Environmental Factor, February 2010, National Institute of Environmental Health Sciences
Lewis Explores Federal Partnerships in Health Research
By Erin D. Hopper
In a January 15 lecture at NIEHS, Denise Riedel Lewis, Ph.D., discussed her diverse experience as an epidemiologist and health scientist in a number of government organizations. Hosted by NIEHS/NTP Director Linda Birnbaum, Ph.D., Lewis presented a seminar titled "Environmental Health Research: A Panorama of Federal Partnerships." The talk focused on her recent work in the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program(http://seer.cancer.gov/) and her experiences with other federal agency initiatives.
Lewis is an epidemiologist in the NCI Division of Cancer Control and Population Sciences Surveillance Research Program, which is the home of SEER. Begun in 1973, the SEER program collects and publishes cancer incidence, mortality, and survival data from population-based cancer registries covering approximately 26 percent of the US population.
Surveillance to understand patterns of exposures and cancer
In her description of SEER, Lewis spoke about the spectrum of disease and various types of exposures, some of which are regulated and some of which are not. Exposures under surveillance and regulation include such environmental factors as pathogens, food contaminants, medications, and air pollutants. Unmonitored and unregulated exposures include environmental conditions that are more variable according to each individual's lifestyle, such as diet and exercise.
One benefit of SEER and similar surveillance programs is that the resulting data can be used for hypothesis generation. NCI has developed such tools as the State Cancer Profiles website(http://statecancerprofiles.cancer.gov/) that scientists can use to map cancer incidence spatially and temporally across the country by geographic location, gender, ethnicity, and cancer type with a number of visualization tools to display the data.
USDA and EPA: Studies of food-borne pathogens and arsenic
In addition to her discussion of the SEER program, Lewis talked about her experience at other government organizations, including the Food Safety and Inspection Service (FSIS) at the U.S. Department of Agriculture (USDA) and the National Health and Environmental Effects Laboratory (NHEERL) at the U.S. Environmental Protection Agency (EPA).
While working at FSIS, Lewis came to view food-borne outbreaks as a type of environmental health investigation. To illustrate the challenges of her role at FSIS, Lewis outlined a hypothetical scenario of an E. coli O157:H7 outbreak in which the outbreak investigation team works collaboratively to determine the source of the pathogen. Once the team identifies the source of the outbreak, the appropriate regulatory agency takes control to determine the proper corrective actions.
Lewis described her work at FSIS as "adrenaline-inducing." She added, "There were times when I felt I needed to have my suitcase packed just in case something came up." When describing the FSIS response to food-borne outbreaks, Lewis emphasized the importance of a well-designed investigation team, which should include epidemiologists, microbiologists, physicians, sanitarians, toxicologists, veterinarians, inspectors, and community-based compliance officers.
The conclusion of Lewis's lecture focused on her years at the EPA, during which she helped to conduct epidemiological and biomarker studies on arsenic in drinking water. During studies in Millard County, Utah, Lewis and her colleagues compared exposure and mortality rates in subjects with arsenic-contaminated drinking water. The results from the Utah Mortality Cohort were particularly valuable because most of the previous arsenic exposure studies had been conducted outside the United States.
(Erin D. Hopper, Ph.D. is a postdoctoral fellow in the NIEHS Laboratory of Structural Biology Mass Spectrometry Group.)
Working Toward a More Comprehensive View of Cancer Control
During her tenure at NCI, Lewis helped to organize a Workshop on Developing a Research Agenda to Improve Cancer Control to bring together experts from across the country in an attempt to identify knowledge gaps and technological advances to improve cancer surveillance and control. One of the products of the workshop was a list of the top six ideas for moving its work forward:
- Ensure confidentiality for study participants
- Create tools and theory for time and spatial/temporal aspects
- Develop searchable and user-friendly one-stop portals for data, boundaries, references, and tools
- Devise strategies and tools for communicating uncertainty
- Generate methods for effective use of census data with health data
- Emphasize community-based participatory research
Citation: Pickle LW, Szczur M, Lewis DR, Stinchcomb DG(http://www.ncbi.nlm.nih.gov/pubmed/17118204?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=7) . 2006. The Crossroads of GIS and Health Information: A Workshop on Developing a Research Agenda to Improve Cancer Control.Int J Health Geogr 5:51.