Boffetta Paolo
Unit of Environmental Cancer Epidemiology, International Agency for Research on Cancer, Lyon, France.
Eur J Surg Suppl. 2002(587):62-9.
The use of biomarkers in medicine, and in epidemiology in particular, is not new but recent developments in molecular biology and genetics have increased the opportunities for their use. Epidemiological studies based on biomarkers, which belong to the discipline defined as 'molecular epidemiology', offer new avenues to investigate associations between genetic and environmental factors, diseases, and medical interventions. Important recent contributions of molecular epidemiology to cancer research include the definitive evidence of the carcinogenicity of aflatoxin in humans, and the elucidation of the mechanisms of tobacco-related carcinogenesis. However, molecular epidemiology studies are subject to problems of design and analysis similar to those of 'traditional' epidemiological studies. If biomarkers offer new opportunities to overcome some of the limitations of epidemiology, their added value over traditional approaches should be systematically assessed. Biomarkers should be validated though transitional studies; consideration to sources of bias and confounding in molecular epidemiology studies should be no less stringent than in traditional studies.
生物标志物在医学，尤其是流行病学中的应用并非新鲜事物，但分子生物学和遗传学的最新进展增加了其应用机会。基于生物标志物的流行病学研究属于 “分子流行病学” 这一学科范畴，为研究遗传与环境因素、疾病及医学干预措施之间的关联提供了新途径。分子流行病学近期对癌症研究的重要贡献包括黄曲霉毒素对人类致癌性的确凿证据，以及烟草相关致癌机制的阐明。然而，分子流行病学研究也面临与 “传统” 流行病学研究类似的设计和分析问题。如果生物标志物为克服流行病学的某些局限性提供了新机会，那么应系统评估其相对于传统方法的附加价值。生物标志物应通过过渡性研究进行验证；对分子流行病学研究中偏差和混杂因素来源的考量应与传统研究同样严格。
