1 / 30

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”

eli
Download Presentation

Cancer Epidemiology An Introduction

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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)

More Related