Cancer Epidemiology Program
The Cancer Epidemiology Program has made important contributions to knowledge in cancer etiology and diagnosis, prognosis, prevention, and survivorship. This has been possible through the development of unique population-based resources, strong faculty, an interdisciplinary perspective, and effective utilization of UNC Lineberger cores and resources.
The population of North Carolina is diverse with regard to race and ethnicity, economic factors and environmental exposures. The Program is well positioned to conduct interdisciplinary research to examine the influence of this diversity and associated disparities on cancer risk and prognosis. This is made possible through the program’s collaborations with other UNC Lineberger programs, its strong ties with the UNC School of Medicine and the Gillings School of Global Public Health. In fact, the School of Public Health has declared that cancer is one of its five strategic initiatives.
The program has been particularly adaptive employing new technology and approaches such as the integration of basic bench and clinical science in a translational framework. Program studies have incorporated cutting-edge genomics with population germline DNA and tumor sample resources to interrogate pathways related to etiology and prognosis. Future research plans will not only continue to provide epidemiologic input into the development of large population resources, such as the Carolina Breast Cancer Study-Phase 3, UNC Cancer Survivorship Study, and the Cancer Information & Population Health Resource, but will also extend the Program’s capabilities to study prognosis, survivorship, and outcomes in collaboration with the Cancer Prevention and Control, Clinical Research, and other cancer center enter programs. This is made possible through the value added provided by expanded UNC Lineberger resources, including large-scale cancer center commitment to projects, core resources, pilot project funding, faculty recruitment, and mechanisms to enhance intra- and inter-programmatic collaborations.
The program’s studies have drawn participants from all 100 NC counties. Multiple studies have focused on central and eastern NC where the majority of African Americans and other minorities live. The primary goal of the Cancer Epidemiology Program is to uncover new knowledge relevant to cancer etiology, diagnosis, prognosis, prevention, and survivorship using an interdisciplinary epidemiologic approach. To date, this research has been conducted primarily in the context of large population-based case-control studies in North Carolina with an emphasis on inclusion of African-Americans. Cancers of particular interest have included breast cancer, colorectal cancer, malignant melanoma, prostate cancer, non-Hodgkin’s lymphoma, head and neck cancer, esophageal and childhood cancer. The areas of research emphasis include:
The role of environmental and lifestyle exposures in the etiology of cancer. A wide range of exposures have been investigated including diet, obesity, physical activity, hormones, occupation, tobacco and alcohol use, medications, infectious agents, sunlight and pesticides.
Genes and Environment
Molecular epidemiologic investigation of genetic susceptibility and gene-environment interaction in cancer etiology. Common polymorphisms of genes involved in the metabolism of tobacco, alcohol, hormones, nutrients and other exposures have been investigated. Research will continue to focus on these carcinogen metabolizing enzymes and cell cycle, apopotosis, DNA repair genes and other genes involved in carcinogenesis.
Current work integrates multiple polymorphisms and haplotypes within common mechanistic pathways. In addition, program faculty have participated in collaborative GWAS projects. The availability of DNA from over 12,000 cases and 6,000 controls from population-based studies; a state-of-the-art high-throughput genotyping core facility, the development of haplotype and data mining methods by Center biostatistics faculty, and the ongoing collaborations with new faculty in the Cancer Genetics Program provide the infrastructure and intellectual collaborations to conduct large-scale genome-wide association studies to examine gene-gene and gene-environment interactions in a comprehensive and rigorous manner. It is anticipated that fundamental studies using the Collaborative Cross (a cohort of 500 mouse strains being phenotyped and genotyped by the Center’s Cancer Genetics faculty) will provide insight into complex traits and inform future epidemiologic studies.
- Examination of health disparities, especially among African-Americans, in relation to cancer etiology, progression, and survivorship.
- Examination of the differential effects of exposures and social class on cancer risk between ethnic groups will continue as a priority goal of all studies.
- Recent studies have expanded to examine health disparities questions in relation to health behaviors, screening, access to heath care, and application of health care provider services.
Investigation of the influence of genetic, environmental, lifestyle, and other factors on cancer survivorship. Case groups from selected large population-based case-control studies are forming the basis of survivor cohorts that are being updated and evaluated for multiple predictors of survival. Recent studies have utilized these study resources and have expanded data collection to include measures of co-morbidity, quality of life, high-risk behaviors and addiction, social support and access to health care. The ongoing development of the UNC Health Registry/UNC Cancer Survivorship Cohort will greatly extend this line of research. These studies will also continue to study survivorship and health disparities and form a natural link with members of the Cancer Prevention and Control and Clinical Research Programs.
The Program has recently initiated research and new collaborations on factors influencing health care access and quality, comparative effectiveness, and cancer outcomes. The use of administrative claims databases such as Medicare will provide unique resources to examine a variety of important research questions related to medications, health services and other factors influencing cancer outcomes. The Cancer Epidemiology Program provides expertise in methodologic approaches to the use of these databases. The research is in collaboration with the Cancer Prevention and Control and Clinical Research Programs.
Hazel B. Nichols