Can Big Data Shed Light on the Origins of Pediatric Cancer?

Twenty-five years ago, Sir Richard Doll and Sir Richard Peto estimated in their landmark monograph, The Causes of Cancer, that 75% to 80% of adult cancer could be attributed to lifestyle choices and environmental exposures.1 In stark contrast, elucidating the causes of childhood cancer remains one of the most vexing questions in medicine. Despite progress in identifying the molecular causes of many pediatric tumors, whether there are extrinsic environmental causes of pediatric cancer remains an elusive question. Without this evidence, the “primary” prevention of childhood cancer remains out of reach. The inherent epidemiologic challenge of studying the etiology of childhood cancer is simple math. Childhood cancer is a rare event, and the power to detect an association is limited by the small number of incident cases.