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Reconciling the Epidemiology, Physiology, and Molecular Biology of Colon Cancer

John D. Potter, MD, PhD
JAMA. 1992;268(12):1573-1577. doi:10.1001/jama.1992.03490120087033.
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A QUESTION relevant to the etiology of cancer that is seldom asked is: What gets cancer—the genes, the cell, the organ, the organism, or perhaps even the population? The potential answers are not necessarily exclusive, even given reductionist tendencies and the genuine and justified excitement over discoveries in the molecular biology of cancer. Rather, these are levels of explanation that may be more or less coherent within themselves but provide even more information when they exist in a framework provided by all of the explanatory modes. For the purpose of exemplifying this framework, consider that theories of the etiology of colon cancer have been presented at a number of levels—epidemiologic, physiological, and cellular/ molecular. It is proposed herein that it is worthwhile considering both the coherence and interdependence of these levels of explanation, not as a sterile exercise, but because of its heuristic value and its capacity to shape a


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