Epidemiology Research at KCI. Epidemiology Epidemiology is the study of the distribution of diseases in the population. Epidemiologic methods are used.

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.

Behavior, Genetics, Environment, Social/Cultural Risk Factors

HealthPre-cancer

Cancer Recurrence

• Etiologic studies• Genetic• Molecular• Environmental• Social/Cultural

• Behavioral Interventions

• Screening• Chemoprevention

Trials

• Quality of life• Predictors of

survival• Chemoprevention

Trials

Survivorship

Risk Assessment,Primary Prevention

Early Detection,Secondary Prevention

Tertiary Prevention

Population Sciences at KCI

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 timein 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

Utah ‘73Iowa ‘73

Detroit ‘73

Connecticut ‘73

Seattle-Puget Sound ‘74

Atlanta ’75

New Jersey ‘01

Kentucky ‘01

Louisiana ‘01

New Mexico ‘73

Arizona ‘80

Alaska ‘92

Hawaii ‘73

San Francisco-Oakland ‘73

Los Angeles ‘ 92

Greater CA ‘01

Rural Georgia ‘78

San Jose-Monterey ‘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 African-American Other Race

Site Group Total Male Female Male Female Male Female

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

Other Cancers 7,307 2,697 2,719 788 914 85 104

Total 24,838 8,508 10,093 2,430 2,945 392 470

Descriptive Epidemiology

Age-Adjusted Incidence for Invasive Lung & Bronchus, Prostate & Female Breast Cancers, Metropolitan Detroit,

1973-2004

0

50

100

150

200

250

300

1973

1976

1979

1982

1985

1988

1991

1994

1997

2000

2003

RA

TES

PER

100

,000

PO

PULA

TIO

N

Male Lung

Female Lung

Prostate

Female Breast

Age-Adjusted Mortality Rates for Invasive Lung & Bronchus, Prostate & Female Breast Cancers,

Metropolitan Detroit, 1973-2004

0

20

40

60

80

100

RATE

S PE

R 10

0,00

0 PO

PULA

TIO

N

Male Lung

Female Lung

Prostate

Female Breast

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 MDCSS572 AA volunteer controlsBiospecimens 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 RiskKato I; R01 CA93817

Genotyping for FABP2 A54, APO E2/E3 polymorphisms, which are postulated to modify intestinal lipid absorption

1205 cases from MDCSS1552 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/Chaldean men had greater proportions of leukemia , multiple myeloma, liver, kidney, and urinary bladder cancers.

•Arab/Chaldean women hadgreater proportions of leukemia, thyroid, and brain cancers.

•Arab–American women have similar distribution ofbreast cancer histology to European–Americanwomen.

•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.

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. Rapid case ascertainment for case identification

3. Control Identification

4. Oversight and support of study interviews

5. Collection and abstraction of medical records

6. Collection of biological specimens

7. Response to data requests requiring access to local and national SEER data

8. Linkage of external data sources to local SEER data