Cancer Epidemiology Research

1. Liam Murray Queen�s University Belfast January 2011 Cancer Epidemiology Research

2. What is (cancer) epidemiology? The study of the distribution and determinants of disease Distribution of cancer Age/sex Geography Time Socioeconomic status Determinants of cancer Aetiology/causes of /risk (or protective) factors for cancer Genetic Lifestyle Smoking, alcohol, diet, obesity, lack of physical activity etc. Environmental Occupational exposures, infectious agents, pharmaceutical exposures

3. What is (cancer) epidemiology? Early diagnosis/detection of cancer Premalignant states Screening Markers of early diagnosis � PSA, proteomics etc. Symptoms of early disease Population awareness Symptom investigation and management Cancer progression/prognosis Risk/protective factors for disease progression Genetic, lifestyle, environmental Survival analysis Markers/Biomarkers of progression Health services research Impact of health services organisation on cancer outcomes Observation rather than interventionObservation rather than intervention

4. What is (cancer) epidemiology? Observation rather than experimentation/intervention Large scale studies Population based or population representative �Normal� subjects as well as cancer patients Study designs Cross- sectional studies Case control Cohort Secondary data analysis Before after designs Observation rather than interventionObservation rather than intervention

5. Designing cancer epidemiology studies THE MAIN RESEARCH QUESTION What is your main research question? Why is this an important question? Public health relevance International, national or local relevance Has the question been addressed before? Few studies Inconsistent findings Study deficiencies Comprehensive knowledge of prior work required What is novel about your proposed proposal How will your study address the deficiencies/problems associated with previous work? Why do it in Ireland/in your research group?

6. Example � The FINBAR case control study of oesophageal adenocarcinoma and its precursors? THE MAIN RESEARCH QUESTION What is your main research question? Why is this an important question? Public health relevance International, national or local relevance Has the question been addressed before? Few studies Inconsistent findings Study deficiencies Comprehensive knowledge of prior work required What is novel about your proposed proposal How will your study address the deficiencies/problems associated with previous work? Why do it in Ireland/in your research group?

7. Designing cancer epidemiology studies MAIN STUDY DESIGN ISSUES What overall study design is appropriate? Is an observational study appropriate? Which observational study design? What is your reference population? external validity Who are your study subjects? Define and apply criteria for inclusion and exclusion How are you going to identify and recruit study subjects? Is there an appropriate comparison group? How are you going to minimise selection bias? Criteria should be strict and reproducibleCriteria should be strict and reproducible

8. Example � The FINBAR case control study of oesophageal adenocarcinoma and its precursors? MAIN STUDY DESIGN ISSUES What overall study design is appropriate? Is an observational study appropriate? Which observational study design? What is your reference population? external validity Who are your study subjects? Define and apply criteria for inclusion and exclusion How are you going to identify and recruit study subjects? Is there an appropriate comparison group? How are you going to minimise selection bias? Criteria should be strict and reproducibleCriteria should be strict and reproducible

9. Designing cancer epidemiology studies MAIN STUDY DESIGN ISSUES What are the main exposures of interest? How will you measure them? What are the principal outcome measures? How will you measure them? What size does your study need to be? How will you achieve adequate study size? Number of centres involved? Period of recruitment Have you the appropriate network of collaborators involved What statistical methods will you use? Have you got appropriate statistical support? Criteria should be strict and reproducibleCriteria should be strict and reproducible

10. Example � The FINBAR case control study of oesophageal adenocarcinoma and its precursors? MAIN STUDY DESIGN ISSUES What are the main exposures of interest? How will you measure them? What are the principal outcome measures? How will you measure them? What size does your study need to be? How will you achieve adequate study size? Number of centres involved? Period of recruitment Have you the appropriate network of collaborators involved What statistical methods will you use? Have you got appropriate statistical support? Criteria should be strict and reproducibleCriteria should be strict and reproducible

11. Some general observations Epidemiology is a collaborative discipline Multiple disciplines often required to ensure appropriate collection/analysis of data Nutrition, psychology, exercise science, molecular science, genetics etc. Clinical network required to recruit subjects International experts/consortia Track record important Epidemiological studies are very expensive Clinical/public health input and biostatical support are essential ? Too late to undertake aetiological studies Investigation of aetiological factors with respect to disease progression Data linkage/secondary data analysis provides a wealth of opportunities Carving out a niche is crucial