Explaining lifecourse research within cancer
Dr Jennifer Lyn Baker
Traditionally, research has tended to focus on how factors in adulthood related to diet, physical activity and body weight influence cancer risk.
In this email Q&A World Cancer Research Fund International’s Research Translation Manager (Dr Vanessa Gordon-Dseagu) and Dr Jennifer Lyn Baker discuss research that has a slightly different focus.
Called lifecourse research, this type of study looks at how risk factors during our early life – defined as birth, childhood, adolescence, and young adulthood – change our risk of developing cancer (or other diseases and conditions) in adulthood.
Dr Vanessa Gordon-Dseagu
Vanessa: Hi Jennifer. Thank you for taking part in this conversation about lifecourse research. I hope that, by the end, our readers will have a better understanding of these types of investigations, including the opportunities it gives us to better understand cancer but also the challenges it presents us with.
I would like to begin by asking you a couple of questions about you, your career, and your motivations for focusing on lifecourse research.
Please could you introduce yourself and give us a little bit of information about your career and the experiences you have had that led you to work/specialise in lifecourse research?
Jennifer: My research career began in maternal and child health, where I saw that supporting a woman during pregnancy is a win-win situation – improving her health also improves health in her baby.
At the same time, new ideas about how early experiences shape health in adulthood were taking shape, which led me to look at childhood as another critical period for building a healthy future.
From there, it was natural to look at later stages of life as well. That journey launched my specialisation in lifecourse epidemiology.
Vanessa: What are your personal motivations for undertaking research that explores our early years and later life cancer risk?
Jennifer: Just like too many people, I have lost loved ones to cancer. From a prevention and intervention perspective, I wanted to know how early in life can we find indicators of the later risk of cancer. My hope is that the earlier we can spot these signals, the better chance we have at reducing cancer and its devastating impact on lives.
Vanessa: I totally agree with you, a personal experience of cancer is the motivation for so many of us undertaking research to better understand the disease and how to prevent it.
What is lifecourse research?
Vanessa: Moving on to lifecourse research, specifically. In your own words, could you introduce/define lifecourse research?
Jennifer: Lifecourse research examines how exposures across all stages of life – from the prenatal (before birth) period to late adulthood – individually and in combination, affect health and well-being.
It also considers influences across generations. The lifecourse approach is used in many disciplines, including epidemiology, sociology, psychology and economics.
Vanessa: What are the key aspects of lifecourse research that make it different to other approaches that look at the links between diet, body weight, physical activity and cancer risk?
Jennifer: Lifecourse research has a particular focus on the timing of when exposures happen across time. Most studies linking the factors you mention to cancer have focused on mid-adult ages, by which time these exposures may have already been present and affecting the body for many years.
What are the pros and cons of lifecourse research?
Vanessa: What do you think are the advantages and opportunities of undertaking this type of research?
Jennifer: Lifecourse research is valuable because it considers the entire lifespan rather than a snapshot at a point in time, and this allows us to gain a broader understanding of what shapes health and cancer risk.
By studying earlier stages of life, we have more chances to prevent or change harmful exposures before they become too fixed and harder to change.
It also shows us when in life certain factors matter most, so we can design better and more timely ways to prevent and reduce risks of cancer.
Vanessa: What are some of the key limitations and challenges when undertaking lifecourse research?
Jennifer: Most cancers develop later in life, but to study the role of earlier life exposures, we need data from this period. This data is often rare.
While it’s easy to picture that smoking or drinking alcohol over many years could increase cancer risk, it’s much harder to find detailed and repeated information on these behaviours across the lifespan.
And even if we can see this bigger picture, we still need better statistical tools to answer these important questions.
What still needs to be understood?
Vanessa: Briefly, because it is obviously a huge area of research, what are some of your personal unanswered questions in terms of our early life and cancer?
Jennifer: That’s a tough question! What I’d really like to understand is how early life exposures affect the body’s biology in ways that raise cancer risk later in life.
The breakthroughs we’re seeing in cancer treatment are giving us new insights into how cancer develops, and I think that same knowledge could also help us prevent it – if we can learn how these processes begin earlier in life.
Vanessa: A search of the published evidence shows that lifecourse research has tended to focus on other diseases, such as cardiovascular disease, rather than cancer. Why do you think cancer hasn’t been the focus?
Jennifer: Simply put – it comes down to a lack of data. Because most cancers occur later in life and are less common than cardiometabolic disease, they require specialised data resources to study.
These kinds of data are much harder to come by, and this has limited research in this area. It’s certainly not for lack of interest in this important topic!
Why is lifecourse research growing in popularity?
Vanessa: On the other side of the same coin, why do you think cancer has gained traction in lifecourse research more recently?
Jennifer: I think it’s a combination of factors. Big studies like the UK Biobank and the Nurse’s Health Study have asked participants to remember parts of their earlier lives, and this information has been used in lifecourse cancer research.
Additionally, there’s been an increased recognition of early life as a time when many health-related habits, exposures, and social influences develop, and this has also contributed.
What’s the future of lifecourse cancer research?
Vanessa: As more research is published and we understand more about our early years and future cancer risk, how do you see lifecourse cancer research progressing in the future?
Jennifer: I think it will progress at a rapid pace. Large cohorts that are being followed for many years, alongside new ways of analysing this data give us a better understanding of risk factors for cancer. For example, as many of the large, repeatedly followed, and deeply phenotyped and genotyped cohorts established in the late 20th century are aging, it will open up new opportunities for advanced research into lifecourse cancer research.
Furthermore, the growing trend towards collaboration across disciplines – such as epidemiology and economics – will bring diverse expertise that will strengthen this work and yield new insights.
Vanessa: What key things do you think the research community needs to be able to better undertake lifecourse cancer research? For example, what types of data are needed?
Jennifer: I think we need newer statistical tools that can meaningfully integrate biological, social, and environmental data across the lifecourse in relation to cancer. We also need better ways to capture the timing of exposures, especially those that occur repeatedly.
And importantly, we must remember that in many parts of the world even basic high-quality cancer data are lacking. The research and cancer community needs to continue advocating and campaigning to improve this situation.
The dream lifecourse in cancer project
Vanessa: Finally, in a perfect world, free of budgetary, data, and other constraints (although staying within ethical boundaries), what would your dream lifecourse cancer research project look like?
Jennifer: I dream of the global establishment of population-based cohorts that gather detailed information across the lifecourse and generations, spanning from -omics to population-level factors.
Omics research typically uses a large amount of data to comprehensively understand a biological system or the functioning of specific tissue or molecules within the body – examples include genomics (investigations of the genome) and metabolomics (investigations of the metabolome).
Crucially, these cohorts should also capture data on health, well-being, and social circumstances, so that research can be understood in context—no one’s health exists in isolation. This is possible within an ethical framework.
I would place a particular emphasis on regions such as Africa and South Asia and other areas, where resources are limited but the need and potential impact are immense. Such lifecourse cohorts would provide the foundation for a wide range of cancer studies and, ultimately, guide the design of interventions to prevent and reduce the risk of this disease in an equitable way worldwide.
