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NORTHERN CALIFORNIA CANCER CENTER (NCCC) OVERVIEW OF RESEARCH PORTFOLIO January 2007

NORTHERN CALIFORNIA CANCER CENTER (NCCC) OVERVIEW OF RESEARCH PORTFOLIO January 2007 . PURPOSE OF OVERVIEW. To introduce members of the Stanford Comprehensive Cancer Center (SCCC) to on-going research at the Northern California Cancer Center (NCCC)

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NORTHERN CALIFORNIA CANCER CENTER (NCCC) OVERVIEW OF RESEARCH PORTFOLIO January 2007

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  1. NORTHERN CALIFORNIA CANCER CENTER (NCCC) OVERVIEW OF RESEARCH PORTFOLIO January 2007

  2. PURPOSE OF OVERVIEW • To introduce members of the Stanford Comprehensive Cancer Center (SCCC) to on-going research at the Northern California Cancer Center (NCCC) • To identify common and/or complementary research interests and expertise among SCCC and NCCC program members • To stimulate interactions and collaborations between SCCC and NCCC program members • Contact information for specific scientists at NCCC: • www.nccc.org orcancer.stanford.edu/find/ • Or contact Esther M. John, Co-Leader of Program 9 • ejohn@nccc.org

  3. Population Sciences Program – Associate Director • Dee W. West, NCCC/SU • NCCC members - Program 9 • Ellen Chang • Tina Clarke Dur • Sally L. Glaser • Scarlett Lin Gomez • Pamela L. Horn-Ross • Esther M. John, Program Co-Leader • Theresa Keegan • Peggy Reynolds • Rudy Rull • NCCC members - Program 10 • Bang H. Nguyen • Ingrid Oakley-Girvan

  4. MAIN AREAS OF RESEARCH AT NCCC • Cancer Surveillance • Cancer Etiology • Cancer Outcomes • Research focus on • racial, ethnic, cultural, and other groupswith an unequal burden of cancer

  5. SURVEILLANCE RESEARCH What is Cancer Surveillance Research? “…a discipline in which systematically collected data on cancer patients and population characteristics are analyzed and interpreted to examine and test hypotheses about cancer predictors, incidence, and outcomes in geographically defined populations over time.” (Glaser et al., 2005) Lead Investigators: S. Glaser T. Clarke S. Gomez T. Keegan D. West

  6. SURVEILLANCE RESEARCH Goals • Address cancer occurrence patterns and issues of public health relevance • Use creative methodologies to collect and present data • Work with interdisciplinary research teams • Identify cancer patients for etiology and outcomes research studies Data Sources • Cancer registry • Greater Bay Area Cancer Registry (Greater Bay Area data) • California Cancer Registry (statewide data) • SEER Program (data from around the nation) • International Cancer Registry (world wide data) • Population risk factor data • California Health Interview Survey - CHIS • Behavioral Risk Factor Surveillance System - BRFSS • Linkage to Medicare data • Linkage to Medi-Cal data

  7. SURVEILLANCE RESEARCH Research Examples • Breast cancer • Hodgkin lymphoma • Non-Hodgkin lymphoma • Racial/ethnic variation • Survival

  8. SURVEILLANCE RESEARCH Breast Cancer • Incidence and survival patterns • Trends over time (e.g. cancer in Marin county) • Racial/ethnic variation • Prevalence of risk factors • Mammography utilization • Treatment choices • Breast cancer in females and males

  9. SURVEILLANCE RESEARCH Hodgkin Lymphoma • Incidence and survival • Trends over time • Socio-economic variation • HIV-associated disease Non-Hodgkin Lymphoma • Subtype classification methods • Incidence trends over time • Socio-economic variation

  10. SURVEILLANCE RESEARCH Racial/ethnic variation • Incidence • Treatment • Survival • Trends in Asian subgroups, African-Americans & Hispanics • Methods for racial/ethnic and immigration classification • Cancer risk factor profiles • SES and stage at diagnosis • Cancer in Asia and in Asian Americans

  11. CANCER ETIOLOGY Cohort studies • California Teachers Study Family-based studies • Breast Cancer Family Registry • Colon Cancer Family Registry Case-control studies • Population-based case-control studies of specific cancers

  12. CANCER ETIOLOGY Focus on • Breast cancer • Endometrial cancer • Ovarian cancer • Thyroid cancer • Prostate cancer • Lymphomas • Leukemia • Racial/ethnic disparities • Environmental risk factors • Nutrition • Social and built environment • Genetic susceptibility

  13. CANCER ETIOLOGY California Teachers Study Lead investigators:P. Horn-Ross, P. Reynolds, D. West • Cohort study of 133,479 women established in 1995 • Collected risk data by questionnaires and cancer data through linkage with cancer registries • Diet, alcohol, phytochemicals, body composition, smoking, environmental exposures, physical activity, hormone treatment, psychosocial factors, family history • Genetic susceptibility • Breast, ovarian, endometrial, and thyroid cancers, melanoma, NHL

  14. CANCER ETIOLOGY Family Registry for Breast Cancer Lead investigator:E. John, D. West • Family Registry established in 1995 at 6 international sites • Over 2,800 high-risk and sporadic breast cancer families from San Francisco Bay area • Over-sampling of minorities and early-onset breast cancer • Research focus on: • BRCA1 and BRCA2, ATM, CHK2, TGFB, IGF, other genes • GxE and GxG interactions (G=Gene; E=Environment)

  15. CANCER ETIOLOGY Multiethnic Case-Control Study of Breast Cancer Lead investigator:E. John • Over 4,900 Hispanic, African-American and white women • Racial/ethnic differences in risk factors • Modifiable lifestyle factors Physical activity, body size, sun exposure, vitamin D, dietary intake, heterocyclic amines, occupational exposures, exposures in adolescence, migration, acculturation • Genetic susceptibility (VDR, IGF, OB-R, AR, LOX, TGFB, POR) • Genetic admixture in Hispanics and African-Americans

  16. CANCER ETIOLOGY Breast Cancer and HLA / Immune Function Lead investigator: S. Glaser • HLA genotype and variation across racial/ethnic groups Breast Cancer and Hygiene Hypothesis Lead investigator:T. Clarke • Reduced/delayed exposure to microbes, particularly in childhood, may reduce risk • Markers of microbial exposure, including childhood social class, day care attendance, exposure to farming

  17. CANCER ETIOLOGY Breast Cancer and Epstein-Barr Virus Lead investigator: S. Glaser • Controversy regarding EBV presence in breast tumors • Developed a range of EBV assays and applied them to tumors from women at high and low risk of breast cancer Breast Cancer Risk in Nail Salon Workers Lead investigator: P. Reynolds • Preliminary study of characteristics of nail salon workers in Alameda County

  18. CANCER ETIOLOGY Breast Cancer and Early Life Exposures Lead investigator:P. Reynolds • Association of birth characteristics/childhood SES • Linkage with birth certificate information Growth and Lifestyle Study Lead investigator:P. Horn-Ross • Cohort study of 215 girls aged 10-13 years • Followed for 2 years • Effect of soy intake on age at menarche • Modification of effect by variants of genes that regulate steroid hormones

  19. CANCER ETIOLOGY Northern CA Childhood Leukemia Study Lead investigator: P. Reynolds • Population-based case-control study, 35 counties • Environmental risk factors • Variability in risk by molecular subtypes Leukemia and Exposure Insights with GIS Lead investigators: P. Reynolds, R. Rull • GIS (Geographic Information System) neighborhood attribute data on environmental exposures • Neighborhood information on agricultural pesticide applications, traffic density, measured air quality

  20. CANCER ETIOLOGY EBV and Hodgkin Lymphoma Lead investigator: S. Glaser • Large case-series from California • Cancer registry demographic and tumor data with tumor EBV status determined from archival tumor specimens Genetic Susceptibility and Hodgkin Lymphoma Lead investigator: S. Glaser • Pilot study to assess familial factors and genetic susceptibility

  21. CANCER ETIOLOGY Collaborative Work on Etiologic Study of non-Hodgkin and Hodgkin Lymphomas in Scandinavia Lead investigator: E. Chang • Large case-control study in Denmark and Sweden • Infections, medical history, diet and alcohol intake, sunlight exposure, family history • Genetic susceptibility

  22. CANCER ETIOLOGY Risk Factors for Advanced Prostate Cancer Lead investigator:E. John • Modifiable lifestyle factors Sun exposure, vitamin D, physical activity, body size, diet, heterocyclic amines, NSAIDS • Genetic susceptibility (VDR, AR) • Genetic admixture

  23. CANCER ETIOLOGY Social and Built Environment and Cancer Risk Lead investigator: S. Gomez • Assessment of social and built environment through community-level geo-spatial data Population and housing density, housing characteristics, immigration/acculturation, racial/ethnic composition, medical care, businesses/services, walkability, commute, residential segregation, unemployment • Impact of built environment on physical activity and breast cancer risk • Impact of nutrition environment on dietary patterns and cancer risk

  24. OUTCOMES RESEARCH Focus on • Early detection and screening • Survival • Treatment • Quality of life • Quality of care • Co-morbidity • Social and built environment

  25. OUTCOMES RESEARCH Colorectal Screening in Vietnamese Lead investigator: B. Nguyen • Controlled intervention trial • Radio, TV, and newspaper articles and ads • Vietnamese language booklets and flyers • Physician training DVD’s • Evaluation of pre- and post-intervention screening attitudes and behaviors

  26. OUTCOMES RESEARCH Determinants of Hepatitis B Awareness and Screening in Chinese and Chinese Americans Lead investigator:E. Chang • Pilot study using focus groups to develop • Motivational messages to promote hepatitis B screening, vaccination, and clinical follow-up • Knowledge and behavior surveys • Foundation for large community intervention study

  27. OUTCOMES RESEARCH SEER Patterns of Care Studies Lead investigator:T. Keegan • NCCC has participated in these studies for over 10 years • Variation in patterns of treatment for a variety of cancer sites by • Type of community and treatment facility • Age and racial/ethnic groups • Time period • Insurance status • Effects of co-morbidity and other conditions on treatment

  28. OUTCOMES RESEARCH Breast Cancer Treatment Choices Lead investigator: S. Gomez • Pilot study to develop linguistically- and culturally-appropriate survey instrument • Incorporation of mixed methodology: qualitative, focus groups, cognitive, epidemiologic pilot interviews • Focus on: • Cultural factors in decision-making processes for early-stage breast cancer • Family influences on decision-making • Treatment impacts on quality of life • Provider perspectives

  29. OUTCOMES RESEARCH Treatment Choice and Quality of Life for Men with Localized Prostate Cancer Lead investigator: I. Oakley-Girvan • Multi-center Prospective Cohort • Questionnaire prior to treatment • Questionnaire after 6 months of follow-up • Factors influencing treatment decisions  

  30. OUTCOMES RESEARCH Prostate Cancer Progression and Survival Lead investigator: I. Oakley-Girvan • Equal-access HMO based multi-ethnic cohort • Effect of racial differences in • Health care usage • SES • Co-morbidity on racial differences in disease progression, recurrence, and survival

  31. OUTCOMES RESEARCH Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) Lead investigator: D. West • Multi-center cohort study of 10,000 newly diagnosed lung and colorectal cancer patients (2,000 from NCCC) • Characteristics and beliefs of cancer patients, caregivers, and providers • Characteristics and systems of organizations delivering cancer care • Impact on: • Effective treatment and good outcomes (measured from medical record reviews) • Continuum of care (diagnosis to recovery or death) • Disparities (age, gender, race/ethnicity, insurance, residence)

  32. OUTCOMES RESEARCH Cancer Survival Following Screenable Cancers in Asians Lead investigator: S. Gomez • Analysis of linked SEER-Medicare and California cancer registry data • Survival patterns among specific Asian subgroups • Association of survival with: • Socio-demographic factors (e.g., census SES) • Clinical factors (e.g., treatment) • Co-morbidity (other medical conditions)

  33. OUTCOMES RESEARCH Social and Built Environment and Cancer Outcomes Lead investigator: S. Gomez • Impact of social and built environment and residential segregation on racial/ethnic disparities in cancer outcomes • Individual- and institutional-level discrimination in cancer medical care and quality of life • Impact of built environment on physical activity and breast cancer survival

  34. OUTCOMES RESEARCH Survival in High-risk Breast Cancer Families Lead investigator: D. West • Association of survival with genetic factors • Family history of cancer • BRCA1 and BRCA2 mutations • Polymorphisms in low penetrance genes • Association of survival with non-genetic factors • Hormonal and lifestyle factors

  35. OUTCOMES RESEARCH Young Breast Cancer Survivors - 10 Years Later Lead investigator: I. Oakley-Girvan • 10 year follow-up of breast cancer survivors diagnosed at age <50 years • Concerns of 10 year survivors compared to friend controls • Physical well-being • Psychological well-being • Social well-being • Spiritual well-being • Concerns of 10 year survivors vs. 5 year survivors

  36. OUTCOMES RESEARCH Bone Health in Young Breast Cancer Survivors Lead investigator: I. Oakley-Girvan • Randomized intervention trial of 400 breast cancer patients aged <50 years at diagnosis and with recently completed chemotherapy • Effect of one year exercise intervention on: • Frequency and duration of resistance and aerobic exercise • Bone mineral loss as measured by spine DXA and biochemical markers of bone turnover • Body composition (body mass index, lean body mass, fat mass) • Mental and physical health

  37. OUTCOMES RESEARCH APECC Study: Bladder Cancer, Colorectal Cancer, and Leukemia Lead investigator: I. Oakley-Girvan • Population-based study of 750 cancer survivors • 2-5 year survivors • Approx. equal enrollment by race/ethnicity and gender • Focus groups with 30 participants each • Patient care, patient participation in care, health outcomes, and social support • Patient preference for involvement in medical decision- making and information seeking • Unmet information needs, sources for information, and information barriers • Patient attitudes towards discussing psychosocial issues, health history, and co-morbidity

  38. OUTCOMES RESEARCH FOCUS Study: Breast, Colorectal, Endometrial, Ovarian, and Prostate Cancer Lead investigator: I. Oakley-Girvan • Population-based study of 1600 cancer survivors • 4-13 year survivors • Equal enrollment by race/ethnicity and gender • Interviews on frequency, content and setting of follow-up care • Improvement of follow-up care for the increasing number of people living with cancer

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