This approach maximizes the use of epidemiological, clinical, behavioral, and molecular data from the same subjects to answer multiple questions at the same time. For example, we supplemented the detailed information on smoking and family history of lung cancer needed for the etiologic study with additional information on behavioral factors and family history of smoking from the first degree relatives of cases and controls. This allows study of genetic determinants of persistence or cessation of smoking in controls and enhances our ability to assess the effect of shared familial tobacco use on the putative genetic effect of family history of lung cancer on lung cancer risk. We supplemented collection of blood specimens needed to study genetic variation on susceptibility to lung cancer with fresh frozen lung tissue samples to study whether these germ-line variations (with or without smoking exposure) are associated with altered expression of these same genes and related pathways in the target organ. We supplemented detailed pathology information from each lung cancer case needed to assess etiologic heterogeneity with collection of treatment and outcome data to learn about disease progression and efficacy of treatment.
