northern california cancer center (nccc) overview of research portfolio january 2007

NORTHERN CALIFORNIA NORTHERN CALIFORNIA CANCER CENTERCANCER CENTER

(NCCC)(NCCC)

OVERVIEW OF RESEARCH PORTFOLIOOVERVIEW OF RESEARCH PORTFOLIO

January 2007 January 2007

PURPOSE OF OVERVIEWPURPOSE OF OVERVIEW• To introduce members of the Stanford Comprehensive

Cancer Center (SCCC) to on-going research at the Northern California Cancer Center (NCCC)

• To identify common and/or complementary research interests and expertise among SCCC and NCCC program members

• To stimulate interactions and collaborations between SCCC and NCCC program members

Contact information for specific scientists at NCCC:

www.nccc.org www.nccc.org or cancer.stanford.edu/find/ cancer.stanford.edu/find/

Or contact Esther M. John, Co-Leader of Program 9

[email protected]@nccc.org

Population Sciences Program – Associate DirectorPopulation Sciences Program – Associate DirectorDee W. West, NCCC/SUDee W. West, NCCC/SU

NCCC members - Program 9NCCC members - Program 9Ellen ChangEllen ChangTina Clarke DurTina Clarke DurSally L. GlaserSally L. GlaserScarlett Lin GomezScarlett Lin GomezPamela L. Horn-RossPamela L. Horn-RossEsther M. John, Program Co-LeaderEsther M. John, Program Co-LeaderTheresa KeeganTheresa KeeganPeggy ReynoldsPeggy ReynoldsRudy RullRudy Rull

NCCC members - Program 10NCCC members - Program 10Bang H. NguyenBang H. NguyenIngrid Oakley-GirvanIngrid Oakley-Girvan

MAIN AREAS OF RESEARCHMAIN AREAS OF RESEARCHAT NCCCAT NCCC

• Cancer Surveillance• Cancer Etiology• Cancer Outcomes

• Research focus onracial, ethnic, cultural, and other groups with an unequal burden of cancer

SURVEILLANCE RESEARCHSURVEILLANCE RESEARCH

What is Cancer Surveillance Research?What is Cancer Surveillance Research?

“…a discipline in which systematically collected data on cancer patients and population characteristics are analyzed and interpreted to examine and test hypotheses about cancer predictors, incidence, and outcomes in geographically defined populations over time.” (Glaser et al., 2005)

Lead Investigators:S. GlaserT. ClarkeS. GomezT. KeeganD. West

SURVEILLANCE RESEARCHSURVEILLANCE RESEARCHGoalsGoals• Address cancer occurrence patterns and issues of public health

relevance• Use creative methodologies to collect and present data• Work with interdisciplinary research teams• Identify cancer patients for etiology and outcomes research studies

Data SourcesData Sources• Cancer registry

Greater Bay Area Cancer Registry (Greater Bay Area data) California Cancer Registry (statewide data) SEER Program (data from around the nation) International Cancer Registry (world wide data)

• Population risk factor data California Health Interview Survey - CHIS Behavioral Risk Factor Surveillance System - BRFSS

• Linkage to Medicare data• Linkage to Medi-Cal data


Research ExamplesResearch Examples

• Breast cancer• Hodgkin lymphoma• Non-Hodgkin lymphoma• Racial/ethnic variation• Survival


Breast CancerBreast Cancer

• Incidence and survival patterns Trends over time (e.g. cancer in Marin county) Racial/ethnic variation

• Prevalence of risk factors • Mammography utilization• Treatment choices • Breast cancer in females and males


Hodgkin LymphomaHodgkin Lymphoma

• Incidence and survival Trends over time Socio-economic variation

• HIV-associated disease

Non-Hodgkin LymphomaNon-Hodgkin Lymphoma

• Subtype classification methods • Incidence trends over time• Socio-economic variation


Racial/ethnic variationRacial/ethnic variation

• Incidence• Treatment• Survival • Trends in Asian subgroups, African-Americans & Hispanics• Methods for racial/ethnic and immigration classification• Cancer risk factor profiles• SES and stage at diagnosis• Cancer in Asia and in Asian Americans

CANCER ETIOLOGYCANCER ETIOLOGY

Cohort studies• California Teachers Study

Family-based studies• Breast Cancer Family Registry• Colon Cancer Family Registry

Case-control studies• Population-based case-control studies

of specific cancers


Focus on• Breast cancer• Endometrial cancer • Ovarian cancer• Thyroid cancer• Prostate cancer• Lymphomas• Leukemia• Racial/ethnic disparities• Environmental risk factors• Nutrition• Social and built environment• Genetic susceptibility


California Teachers StudyLead investigators: P. Horn-Ross, P. Reynolds, D. West

• Cohort study of 133,479 women established in 1995• Collected risk data by questionnaires and cancer data

through linkage with cancer registries• Diet, alcohol, phytochemicals, body composition,

smoking, environmental exposures, physical activity, hormone treatment, psychosocial factors, family history

• Genetic susceptibility• Breast, ovarian, endometrial, and thyroid cancers,

melanoma, NHL


Family Registry for Breast CancerLead investigator: E. John, D. West

• Family Registry established in 1995 at 6 international sites• Over 2,800 high-risk and sporadic breast cancer families

from San Francisco Bay area• Over-sampling of minorities and early-onset breast cancer• Research focus on:

BRCA1 and BRCA2, ATM, CHK2, TGFB, IGF, other genes GxE and GxG interactions (G=Gene; E=Environment)


Multiethnic Case-Control Study of Breast CancerLead investigator: E. John

• Over 4,900 Hispanic, African-American and white women• Racial/ethnic differences in risk factors• Modifiable lifestyle factors

Physical activity, body size, sun exposure, vitamin D, dietary intake, heterocyclic amines, occupational exposures, exposures in adolescence,

migration, acculturation • Genetic susceptibility (VDR, IGF, OB-R, AR, LOX, TGFB, POR)

• Genetic admixture in Hispanics and African-Americans


Breast Cancer and HLA / Immune FunctionLead investigator: S. Glaser

• HLA genotype and variation across racial/ethnic groups

Breast Cancer and Hygiene HypothesisLead investigator: T. Clarke

• Reduced/delayed exposure to microbes, particularly in childhood, may reduce risk• Markers of microbial exposure, including childhood social class, day care attendance, exposure to farming


Breast Cancer and Epstein-Barr VirusLead investigator: S. Glaser

• Controversy regarding EBV presence in breast tumors• Developed a range of EBV assays and applied them to tumors

from women at high and low risk of breast cancer

Breast Cancer Risk in Nail Salon WorkersLead investigator: P. Reynolds

• Preliminary study of characteristics of nail salon workersin Alameda County


Breast Cancer and Early Life Exposures Lead investigator: P. Reynolds

• Association of birth characteristics/childhood SES• Linkage with birth certificate information

Growth and Lifestyle Study Lead investigator: P. Horn-Ross

• Cohort study of 215 girls aged 10-13 years • Followed for 2 years• Effect of soy intake on age at menarche• Modification of effect by variants of genes that regulate

steroid hormones


Northern CA Childhood Leukemia Study Lead investigator: P. Reynolds

• Population-based case-control study, 35 counties• Environmental risk factors• Variability in risk by molecular subtypes

Leukemia and Exposure Insights with GIS Lead investigators: P. Reynolds, R. Rull

• GIS (Geographic Information System) neighborhood attribute data on environmental exposures

• Neighborhood information on agricultural pesticide applications, traffic density, measured air quality


EBV and Hodgkin Lymphoma Lead investigator: S. Glaser

• Large case-series from California• Cancer registry demographic and tumor data with tumor

EBV status determined from archival tumor specimens

Genetic Susceptibility and Hodgkin Lymphoma Lead investigator: S. Glaser

• Pilot study to assess familial factors and genetic susceptibility


Collaborative Work on Etiologic Study of non-Hodgkinand Hodgkin Lymphomas in Scandinavia Lead investigator: E. Chang

• Large case-control study in Denmark and Sweden• Infections, medical history, diet and alcohol intake,

sunlight exposure, family history • Genetic susceptibility


Risk Factors for Advanced Prostate Cancer Lead investigator: E. John

• Modifiable lifestyle factors

Sun exposure, vitamin D, physical activity,

body size, diet, heterocyclic amines, NSAIDS

• Genetic susceptibility (VDR, AR)

• Genetic admixture

Social and Built Environment and Cancer Risk Lead investigator: S. Gomez

• Assessment of social and built environment through community-level geo-spatial data

Population and housing density, housing characteristics,

immigration/acculturation, racial/ethnic composition, medical care, businesses/services, walkability, commute,residential segregation, unemployment

• Impact of built environment on physical activity and breast cancer risk

• Impact of nutrition environment on dietary patterns and cancer risk


Focus onFocus on

• Early detection and screening• Survival• Treatment• Quality of life• Quality of care• Co-morbidity• Social and built environment

OUTCOMES RESEARCHOUTCOMES RESEARCH

Colorectal Screening in Vietnamese Colorectal Screening in Vietnamese Lead investigator: B. NguyenB. Nguyen

• Controlled intervention trialControlled intervention trial Radio, TV, and newspaper articles and ads Vietnamese language booklets and flyers Physician training DVD’s

• Evaluation of pre- and post-intervention screening attitudes and behaviors


Determinants of Hepatitis B Awareness and Screening Determinants of Hepatitis B Awareness and Screening in Chinese and Chinese Americans in Chinese and Chinese Americans Lead investigator:Lead investigator: E. ChangE. Chang

• Pilot study using focus groups to developPilot study using focus groups to develop Motivational messages to promote hepatitis B

screening, vaccination, and clinical follow-up Knowledge and behavior surveys

• Foundation for large community intervention study


SEER Patterns of Care Studies SEER Patterns of Care Studies Lead investigator:Lead investigator: T. KeeganT. Keegan

• NCCC has participated in these studies for over 10 years• Variation in patterns of treatment for a variety of cancer

sites by Type of community and treatment facility Age and racial/ethnic groups Time period Insurance status

• Effects of co-morbidity and other conditions on treatment



Breast Cancer Treatment ChoicesLead investigator: S. GomezLead investigator: S. Gomez

• Pilot study to develop linguistically- and culturally-appropriate survey instrument

• Incorporation of mixed methodology: qualitative, focus groups, cognitive, epidemiologic pilot interviews

• Focus on: Cultural factors in decision-making processes for early-stage breast cancer Family influences on decision-making Treatment impacts on quality of life Provider perspectives


Treatment Choice and Quality of Life for Men withTreatment Choice and Quality of Life for Men withLocalized Prostate Localized Prostate Cancer Cancer Lead investigator: I. Oakley-GirvanLead investigator: I. Oakley-Girvan

• Multi-center Prospective CohortMulti-center Prospective Cohort Questionnaire prior to treatmentQuestionnaire prior to treatment Questionnaire after 6 months of follow-upQuestionnaire after 6 months of follow-up

• Factors influencing treatment decisions Factors influencing treatment decisions


Prostate Cancer Progression and Survival Prostate Cancer Progression and Survival Lead investigator: I. Oakley-GirvanLead investigator: I. Oakley-Girvan

• EEqual-access qual-access HMO based multi-ethnic cohortHMO based multi-ethnic cohort• Effect of Effect of racial differences in racial differences in

Health care usage Health care usage SES SES Co-morbidityCo-morbidity

on racial differences in disease progression, recurrence, and on racial differences in disease progression, recurrence, and survival survival


Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) Lead investigator: D. West

• Multi-center cohort study of 10,000 newly diagnosed lung and colorectal cancer patients (2,000 from NCCC)• Characteristics and beliefs of cancer patients, caregivers, and providers• Characteristics and systems of organizations delivering

cancer care• Impact on:

Effective treatment and good outcomes (measured from medical record reviews)

Continuum of care (diagnosis to recovery or death) Disparities (age, gender, race/ethnicity, insurance,

residence)


Cancer Survival Following Screenable Cancers in AsiansLead investigator: S. Gomez

• Analysis of linked SEER-Medicare and California cancer registry data

• Survival patterns among specific Asian subgroups• Association of survival with:

Socio-demographic factors (e.g., census SES) Clinical factors (e.g., treatment) Co-morbidity (other medical conditions)


Social and Built Environment and Cancer OutcomesLead investigator: S. Gomez

• Impact of social and built environment and residential

segregation on racial/ethnic disparities in cancer outcomes• Individual- and institutional-level discrimination in cancer

medical care and quality of life• Impact of built environment on physical activity and breast

cancer survival


Survival in High-risk Breast Cancer FamiliesLead investigator: D. West

• Association of survival with genetic factors Family history of cancer BRCA1 and BRCA2 mutations Polymorphisms in low penetrance genes

• Association of survival with non-genetic factors Hormonal and lifestyle factors


Young Breast Cancer Survivors - 10 Years Later Young Breast Cancer Survivors - 10 Years Later Lead investigator: I. Oakley-GirvanLead investigator: I. Oakley-Girvan

• 10 year follow-up of breast cancer survivors diagnosed at 10 year follow-up of breast cancer survivors diagnosed at age <50 years age <50 years

• Concerns of 10 year survivors compared to friend controlsConcerns of 10 year survivors compared to friend controls Physical well-beingPhysical well-being Psychological well-beingPsychological well-being Social well-beingSocial well-being Spiritual well-being Spiritual well-being

• Concerns of 10 year survivors vs. 5 year survivorsConcerns of 10 year survivors vs. 5 year survivors


Bone Health in Young Breast Cancer Survivors Bone Health in Young Breast Cancer Survivors Lead investigator: I. Oakley-GirvanLead investigator: I. Oakley-Girvan

• Randomized intervention trial of 400 breast cancer Randomized intervention trial of 400 breast cancer patients aged <50 years at diagnosis and with recently patients aged <50 years at diagnosis and with recently completed chemotherapycompleted chemotherapy

• Effect of one year exercise intervention on:Effect of one year exercise intervention on: Frequency and duration of resistance and aerobic exercise Frequency and duration of resistance and aerobic exercise Bone mineral loss as measured by spine DXA and Bone mineral loss as measured by spine DXA and

biochemical markers of bone turnover biochemical markers of bone turnover Body composition (body mass index, lean body mass, fat Body composition (body mass index, lean body mass, fat

mass) mass) Mental and physical healthMental and physical health

OUTCOMES RESEARCHOUTCOMES RESEARCH APECC Study: APECC Study: Bladder Cancer, Colorectal Cancer, and LeukemiaBladder Cancer, Colorectal Cancer, and Leukemia Lead investigator: I. Oakley-GirvanLead investigator: I. Oakley-Girvan

• Population-based study of 750 cancer survivorsPopulation-based study of 750 cancer survivors 2-5 year survivors 2-5 year survivors Approx. equal enrollment by race/ethnicity and genderApprox. equal enrollment by race/ethnicity and gender

• Focus groups with 30 participants each Focus groups with 30 participants each Patient care, patient participation in care, health outcomes, and Patient care, patient participation in care, health outcomes, and

social supportsocial support Patient preference for involvement in medical decision-Patient preference for involvement in medical decision- making making and information seeking and information seeking Unmet information needs, sources for information, and information Unmet information needs, sources for information, and information

barriers barriers Patient attitudes towards discussing psychosocial issues, health Patient attitudes towards discussing psychosocial issues, health

history, and co-morbidityhistory, and co-morbidity


FOCUS Study: FOCUS Study: Breast, Colorectal, Endometrial, Ovarian, and Prostate CancerBreast, Colorectal, Endometrial, Ovarian, and Prostate CancerLead investigator: I. Oakley-GirvanLead investigator: I. Oakley-Girvan

• Population-based study of 1600 cancer survivorsPopulation-based study of 1600 cancer survivors 4-13 year survivors 4-13 year survivors Equal enrollment by race/ethnicity and genderEqual enrollment by race/ethnicity and gender

• Interviews on frequency, content and setting of follow-up careInterviews on frequency, content and setting of follow-up care• Improvement of follow-up care for the increasing number of Improvement of follow-up care for the increasing number of people living with cancer people living with cancer

northern california cancer center (nccc) overview of research portfolio january 2007

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