1. Epidemiology Research at KCI

2. 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.

3. 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.

4. 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.

5. Behavior, Genetics, Environment, Social/Cultural Risk Factors Health Pre- 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

6. 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.

7. SEER Registries Utah ‘73 Iowa ‘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

8. 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.

9. MDCSS Table 1. Estimated annual number of metropolitan Detroit area cancer cases by site group, race and gender CaucasianAfrican-AmericanOther Race Site GroupTotalMaleFemaleMaleFemaleMaleFemal e Breast3,677242,8004783165 Lung & Bronchus 3,3071,3291,214371359259 Prostate3,0241,964.861.199. Colon1,556522604177223921 Cervix Uteri1,555.976.362.217 Skin Melanoma1,175644488741913 Urinary Bladder1,07566723576453715 NHL883362354688289 Kidney658299207785798 Corpus Uteri621.496.116.9 Other Cancers7,3072,6972,71978891485104 Total24,8388,50810,0932,4302,945392470

10. Descriptive Epidemiology

11. 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

12. 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

13. 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 had greater proportions of leukemia, thyroid, and brain cancers. 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.

14. 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

15. 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