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Transcript of Introduction to Cancer Epidemiology Faina Linkov, PhD Research Assistant Professor of Medicine and...
Introduction to Cancer Epidemiology
Faina Linkov, PhD
Research Assistant Professor of Medicine and Epidemiology
University of Pittsburgh Cancer Institute
E-mail (preferred mode of communications): fyL1 (at) pitt.edu
University of Pittsburgh Graduate School of Public Health, one of the oldest school to advocate for chronic disease epidemiology
research
What this course is about
• Learning more about cancer epidemiology
• Investigating risk factors implicated in cancer development
• Learning to write grants and critique articles
• Learning to be passionate about chronic disease epidemiology
True or False?
In the past 20 years tremendous improvements in the treatment of all cancers have been achieved
Cancer EpidemiologyHistorical Perspective
1775British surgeon, Percival
Pott reported probably the first description of
occupational carcinogenesis in the
form of scrotum cancer among chimney sweeps.
Cancer EpidemiologyHistorical Perspective
Tight corsets and cancer
1842 Rigoni-Stern, Italian physician, observed
that married women in the city were getting cervical cancer, but nuns in nearby convents weren’t. He also
observed that nuns had higher rates of breast cancer, and suggested that the
nuns’ corsets were too tight.
Five Criteria for a Cause Effect Relationship
Criteria Risk Factor for Disease
1) Timing Exposure occurs before development
of disease or during its progression
2) Strength Is dose-dependent Cessation of exposure can modify disease
3) Prevalence Occurs in multiple populations
4) Relationship to
other risk factors
Is independent Can also act synergistically
5) Plausibility Produces structural‡ or functional changes
which are events in mechanism of disease
‡ anatomic or molecular
Cancer EpidemiologyHistorical Perspective
1700s: tobacco and cancer
Reports of cancer risks associated with tobacco in the 18th century included
snuff taking and nasal cancer, reported by Hill in 1761, and pipe smoking and lip
cancer by von Soemmering in 1795.
Cancer EpidemiologyHistorical Perspective
• Tobacco and Lung Cancer• Asbestos and Lung Cancer• Leather Industry and Nasal Cancer• Dyes and Bladder Cancer• Ionizing Radiation and Many Cancers• DES and Vaginal Adenocarcinoma• EBV and Burkitt’s Lymphoma• HPV and Cervical Cancer
Cancer EpidemiologyAn Introduction
• The Epidemiologic Perspective
• Aims of Cancer Epidemiology
• Methods of Epidemiology
• Historical Perspective and Examples
• Contemporary Studies
• The Future
Aims of Cancer Epidemiology
• Uncover new etiologic leads – study of the distribution of cancer – quantify the risk associated with different
exposures and host factors
• Promote insights into the mechanisms of carcinogenesis
• Assess efficacy of preventive measures• Investigate predictors of survival
Methods of Cancer Epidemiology
• Descriptive Studies– Incidence, mortality, survival– Time Trends– Geographic Patterns– Patterns by Age, Gender, SES, Ethnicity
• Analytic Studies – Case-control– Cohort
Challenges to Interpretation
– Observational vs. Experimental Design– Cancer “clusters”– Study Design and Conduct
• Study Size• Biases: Misclassification, confounding, selection
– Exposure assessment important– Epidemiology and “strong” and “weak” effects – Impact on a population level– Replication critical
Cancer EpidemiologySources
• US SEER Registry System
• IARC International Registries
• State/Hospital Registries
• Etiologic Clues– “Alert” Clinician– Experimental Studies
Cancer EpidemiologyCurrent/Future Topics
• Infectious Agents• Cancer and inflammation• Obesity• Physical Activity• Diet• Hormones• Immunologic Factors• Cancer disparities• Inherited Susceptibility (Polymorphisms)