Transcript Document

Epidemiology Research at
KCI
Epidemiology
Epidemiology is the study of the distribution of diseases
in the population.
Epidemiologic methods are used for the identification of
risk factors for disease and determination of optimal
treatment approaches used in clinical practice.
In the study of communicable and chronic diseases,
the work of epidemiologists involves study design, data
collection and statistical analysis.
Epidemiologic Methods
Observational:
Case-Control: Exposures, genes, and/or behaviors in
individuals with a particular disease (cases) are compared
to individuals without the disease (controls).
Cohort: A group of individuals with and without a particular
exposure are followed to compare disease outcomes.
Interventional:
Clinical Trials: Individuals are randomized to receive a
particular treatment within the clinic setting.
Community Trials: A community participates in a
behavioral intervention, a screening intervention, etc.
Study Design
Study Design:
Population-Based: Individuals under study
belong to a defined population, i.e., residents of
a geographic region.
Clinic or Hospital-Based: Studies are based
upon patients seen at a particular hospital or
clinic.
Community-Based: Participants are volunteers
in the community.
Population Sciences at KCI
Behavior, Genetics, Environment, Social/Cultural Risk Factors
Precancer
Risk Assessment,
Primary Prevention
Health
Cancer
Recurrence
Early Detection,
Secondary Prevention
• Etiologic studies
• Screening
• Genetic
• Chemoprevention
• Molecular
Trials
• Environmental
• Social/Cultural
• Behavioral Interventions
Survivorship
Tertiary Prevention
• Quality of life
• Predictors of
survival
• Chemoprevention
Trials
All studies conducted in a population that is racially
and ethnically diverse
Population-Based Cancer
Epidemiology
Surveillance Epidemiology and End Results
(SEER) Program
• Assemble and report estimates of cancer incidence and mortality in
the United States.
• Monitor annual cancer incidence trends.
• Provide continuing information on changes over time
in extent of disease at diagnosis, trends in therapy, and associated
changes in patient survival.
• Promote studies designed to identify factors amenable to cancer
control interventions.
SEER Registries
Seattle-Puget
Sound ‘74
Connecticut ‘73
Detroit ‘73
San Francisco-Oakland ‘73
Utah ‘73
San Jose-Monterey ‘92
Greater CA ‘01
Los Angeles ‘ 92
Arizona ‘80
New Mexico ‘73
Iowa ‘73
New Jersey ‘01
Kentucky ‘01
Atlanta ’75
Rural Georgia ‘78
Louisiana ‘01
Hawaii ‘73
Alaska ‘92
Metropolitan Detroit Cancer
Surveillance System (MDCSS)
• Cancer is a reportable disease in Michigan.
• The Metropolitan Detroit Cancer Surveillance System
(MDCSS) is the designated arm of the Michigan
Department of Community Health for collection of cancer
information for the tri-county area.
• About 25,000 in situ and invasive cancers are diagnosed
among residents each year.
• Our database includes information
on over 700,000 cancer cases.
MDCSS
Table 1. Estimated annual number of metropolitan Detroit area cancer cases
by site group, race and gender
Caucasian
Site Group
Total
Male
African-American
Female
Male
Other Race
Female
Male
Femal
e
Breast
3,677
24
2,800
4
783
1
65
Lung &
Bronchus
3,307
1,329
1,214
371
359
25
9
Prostate
3,024
1,964
.
861
.
199
.
Colon
1,556
522
604
177
223
9
21
Cervix Uteri
1,555
.
976
.
362
.
217
Skin Melanoma
1,175
644
488
7
4
19
13
Urinary Bladder
1,075
667
235
76
45
37
15
NHL
883
362
354
68
82
8
9
Kidney
658
299
207
78
57
9
8
Corpus Uteri
621
.
496
.
116
.
9
7,307
2,697
2,719
788
914
85
104
24,838
8,508
10,093
2,430
2,945
392
470
Other Cancers
Total
Descriptive Epidemiology
Age-Adjusted Mortality Rates for Invasive Lung &
Bronchus, Prostate & Female Breast Cancers,
Metropolitan Detroit, 1973-2004
40
Prostate
Female Breast
20
03
20
97
00
20
19
91
94
19
19
19
19
85
88
0
79
82
2003
2000
1997
1994
1991
1988
1985
1982
1979
1976
0
Female Lung
19
Female Breast
50
60
19
Prostate
100
Male Lung
73
76
Female Lung
150
80
19
Male Lung
200
100
19
250
RATES PER 100,000
POPULATION
300
1973
RATES PER 100,000
POPULATION
Age-Adjusted Incidence for Invasive Lung & Bronchus,
Prostate & Female Breast Cancers, Metropolitan Detroit,
1973-2004
Exploring Health, Ancestry and
Lung Epidemiology (EXHALE)
Schwartz AG; R01 CA60691
Case-Control study to identify chromosomal regions
associated with risk of lung cancer among African
Americans (AA)
549 AA cases from MDCSS
572 AA volunteer controls
Biospecimens collected for 94% of participants
Schwartz AG, Cote ML, Wenzlaff AS, Land S, Amos CI. Racial Differences in
the Association Between SNPs on 15q25.1, Smoking Behavior, and Risk of
Non-small Cell Lung Cancer. J Thorac Oncol 2009
•
•
SNPS in the CHRNA3 and CHRNA5 region contribute to lung cancer risk
While variant alleles are less frequent in African Americans, risk may be greater
than in whites and less likely to reflect an indirect effect on lung cancer risk
through nicotine dependence
Luminal Lipid Exposure, Genetics &
Colon Cancer Risk
Kato I; R01 CA93817
Genotyping for FABP2 A54, APO E2/E3
polymorphisms, which are postulated to modify
intestinal lipid absorption
1205 cases from MDCSS
1552 controls using random digit dialing
(RDD)
• Populations with lower intake of luminal modifiers (calcium, fiber)
may have differential risks of colorectal cancer associated with
dietary fatty acid intake
• These SNPs may not be useful in predicting colorectal cancer risk
in populations with high fat intake
Cancer In Arab Americans: Estimating
Rates & Fostering Research
Schwartz K, N01 PC35154-RRSS
•Arab–American women have similar distribution of
breast cancer histology to European–American
women.
•Arab–American stage, age, and hormone receptor
status at diagnosis was more similar to African–
American women.
•Arab–American women have a better overall
survival than even European–American women.
•Arab/Chaldean men had greater proportions of
leukemia , multiple myeloma, liver, kidney, and
urinary bladder cancers.
•Arab/Chaldean women had
greater proportions of leukemia, thyroid, and
brain cancers.
Epidemiology Research
Core (ERC)
Established in December, 2007 due to a
specific need for standardizing
procedures for access to and use of the
local and national SEER data
– Confidentiality of metropolitan Detroit
SEER registry data
– Complexity of SEER registry data
ERC Services
1.
Consultation and collaboration
study design, proposal development, interpretation of
population-based local and national SEER data
2.
3.
4.
5.
6.
7.
8.
Rapid case ascertainment for case identification
Control Identification
Oversight and support of study interviews
Collection and abstraction of medical records
Collection of biological specimens
Response to data requests requiring access to local and
national SEER data
Linkage of external data sources to local SEER data