation to disease (and even these function variably across rural and urban areas). New technology could assist in better clarifying a fuller scope of residential exposures, including what elements/exposures the All of Us participants actually come into contact with.
Chronic stress has significant suppressive impact on the immune system and would influence the risk of infection-associated cancers if high risk infections are allowed to persist. In general populations and healthy adult populations, this question has not been addressed. It would involve serial measurement of oral or anogenital human papillomavirus, or even helicobacter pylori.
Adverse childhood experiences (ACE) can be retrospectively assessed in adults, ideally before the onset of the diseases under study. There are existing ACE instruments, or attempts to refine these instruments could be undertaken within All of Us.
Randomized trials could be set within All of Us to test these interventions at specific research sites.
Animal models are compelling that activating the beta-adrenergic pathway (via stress) results in tumor growth and metastasis. Beta-blockers blunt this effect in animals. All of Us could design a randomized intervention trial to test this potential benefit in humans. An observational approach could also be taken with careful attention to pharmacoepi principles and biases such as confounding by indication.
In animal models, stress is a trigger for tumor growth and metastasis, yet we have not adequately addressed this question in human cancer patients or survivors.
All of Us could longitudinally assess the biological experience of psychosocial stress (via biomarker or wearable technology) at specified times in the cancer survivorship period, and conduct an analysis of time to recurrence or time to death.
The impact of psychosocial stress on child and adult health risk is increasingly appreciated. The measurement of this exposure is currently poor, and All of Us has the opportunity to develop or refine biomarkers that could help push this field of research forward in a valid way for the future. Such biomarkers could be a part of individual studies of stress and disease, and could also be used as a gold standard to develop... more »
Pesticides are commonly used inside and outside the home. Evidence from studies of farmers suggests that some pesticides are likely carcinogenic, but the impact of lower levels of exposure is less clear. By collecting information on pesticide exposure through surveys and analysis of carpet dust, we could evaluate the risk of cancer associated with low levels of pesticide exposure. Given their widespread use, even a small... more »