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Cancer Epidemiology An Introduction

Cancer Epidemiology An Introduction. The Epidemiologic Perspective Aims of Cancer Epidemiology Methods of Epidemiology Historical Perspective and Examples Contemporary Studies The Future. Epidemiology. “ Distribution and determinants of disease frequency in human populations”

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Cancer Epidemiology An Introduction

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  1. Cancer EpidemiologyAn Introduction • The Epidemiologic Perspective • Aims of Cancer Epidemiology • Methods of Epidemiology • Historical Perspective and Examples • Contemporary Studies • The Future

  2. Epidemiology • “Distribution and determinants of disease frequency in human populations” • Humans: not laboratory animals, cells • Populations: not individuals, case series • Frequency: Quantification of occurrence and risks • Distribution: Descriptive epidemiology • Determinants: Analytic epidemiology

  3. Aims of Cancer Epidemiology • Uncover new etiologic leads • study of the distribution of cancer • quantify the risk associated with different exposures and host factors • Promote insights into the mechanisms of carcinogenesis • Assess efficacy of preventive measures • Investigate predictors of survival

  4. Methods of Cancer Epidemiology • Descriptive Studies • Incidence, mortality, survival • Time Trends • Geographic Patterns • Patterns by Age, Gender, SES, Ethnicity • Analytic Studies • Case-control • Cohort

  5. Challenges to Interpretation • Observational vs. Experimental Design • Cancer “clusters” • Study Design and Conduct • Study Size • Biases: Misclassification, confounding, selection • Exposure assessment important • Epidemiology and “strong” and “weak” effects • Impact on a population level • Replication critical

  6. Cancer EpidemiologySources • US SEER Registry System • IARC International Registries • State/Hospital Registries • Etiologic Clues • “Alert” Clinician • Experimental Studies

  7. Cancer EpidemiologyHistorical Perspective • 1700: Italian Physician noted breast cancer more common among nuns • 1775: Percivall Pott noted scrotal cancer more common among chimney sweeps • 1700s: pipes and lip cancer, snuff and nasal cancer • 1842: Uterine cancer in Verona, Nuns vs. others • 1800s: Occupational cancers

  8. Cancer EpidemiologyHistorical Perspective • Tobacco and Lung Cancer • Asbestos and Lung Cancer • Leather Industry and Nasal Cancer • Dyes and Bladder Cancer • Ionizing Radiation and Many Cancers • DES and Vaginal Adenocarcinoma • EBV and Burkitt’s Lymphoma • HPV and Cervical Cancer

  9. Attributable Risk • Environmental 5% • Lifestyle 45% • Occupational 4% • Pharmacologic 2% • Biologic (viruses) 4%

  10. Cancer EpidemiologyCurrent/Future Topics • Infectious Agents • Obesity • Physical Activity • Diet • Hormones • Immunologic Factors • Inherited Susceptibility (Polymorphisms)

  11. Cancer EpidemiologyCurrent/Future Topics • Tumor (somatic) Alterations • Cancer Classification • Biomarkers of Exposure/Effect • Improved US Registry System • Study Pooling • Epidemiologic/Statistical Methods • Survivorship

  12. Head and Neck Cancer as a Model for Gene-Environment Interaction Andrew F. Olshan, Ph.D. Departments of Epidemiology and Otolaryngology/Head & Neck Surgery University of North Carolina

  13. Epidmiology of Head and Neck Cancer • Squamous Cell Carcinoma of oral cavity, pharynx, larynx • One of the 10 most frequent worldwide (3rd among males) • Oral (10.1 /100,000) Males (15.1) Females (5.9) Blacks (12.3) Whites (10.0) Larynx Males (6.9) Females (1.4) Blacks (6.6) Whites (3.9) • 40,100 new cases/year in US 11,800 new deaths • Survival- Five-year 54% oro-pharyngeal, 65% laryngeal • Blacks (34%) Whites (56%)

  14. SCCHN as a Model System • KNOWN Risk Factors • Molecular Markers • Tumor Suppressor Genes • Oncogenes • Virus • Other Characteristics • Preneoplastic lesions • Recurrence/second primaries

  15. Exposure Preclinical Biologic Effect Biologically Effective Dose Internal Dose DNA Adducts Mutation Oncogenes Tumor Suppressor Agent or Metabolites Preneoplastic Lesions SUSCEPTIBILITY Genetic/Metabolic DNA Repair Nutritional Status Immunologic Status CLINICAL DISEASE

  16. Tobacco and Alcohol Alcohol Drinks/Wk From Blot 88

  17. Research Question • Do polymorphisms of activation, detoxification, and DNA repair genes confer a differential risk of head and neck cancer in individuals with exposure to tobacco and alcohol?

  18. Carolina Head And Neck CancEr Study • Population-Based NC Study • 46 Counties (Central/Eastern NC) • Rapid Case Ascertainment (1-2 months) • Physician Consent • 1,700 cases (4 yrs) • Whites (1330), blacks (402), <50yrs (225) • Oral (779), Pharynx (364), Larynx (589)

  19. 46 County Study Area

  20. CHANCE STUDY • DMV Controls • Phone number search, letter, phone call • Frequency Matched (age, race, gender)

  21. CHANCE STUDY • In-person interview • Demographics • Smoking/Alcohol Hx • Diet (74 items NCI DHQ) • Oral Health • Medical Hx • Screening Hx • Family Hx of Cancer • Blood Draw (3 tubes) or Mouth rinse • Genotyping (HTG)- Taqman method

  22. CHANCE Study TARGET GENES • CYP1A1 CYP1B1 CYP2C9 CYP2E1 • NAT1 GSTM1 GSTT1 GSTP1 • EPHX1 NQO1 MPO MnSOD • ADH2 ADH3 ADH4 • AGT XRCC1 APE1 HOGG1 • XPD

  23. CHANCE Study • Tumor Blocks • Tumor expression arrays • Medical Records • Social Factors • Access to Health Care • Screening • Follow-up of Cases (new survivor study)

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