Translational research and good behavior.

Spurred in part by the sequencing of the human genome, there has been increasing emphasis on the importance of translational research to convert biomedical discoveries in cancer into useful clinical applications. Heightened interest in translational research is reflected more generally in the growing prominence of evidence-based medicine and the perspective of population health. Factors contributing to the intensifying focus on translational research include public demands for accountability, changes in health care financing, public-to-private shifts in responsibilities for the delivery of health services, and the increasing involvement of nontraditional partnerships (1). Unfortunately, conspicuous, by its absence, from much of the discourse and many of the research priorities addressing translational research in cancer is the role of behavior. Yet, human behavior is a pervasive and decisive factor that may account for as much as 50% of cancer incidence (2). Basic and applied findings in behavioral and social science research—together with basic discoveries in biomedical science—jointly provide the basis for translation to useful applications (3). We see this in the development of effective interventions across the cancer control continuum, including those in prevention, early detection, treatment decision-making, symptom management, quality of life, provider-patient communication, partner support, and survivorship/end of life. These interventions include those applied in the clinic (e.g., diagnosed patients), as well as those applied to population health (e.g., the community, health plans, health departments) and those that involve changes in policy. In terms of effect at the population level, the behavioral and social sciences have made huge inroads into reducing the cancer burden through modification of behavioral risk factors and policies (3). Tobacco control interventions stemming from early epidemiologic discoveries were translated into programs and policies nationwide, ultimately resulting in changes in societal norms and expectations related to tobacco use. The prevalence of current tobacco users in the United States for adults >18 years of age has continued to decline (15% in the last 8 years) to 21%, largely due to these policies and social interventions. Other behavioral risk factors have undergone, or are expected to undergo, populationlevel shifts with measurable reductions in cancer incidence and mortality. These include increased use of cancer screening (e.g., for breast, colorectal, and cervical cancer) and improvements in dietary practices, physical activity, safe sexual practices, and reduced sun exposure. Applications of behavioral and social science interventions in genetic susceptibility testing, screening tests using biomarkers and new imaging technology, and in improving the quality of life of cancer survivors will be key features of future cancer research agendas. Behavior-based advances in cancer control at both the clinic and population health levels are consistent with definitions of translational research. The NIH Clinical and Translational Science Awards consortium, for example, defines translational research, in part, as ‘‘. . . the process of applying discoveries generated during research in the laboratory, and in preclinical studies, to the development of trials and studies in humans.’’ The Clinical and Translational Science Award consortium’s definition goes on to state that translational research includes efforts ‘‘aimed at enhancing the adoption of best practices in the community.’’ We believe that it is useful to recognize ‘‘community’’ to include not only public health venues (e.g., neighborhoods, health departments, medical care systems, health plans, schools, and the workplace), but also clinical settings (e.g., physician offices, medical inpatient, and outpatient settings). We also see a distinction between the translation of basic discoveries into effective interventions and the dissemination of effective interventions into the community, although we recognize the process as a continuum from discovery to implementation. The first aspect of behavioral translational research encompasses the application of a broad range of theories and models to the development of interventions that can prevent, detect, and alleviate the burden of cancer. It also requires the evaluation of the efficacy and effectiveness of interventions (4, 5). Behavioral and social scientists work along with biomedical scientists in both the ‘‘bench to bedside’’ or ‘‘bench to trench’’ paradigm (6).