Issues

The cover image is adapted from Figure 1 in the article, “A Complex Systems Model of Breast Cancer Etiology: The Paradigm II Conceptual Model,” by Hiatt and colleagues. The figure illustrates a conceptual model of the etiology of breast cancer. The figure depicts factors in four domains: social, physical, biological, and behavioral. In order to address this limitation of prior models, the authors developed the Paradigm Model, which may be the first conceptual framework of postmenopausal breast cancer incidence taking a complex systems, population-level approach. This framework complemented clinical risk prediction models through an enhanced conceptual understanding of how physical, behavioral, and social factors “get under the skin” to cause biological processes that result in breast cancer. The Paradigm II Model illustrates known etiologic factors in breast cancer as well as gaps in knowledge and areas where better quality data are needed. For more information, see the article beginning on page 1720.