Pub Date : 2017-05-01DOI: 10.1158/1538-7755.CARISK16-IA10
Thomas D. Wang
Background and Significance: Colorectal cancer (CRC) is a leading cause of cancer-related mortality with ~1.4 million new cases diagnosed globally and ~690,000 annual deaths. The serrated pathway is a primary cause of CRC in the proximal colon. Sessile serrated adenomas (SSA) have flat and subtle features that are difficult to detect with conventional white light colonoscopy. Aims: We aim to identify a peptide imaging agent that binds specifically to SSA to improve visualization of pre-malignant lesions in the proximal colon. Methods: We used phage display technology with subtractive biopanning against cells with a V600E point mutation in BRAF. We performed a first-in-humans clinical study by topically administering this FITC-labeled peptide in the proximal colon of n = 38 human subjects, and performed in vivo imaging using a wide-field endoscope that is sensitive to fluorescence. Results: We identified the peptide sequence KCCFPAQ, and measured an apparent dissociation constant of kd = 72 nM and an apparent association time constant of kd = 0.174 min-1 (5.76 min). On in vivo fluorescence images, we measured a 2.43-fold greater target-to-background ratio for SSA than for normal colonic mucosa, and could distinguish SSA with 89% sensitivity and 92% specificity. We found 84% sensitivity and 91% specificity for discriminating SSA from traditional adenomas. No toxicity was attributed to the peptide in either animal or patient studies. On ex vivo images, we found the mean fluorescence intensity for SSA to be significantly greater than that for hyperplastic polyps. Conclusions: We have identified a fluorescently-labeled peptide that is safe for clinical use, and is specific for detecting SSAs in the proximal colon with wide-field imaging. This targeted imaging methodology may be useful for early detection of pre-malignant serrated lesions on routine colonoscopy. Citation Format: Thomas D. Wang. Targeted imaging of the serrated pathway for early detection of colorectal cancer. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr IA10.
{"title":"Abstract IA10: Targeted imaging of the serrated pathway for early detection of colorectal cancer","authors":"Thomas D. Wang","doi":"10.1158/1538-7755.CARISK16-IA10","DOIUrl":"https://doi.org/10.1158/1538-7755.CARISK16-IA10","url":null,"abstract":"Background and Significance: Colorectal cancer (CRC) is a leading cause of cancer-related mortality with ~1.4 million new cases diagnosed globally and ~690,000 annual deaths. The serrated pathway is a primary cause of CRC in the proximal colon. Sessile serrated adenomas (SSA) have flat and subtle features that are difficult to detect with conventional white light colonoscopy. Aims: We aim to identify a peptide imaging agent that binds specifically to SSA to improve visualization of pre-malignant lesions in the proximal colon. Methods: We used phage display technology with subtractive biopanning against cells with a V600E point mutation in BRAF. We performed a first-in-humans clinical study by topically administering this FITC-labeled peptide in the proximal colon of n = 38 human subjects, and performed in vivo imaging using a wide-field endoscope that is sensitive to fluorescence. Results: We identified the peptide sequence KCCFPAQ, and measured an apparent dissociation constant of kd = 72 nM and an apparent association time constant of kd = 0.174 min-1 (5.76 min). On in vivo fluorescence images, we measured a 2.43-fold greater target-to-background ratio for SSA than for normal colonic mucosa, and could distinguish SSA with 89% sensitivity and 92% specificity. We found 84% sensitivity and 91% specificity for discriminating SSA from traditional adenomas. No toxicity was attributed to the peptide in either animal or patient studies. On ex vivo images, we found the mean fluorescence intensity for SSA to be significantly greater than that for hyperplastic polyps. Conclusions: We have identified a fluorescently-labeled peptide that is safe for clinical use, and is specific for detecting SSAs in the proximal colon with wide-field imaging. This targeted imaging methodology may be useful for early detection of pre-malignant serrated lesions on routine colonoscopy. Citation Format: Thomas D. Wang. Targeted imaging of the serrated pathway for early detection of colorectal cancer. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr IA10.","PeriodicalId":9487,"journal":{"name":"Cancer Epidemiology and Prevention Biomarkers","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78455842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1158/1538-7755.CARISK16-A03
Hidemi Ito, I. Oze, K. Matsuo
Advances in molecular genetics have the potential to impact cancer prevention. However, the contribution of this information to determining the risk of cancer of the stomach at the population level in combination with biological and lifestyle-related factors has not been evaluated. Here, we established a risk prediction model of gastric cancer using genetic, biological, and lifestyle-related risk factors as a potential practical application in interventions for cancer prevention. We conducted two independent age- and sex-matched case-control studies, the first for model derivation (697 cases and 1,372 controls) and the second (678 and 678) for external validation. Using the derivation study data, we developed a prediction model by fitting a conditional logistic regression model using the following predictors: age, ABCD classification defined by H.pylori infection and atrophic gastritis, smoking, fruit and vegetable intake, and selected GWAS-identified genotypes. Performance was assessed regarding discrimination (area under the curve, AUC), calibration (calibration plots and Hosmer-Lemeshow test) and reclassification (integrated discrimination improvement (IDI)). We preliminarily found that a combination of rs229400 , one of the GWAS-identified SNPs, H.Pylori infection, atrophic gastritis, smoking and fruit and vegetable intake provided high discriminatory accuracy and good calibration in both the derivation and validation studies, with AUCs of 0.78 (95% confidence intervals, 0.76-0.80) and 0.80 (0.77-0.82), respectively. The calibration plots of both studies stayed close to the ideal calibration line. IDI indices were 0.12 (p rs2294008 , and the other predictors. Citation Format: Hidemi Ito, Isao Oze, Keitaro Matsuo. Risk prediction for gastric cancer using the GWAS-identified SNPs, Helicobacter pylori infection and lifestyle-related risk factors in a Japanese population. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr A03.
{"title":"Abstract A03: Risk prediction for gastric cancer using the GWAS-identified SNPs, Helicobacter pylori infection and lifestyle-related risk factors in a Japanese population","authors":"Hidemi Ito, I. Oze, K. Matsuo","doi":"10.1158/1538-7755.CARISK16-A03","DOIUrl":"https://doi.org/10.1158/1538-7755.CARISK16-A03","url":null,"abstract":"Advances in molecular genetics have the potential to impact cancer prevention. However, the contribution of this information to determining the risk of cancer of the stomach at the population level in combination with biological and lifestyle-related factors has not been evaluated. Here, we established a risk prediction model of gastric cancer using genetic, biological, and lifestyle-related risk factors as a potential practical application in interventions for cancer prevention. We conducted two independent age- and sex-matched case-control studies, the first for model derivation (697 cases and 1,372 controls) and the second (678 and 678) for external validation. Using the derivation study data, we developed a prediction model by fitting a conditional logistic regression model using the following predictors: age, ABCD classification defined by H.pylori infection and atrophic gastritis, smoking, fruit and vegetable intake, and selected GWAS-identified genotypes. Performance was assessed regarding discrimination (area under the curve, AUC), calibration (calibration plots and Hosmer-Lemeshow test) and reclassification (integrated discrimination improvement (IDI)). We preliminarily found that a combination of rs229400 , one of the GWAS-identified SNPs, H.Pylori infection, atrophic gastritis, smoking and fruit and vegetable intake provided high discriminatory accuracy and good calibration in both the derivation and validation studies, with AUCs of 0.78 (95% confidence intervals, 0.76-0.80) and 0.80 (0.77-0.82), respectively. The calibration plots of both studies stayed close to the ideal calibration line. IDI indices were 0.12 (p rs2294008 , and the other predictors. Citation Format: Hidemi Ito, Isao Oze, Keitaro Matsuo. Risk prediction for gastric cancer using the GWAS-identified SNPs, Helicobacter pylori infection and lifestyle-related risk factors in a Japanese population. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr A03.","PeriodicalId":9487,"journal":{"name":"Cancer Epidemiology and Prevention Biomarkers","volume":"150 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86151327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1158/1538-7755.CARISK16-A01
H. In, Marisa Langdon-Embry, J. Wylie-Rosett, B. Rapkin
Background: Gastric adenocarcinoma is the fifth most common cancer and third leading cause of cancer mortality in the world. In the US, outcomes for gastric cancer are dismal with only 28% surviving to 5 years. Upper gastrointestinal endoscopy is the gold standard for early detection of gastric tumors and used in countries with high prevalence for mass screening. However, due to the low prevalence of gastric cancer in the general U.S. population, a national screening program is not cost effective. Tools to identify patients at higher risk of gastric cancer may help identify subpopulations that should be referred for opportunistic screening. Purpose: To characterize the questionnaire development of a comprehensive gastric cancer risk assessment survey instrument that will be used to collect primary data in a large-scale case-control study. This primary data will be used to create a predictive model and determine items that best discriminate between gastric cases and controls, to ultimately create a simple pre-screening instrument that can be used in pre-diagnostic settings to identify at-risk patients who should be referred for upper GI endoscopy. Procedures: Phase 1) comprehensive literature review to identify established risk factors for gastric cancer. Survey instruments that established individual risks for gastric cancer were brought together to create the initial questionnaire. Phase 2) questionnaire refinement through focus groups and cognitive interviews. Focus groups were used to examine the measure for wording, layout, clarity and relevance. The item pool was then translated into Mandarin Chinese, Spanish and Korean, and cognitive interviews were conducted to ensure the questionnaire carried semantic equivalence across languages. Interview notes were aggregated on a question-by-question basis to produce a cognitive interviewing outcome report to guide questionnaire revisions. Results: A 300-item questionnaire was adapted from 16 survey instruments previously validated for gastric cancer. Identified risk factors for gastric cancer included dietary habits, demographics, racial disparities, Helicobacter pylori exposure, smoking and alcohol habits, socioeconomic status and pre-existing conditions. Only risk factors that were not hereditary and could be determined in questionnaire format were included. 29 English-speaking participants with and without gastric completed survey questions and provided feedback in focus group discussions. Participants noted items that needed clarification or simplification, or were redundant or irrelevant. Special attention was given to complex measures such as dietary history and acculturation to ensure that questions about details of ethnicity and timing of immigration were sensitive, appropriate and non-threatening. 60 gastric cancer cases and controls participated in cognitive interviews to ensure the questionnaire carried semantic equivalence across languages. Participants included 40 first-generation immigr
背景:胃腺癌是世界上第五大常见癌症和第三大癌症死亡原因。在美国,胃癌的预后令人沮丧,只有28%的患者存活至5年。上消化道内窥镜检查是早期发现胃肿瘤的金标准,在流行率高的国家用于大规模筛查。然而,由于胃癌在美国普通人群中的患病率较低,因此全国性的筛查计划并不具有成本效益。识别高风险胃癌患者的工具可能有助于确定应该进行机会性筛查的亚群。目的:描述一种综合性胃癌风险评估调查工具的问卷开发过程,该工具将用于收集大规模病例对照研究的原始数据。这些原始数据将用于创建预测模型,并确定最能区分胃病例和对照组的项目,最终创建一个简单的预筛查工具,可用于预诊断设置,以识别应转诊进行上消化道内窥镜检查的高危患者。程序:第一阶段)综合文献综述,确定胃癌的危险因素。确定个人胃癌风险的调查工具被汇集在一起,形成了最初的调查问卷。阶段2)通过焦点小组和认知访谈改进问卷。焦点小组被用来检查措辞、布局、清晰度和相关性。然后将题库翻译成汉语、西班牙语和韩语,并进行认知访谈,以确保问卷在不同语言之间具有语义对等。访谈记录按问题汇总,形成一份认知访谈结果报告,以指导问卷的修订。结果:一份300项的调查问卷改编自16种以前验证过的胃癌调查工具。确定的胃癌风险因素包括饮食习惯、人口统计学、种族差异、幽门螺杆菌暴露、吸烟和饮酒习惯、社会经济地位和既往疾病。仅包括非遗传性且可以通过问卷形式确定的危险因素。29名有或没有胃的英语参与者完成了调查问题,并在焦点小组讨论中提供了反馈。与会者注意到需要澄清或简化,或多余或不相关的项目。特别注意诸如饮食历史和文化适应等复杂措施,以确保有关种族和移民时间细节的问题敏感、适当和不具威胁性。对60例胃癌患者和对照组进行认知访谈,以确保问卷在不同语言间语义对等。参与者包括40名来自亚洲、中美洲/南美洲、欧洲和非洲的第一代移民(每组约10人)和20名在美国出生说英语的人。修订包括语言/种族特定的措辞,以增加翻译之间的语义等效,示例,以提高理解,并改变说明,以提高一致使用的回应选项。在焦点小组和认知访谈过程中,问卷共经历了24次迭代,最终形成了一份227项的问卷。结论:已开发出一种有效、可理解、相关且符合民族要求的调查工具,可全面评估所有经验证的胃癌危险因素,并将在未来的病例对照研究中用于主要数据收集,旨在最终创建一种简单的预筛查工具,可用于胃癌的机会性筛查。引文格式:Haejin In, Marisa Langdon-Embry, Judith Wylie-Rosett, Bruce Rapkin。胃癌预筛查项目:制定综合性胃癌风险问卷。[摘要]。摘自:AACR特别会议论文集:改进癌症风险预测以预防和早期发现;2016年11月16日至19日;费城(PA): AACR;Cancer epidemiology Biomarkers pre2017;26(5增刊):摘要nr A01。
{"title":"Abstract A01: Gastric cancer pre-screener project: Development of a comprehensive gastric cancer risk questionnaire","authors":"H. In, Marisa Langdon-Embry, J. Wylie-Rosett, B. Rapkin","doi":"10.1158/1538-7755.CARISK16-A01","DOIUrl":"https://doi.org/10.1158/1538-7755.CARISK16-A01","url":null,"abstract":"Background: Gastric adenocarcinoma is the fifth most common cancer and third leading cause of cancer mortality in the world. In the US, outcomes for gastric cancer are dismal with only 28% surviving to 5 years. Upper gastrointestinal endoscopy is the gold standard for early detection of gastric tumors and used in countries with high prevalence for mass screening. However, due to the low prevalence of gastric cancer in the general U.S. population, a national screening program is not cost effective. Tools to identify patients at higher risk of gastric cancer may help identify subpopulations that should be referred for opportunistic screening. Purpose: To characterize the questionnaire development of a comprehensive gastric cancer risk assessment survey instrument that will be used to collect primary data in a large-scale case-control study. This primary data will be used to create a predictive model and determine items that best discriminate between gastric cases and controls, to ultimately create a simple pre-screening instrument that can be used in pre-diagnostic settings to identify at-risk patients who should be referred for upper GI endoscopy. Procedures: Phase 1) comprehensive literature review to identify established risk factors for gastric cancer. Survey instruments that established individual risks for gastric cancer were brought together to create the initial questionnaire. Phase 2) questionnaire refinement through focus groups and cognitive interviews. Focus groups were used to examine the measure for wording, layout, clarity and relevance. The item pool was then translated into Mandarin Chinese, Spanish and Korean, and cognitive interviews were conducted to ensure the questionnaire carried semantic equivalence across languages. Interview notes were aggregated on a question-by-question basis to produce a cognitive interviewing outcome report to guide questionnaire revisions. Results: A 300-item questionnaire was adapted from 16 survey instruments previously validated for gastric cancer. Identified risk factors for gastric cancer included dietary habits, demographics, racial disparities, Helicobacter pylori exposure, smoking and alcohol habits, socioeconomic status and pre-existing conditions. Only risk factors that were not hereditary and could be determined in questionnaire format were included. 29 English-speaking participants with and without gastric completed survey questions and provided feedback in focus group discussions. Participants noted items that needed clarification or simplification, or were redundant or irrelevant. Special attention was given to complex measures such as dietary history and acculturation to ensure that questions about details of ethnicity and timing of immigration were sensitive, appropriate and non-threatening. 60 gastric cancer cases and controls participated in cognitive interviews to ensure the questionnaire carried semantic equivalence across languages. Participants included 40 first-generation immigr","PeriodicalId":9487,"journal":{"name":"Cancer Epidemiology and Prevention Biomarkers","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80878017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1158/1538-7755.CARISK16-IA13
A. Douglas
Ovarian cancer has seen a modest improvement in five-year survival over the past three decades. It is well known that the lack of further success is solely due to the advanced stage at diagnosis for most women with ovarian cancers. To reduce the burden of ovarian cancer, we must decrease the incidence (primary prevention), improve early detection (secondary prevention), or develop more effective treatments for newly diagnosed disease (tertiary prevention). Large scale screening trials using traditional methods of imaging and tumor markers have not led to meaningfully stage migration, reduction in mortality, or widespread clinical adoption. In fact, the FDA recently issued a safety alert about the risks associated with the use of tests being marketed as ovarian cancer screening tests. The FDA was specifically concerned about ovarian cancer screening tests being used in lieu of established risk-reduction approaches. This presentation will review practical approaches to reducing the burden of ovarian cancer through primary, secondary, and tertiary prevention. Genetic testing of probands for BRCA1 and BRCA2 germline mutations alone and cascade testing of relatives are currently available approaches to reduce the incidence of ovarian cancer by more than 10%. This tactic is consistent with professional guidelines and has the added advantage of identifying therapeutic options for ovarian cancer patients that could contribute to tertiary prevention efforts today and in the future. Lower penetrant genes also have the potential to lead to primary prevention through risk reduction strategies, but further data is required to firmly establish appropriate age-based recommendations. The identification of the distal fallopian tube as a likely site of origin for most ovarian cancers has opened a new domain for ovarian cancer primary prevention. Some governmental organizations suggest population-based bilateral salpingectomy at the time of any pelvic or abdominal surgery for primary prevention of ovarian cancers considering that one-third of US women will have a hysterectomy by age 70. The reasons for success and failure of this approach will be discussed. The fallopian tube as the site of origin for ovarian cancers has led to new approaches for early detection. The anatomy of the fallopian tube and its proximity to the lower genital tract has led to the development of creative strategies for sampling derivatives of precursor lesions and early invasive disease. Collection of uterine fluid for proteomic analyses and DNA sequencing holds promise for enrichment of cancer-specific biomolecules. Cervical pap smears and the collection of vaginal secretions offer a less invasive approach to early detection through similar theoretical avenues. Through the study of long-term survivors of advanced stage high-grade serous ovarian cancer, we have learned that primary surgical cytoreduction reduces the risk of cancer recurrence and serves as a useful approach to tertiary preve
{"title":"Abstract IA13: A practical approach to reducing the burden of ovarian cancers","authors":"A. Douglas","doi":"10.1158/1538-7755.CARISK16-IA13","DOIUrl":"https://doi.org/10.1158/1538-7755.CARISK16-IA13","url":null,"abstract":"Ovarian cancer has seen a modest improvement in five-year survival over the past three decades. It is well known that the lack of further success is solely due to the advanced stage at diagnosis for most women with ovarian cancers. To reduce the burden of ovarian cancer, we must decrease the incidence (primary prevention), improve early detection (secondary prevention), or develop more effective treatments for newly diagnosed disease (tertiary prevention). Large scale screening trials using traditional methods of imaging and tumor markers have not led to meaningfully stage migration, reduction in mortality, or widespread clinical adoption. In fact, the FDA recently issued a safety alert about the risks associated with the use of tests being marketed as ovarian cancer screening tests. The FDA was specifically concerned about ovarian cancer screening tests being used in lieu of established risk-reduction approaches. This presentation will review practical approaches to reducing the burden of ovarian cancer through primary, secondary, and tertiary prevention. Genetic testing of probands for BRCA1 and BRCA2 germline mutations alone and cascade testing of relatives are currently available approaches to reduce the incidence of ovarian cancer by more than 10%. This tactic is consistent with professional guidelines and has the added advantage of identifying therapeutic options for ovarian cancer patients that could contribute to tertiary prevention efforts today and in the future. Lower penetrant genes also have the potential to lead to primary prevention through risk reduction strategies, but further data is required to firmly establish appropriate age-based recommendations. The identification of the distal fallopian tube as a likely site of origin for most ovarian cancers has opened a new domain for ovarian cancer primary prevention. Some governmental organizations suggest population-based bilateral salpingectomy at the time of any pelvic or abdominal surgery for primary prevention of ovarian cancers considering that one-third of US women will have a hysterectomy by age 70. The reasons for success and failure of this approach will be discussed. The fallopian tube as the site of origin for ovarian cancers has led to new approaches for early detection. The anatomy of the fallopian tube and its proximity to the lower genital tract has led to the development of creative strategies for sampling derivatives of precursor lesions and early invasive disease. Collection of uterine fluid for proteomic analyses and DNA sequencing holds promise for enrichment of cancer-specific biomolecules. Cervical pap smears and the collection of vaginal secretions offer a less invasive approach to early detection through similar theoretical avenues. Through the study of long-term survivors of advanced stage high-grade serous ovarian cancer, we have learned that primary surgical cytoreduction reduces the risk of cancer recurrence and serves as a useful approach to tertiary preve","PeriodicalId":9487,"journal":{"name":"Cancer Epidemiology and Prevention Biomarkers","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84297702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1158/1538-7755.CARISK16-PR16
Pianpian Cao, T. Caverly, R. Hayward, R. Meza
Background: Most low-dose computed tomography (LDCT) lung cancer screening guidelines recommend shared-decision making (SDM) before initiating screening. Indeed, Medicare requires evidence of SDM for reimbursement. The clinical benefit of screening, however, varies dramatically across eligible patients. Also, the harms of LDCT, such as fear and unnecessary procedures incurred by false positive results, can be quite substantive. Clinicians and health systems, therefore, need individually tailored screening guidance, depending on the extent of benefit. To this end, we developed the Personalized Lung Cancer Screening Model, a microsimulation model that estimates individual-specific health gain from LDCT screening. This model evaluates the potential effects of patient preferences on health gains across low- and high-benefit groups. Methods: We estimated the effects of LDCT screening on lung cancer outcomes and quality-adjusted life years (QALYs). Our natural history model was built based on previously validated lung cancer models, constructed by utilizing different data sources: two large randomized lung cancer screening trials (NLST and PLCO) and the Surveillance, Epidemiology and End-Results cancer registry. For this study, we simulated a nationally representative sample of 1 million patients eligible for LDCT screening, whose risk profiles mimic adult smokers participated in the National Health Interview Study (NHIS) from 2010 to 2014. We quantified patient preferences using literature-derived utilities (e.g., the burden of testing, false-positive diagnoses, treatment, and complications that result from the screening and treatment process). Besides inherent uncertainty in some utility measures, our primary aim was to understand the effect of varying patient preferences on the net benefit of screening. Therefore, we performed a further analysis by varying utilities over a plausible range. Results: Our model predictions of lung cancer incidence and mortality rates in the NLST and PLCO participants matched well to the observed rates. Similarly, average incremental QALY gains were consistent with that found in a previous NLST-based cost-effectiveness analysis. Among the simulated NHIS population, incremental QALY gains varied significantly across differing baseline risk of developing lung cancer (range in base-case analysis: 2 QALYs lost per 100 people screened to 6 QALYs gained per 100 screened). Our analysis for patient preferences showed that the magnitude of net benefit from LDCT screening is not very sensitive to patient9s views of the burdens and harms of testing and treatment if the patient9s baseline lung cancer risk was above the third decile. That is, even assuming unfavorable preferences, those above 3rd decile of risk generally experienced net benefit, while the less than 3rd decile of baseline risk was a more preferences sensitive zone. Conclusion: Results from our Personalized Lung Cancer Screening Model demonstrate the importance of an
背景:大多数低剂量计算机断层扫描(LDCT)肺癌筛查指南建议在开始筛查之前进行共同决策(SDM)。事实上,医疗保险需要SDM的证据来报销。然而,筛查的临床益处在符合条件的患者之间差异很大。此外,LDCT的危害,如假阳性结果引起的恐惧和不必要的程序,可能是相当实质性的。因此,临床医生和卫生系统需要根据获益程度量身定制筛查指导。为此,我们开发了个性化肺癌筛查模型,这是一个微观模拟模型,可以估计LDCT筛查对个体特定健康的益处。该模型评估了患者偏好对低收益和高收益群体健康收益的潜在影响。方法:我们估计了LDCT筛查对肺癌结局和质量调整生命年(QALYs)的影响。我们的自然历史模型是基于先前验证的肺癌模型构建的,该模型利用不同的数据源构建:两个大型随机肺癌筛查试验(NLST和PLCO)以及监测、流行病学和最终结果癌症登记处。在这项研究中,我们模拟了一个具有全国代表性的样本,包括100万名符合LDCT筛查条件的患者,他们的风险概况与2010年至2014年参加国家健康访谈研究(NHIS)的成年吸烟者相似。我们使用文献衍生的实用工具(例如,检测负担、假阳性诊断、治疗以及筛查和治疗过程导致的并发症)量化了患者的偏好。除了某些效用测量的固有不确定性外,我们的主要目的是了解不同患者偏好对筛查净收益的影响。因此,我们通过在一个合理的范围内改变效用来执行进一步的分析。结果:我们的模型对NLST和PLCO参与者的肺癌发病率和死亡率的预测与观察到的发病率非常吻合。同样,平均增量QALY收益与先前基于nlst的成本效益分析结果一致。在模拟的NHIS人群中,不同基线肺癌发生风险的QALY增量增加差异显著(基本病例分析范围:每100名筛查者中有2名QALY减少,每100名筛查者中有6名QALY增加)。我们对患者偏好的分析表明,如果患者的基线肺癌风险高于第三个十分位数,LDCT筛查的净收益大小对患者对检测和治疗的负担和危害的看法并不十分敏感。也就是说,即使假设不利的偏好,那些高于风险的第三十分位数的人通常会获得净收益,而低于基线风险的第三十分位数的人则是一个更偏好敏感的区域。结论:我们的个性化肺癌筛查模型的结果证明了个人估计的基线肺癌风险在确定LDCT筛查的净收益方面的重要性。此外,我们发现患者偏好在确定净获益程度方面起着重要作用。这些发现支持通过共同决策使用决策支持工具,而不是建议统一筛查。此摘要也以PosterB19的形式呈现。引文格式:pian Cao, Tanner Caverly, Rodney Hayward, Rafael Meza。癌症风险和患者偏好对肺癌筛查净收益的影响:一个个性化的肺癌筛查模型。[摘要]。摘自:AACR特别会议论文集:改进癌症风险预测以预防和早期发现;2016年11月16日至19日;费城(PA): AACR;癌症流行病学生物标志物pre2017;26(5增刊):摘要nr PR16。
{"title":"Abstract PR16: Effect of cancer risk and patient preferences on net benefit of lung cancer screening: A personalized lung cancer screening model","authors":"Pianpian Cao, T. Caverly, R. Hayward, R. Meza","doi":"10.1158/1538-7755.CARISK16-PR16","DOIUrl":"https://doi.org/10.1158/1538-7755.CARISK16-PR16","url":null,"abstract":"Background: Most low-dose computed tomography (LDCT) lung cancer screening guidelines recommend shared-decision making (SDM) before initiating screening. Indeed, Medicare requires evidence of SDM for reimbursement. The clinical benefit of screening, however, varies dramatically across eligible patients. Also, the harms of LDCT, such as fear and unnecessary procedures incurred by false positive results, can be quite substantive. Clinicians and health systems, therefore, need individually tailored screening guidance, depending on the extent of benefit. To this end, we developed the Personalized Lung Cancer Screening Model, a microsimulation model that estimates individual-specific health gain from LDCT screening. This model evaluates the potential effects of patient preferences on health gains across low- and high-benefit groups. Methods: We estimated the effects of LDCT screening on lung cancer outcomes and quality-adjusted life years (QALYs). Our natural history model was built based on previously validated lung cancer models, constructed by utilizing different data sources: two large randomized lung cancer screening trials (NLST and PLCO) and the Surveillance, Epidemiology and End-Results cancer registry. For this study, we simulated a nationally representative sample of 1 million patients eligible for LDCT screening, whose risk profiles mimic adult smokers participated in the National Health Interview Study (NHIS) from 2010 to 2014. We quantified patient preferences using literature-derived utilities (e.g., the burden of testing, false-positive diagnoses, treatment, and complications that result from the screening and treatment process). Besides inherent uncertainty in some utility measures, our primary aim was to understand the effect of varying patient preferences on the net benefit of screening. Therefore, we performed a further analysis by varying utilities over a plausible range. Results: Our model predictions of lung cancer incidence and mortality rates in the NLST and PLCO participants matched well to the observed rates. Similarly, average incremental QALY gains were consistent with that found in a previous NLST-based cost-effectiveness analysis. Among the simulated NHIS population, incremental QALY gains varied significantly across differing baseline risk of developing lung cancer (range in base-case analysis: 2 QALYs lost per 100 people screened to 6 QALYs gained per 100 screened). Our analysis for patient preferences showed that the magnitude of net benefit from LDCT screening is not very sensitive to patient9s views of the burdens and harms of testing and treatment if the patient9s baseline lung cancer risk was above the third decile. That is, even assuming unfavorable preferences, those above 3rd decile of risk generally experienced net benefit, while the less than 3rd decile of baseline risk was a more preferences sensitive zone. Conclusion: Results from our Personalized Lung Cancer Screening Model demonstrate the importance of an ","PeriodicalId":9487,"journal":{"name":"Cancer Epidemiology and Prevention Biomarkers","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90447364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1158/1538-7755.CARISK16-B18
C. Snyder, S. Haag, Nickie L. Adams, J. Hess, Breann Paskett, E. Borazanci
Introduction: It is estimated that by 2030 pancreatic cancer will be the second leading cause of cancer deaths in the US. Currently, only 9% of newly diagnosed pancreatic cancer is localized and 5-year survival is 7%. Due to most pancreatic cancers (PC) presenting at a later stage with poor overall survival, early detection methods must be implemented to improve treatment outcomes. Yet, effective early screening guidelines do not exist for pancreatic cancer. Our Early Detection Program (EDP) provides personalized early detection including risk assessment, screening, and genetic testing. We aim to evaluate risk assessment criteria, establish a database to delineate a pattern of characteristics, and utilize a biospecimen repository and molecular based technologies to map novel biomarkers for early detection. Methods: This is a prospective study for individuals with a family history or a germline mutation consistent with risk for developing PC. Patients are eligible based on risk assessment criteria and stratified into 3 groups as defined by best available evidence based upon the CAPS Consortium and a prior prospective screening study. Patients are assessed at initial visit, have yearly screenings, and each case is discussed at a multi-disciplinary pancreatic tumor board. At the initial visit, patients undergo a thorough history and physical exam, genetic testing for germline mutations, routine blood tests along with Ca19-9 tumor marker and if indicated, MRI/MRCP abdomen, GI consult and EUS. Patients defined as average risk have one family member diagnosed with PC above the age of 55 years. Those at moderate risk are individuals with two or more first, second, third degree relatives with PC or one first degree relative with PC diagnosed Results: Since the inception of the EDP (IRB approved November 2015), there have been no PC cases identified. Current participants include individuals age 34 to 79 with a mean age of 59. According to the current risk criteria 22% have a low PC risk, 26% have a moderate risk, and 52% have a high PC risk. All were advised a genetic assessment. Of the current sample, 36% were male and 64% were female, 55% used tobacco in the past, and 9% currently use tobacco. The BMI average is 26.85 (overweight), 2 participants have Type 2 diabetes, and several have had other types of cancer such as: 5% breast, 2% colon, 2% ovarian, 1% thyroid, and 38% had basal cell skin cancer. 26% had germline mutations and 10% with intraductal papillary mucinous neoplasm (IPMN). Initial results reveal there is a level of anxiety associated with PC risk and some indicate their chance to develop cancer is high (M = 5.05, SD = 1.80). Compared to other people, participants stated their chance of getting cancer sometime in their life is a little higher (M = 4.10, SD = .85), and their ability to exercise control over their cancer risk was moderate (M = 2.6, SD .93). Conclusions: Although the EDP is still recruiting patients, the effectiveness of our scr
{"title":"Abstract B18: Improving pancreatic cancer risk prediction through early detection","authors":"C. Snyder, S. Haag, Nickie L. Adams, J. Hess, Breann Paskett, E. Borazanci","doi":"10.1158/1538-7755.CARISK16-B18","DOIUrl":"https://doi.org/10.1158/1538-7755.CARISK16-B18","url":null,"abstract":"Introduction: It is estimated that by 2030 pancreatic cancer will be the second leading cause of cancer deaths in the US. Currently, only 9% of newly diagnosed pancreatic cancer is localized and 5-year survival is 7%. Due to most pancreatic cancers (PC) presenting at a later stage with poor overall survival, early detection methods must be implemented to improve treatment outcomes. Yet, effective early screening guidelines do not exist for pancreatic cancer. Our Early Detection Program (EDP) provides personalized early detection including risk assessment, screening, and genetic testing. We aim to evaluate risk assessment criteria, establish a database to delineate a pattern of characteristics, and utilize a biospecimen repository and molecular based technologies to map novel biomarkers for early detection. Methods: This is a prospective study for individuals with a family history or a germline mutation consistent with risk for developing PC. Patients are eligible based on risk assessment criteria and stratified into 3 groups as defined by best available evidence based upon the CAPS Consortium and a prior prospective screening study. Patients are assessed at initial visit, have yearly screenings, and each case is discussed at a multi-disciplinary pancreatic tumor board. At the initial visit, patients undergo a thorough history and physical exam, genetic testing for germline mutations, routine blood tests along with Ca19-9 tumor marker and if indicated, MRI/MRCP abdomen, GI consult and EUS. Patients defined as average risk have one family member diagnosed with PC above the age of 55 years. Those at moderate risk are individuals with two or more first, second, third degree relatives with PC or one first degree relative with PC diagnosed Results: Since the inception of the EDP (IRB approved November 2015), there have been no PC cases identified. Current participants include individuals age 34 to 79 with a mean age of 59. According to the current risk criteria 22% have a low PC risk, 26% have a moderate risk, and 52% have a high PC risk. All were advised a genetic assessment. Of the current sample, 36% were male and 64% were female, 55% used tobacco in the past, and 9% currently use tobacco. The BMI average is 26.85 (overweight), 2 participants have Type 2 diabetes, and several have had other types of cancer such as: 5% breast, 2% colon, 2% ovarian, 1% thyroid, and 38% had basal cell skin cancer. 26% had germline mutations and 10% with intraductal papillary mucinous neoplasm (IPMN). Initial results reveal there is a level of anxiety associated with PC risk and some indicate their chance to develop cancer is high (M = 5.05, SD = 1.80). Compared to other people, participants stated their chance of getting cancer sometime in their life is a little higher (M = 4.10, SD = .85), and their ability to exercise control over their cancer risk was moderate (M = 2.6, SD .93). Conclusions: Although the EDP is still recruiting patients, the effectiveness of our scr","PeriodicalId":9487,"journal":{"name":"Cancer Epidemiology and Prevention Biomarkers","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73150840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1158/1538-7755.CARISK16-PR17
Jihyoun Jeon, S. Berndt, H. Brenner, P. Campbell, A. Chan, J. Chang-Claude, Mengmeng Du, G. Giles, Jian Gong, S. Gruber, T. Harrison, M. Hoffmeister, L. LeMarchand, Li Li, J. Potter, G. Rennert, R. Schoen, M. Slattery, E. White, M. Woods, U. Peters, L. Hsu
Background and Aims: Colorectal cancer (CRC) is one of the most preventable and treatable cancers when detected early via screening. The current screening guidelines for CRC recommend exams only based on age, family history, and previous screening results. Multiple environmental and lifestyle risk factors, however, have been established or suspected for CRC, as have many common genetic susceptibility loci. It is critical to utilize this information to better stratify individuals into low- and high-risk groups for optimized and personalized screening and intervention recommendations. Methods: Using data from two large consortia (8421 CRC cases and 9767 controls): the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO) and the Colorectal Transdisciplinary study (CORECT), we developed risk prediction models for men and women based on family history, environmental and lifestyle risk factors, and known CRC susceptibility loci identified through genome-wide association studies. We constructed an environmental risk score (E-score) as a weighted sum of 19 established or potential environmental and lifestyle risk factors for CRC with weights obtained from a multivariate logistic regression analysis. Similarly, we also constructed a genetic risk score (G-score) using 64 common variants associated with CRC risk. We evaluated the discriminatory accuracy of risk prediction models by calculating the area under the Receiver Operating Characteristic curve (AUC), correcting for potential overestimating by using the training data set. Our models also estimate absolute risk of developing CRC given various risk profiles, and provide recommended ages for the first endoscopic screening exam. Results: Both the E-score and the G-score are independent predictors of CRC risk, and models that incorporate both scores improve the discriminatory accuracy significantly compared to family history-only models. Compared to the model that includes only family history, the E-score significantly improves the discriminatory accuracy for both men (AUC = 0.62 vs. 0.53, p-value Conclusions: Our risk prediction models incorporating both comprehensive environmental and lifestyle risk factors, and known CRC common genetic variants provide more accurate estimation of CRC risk. These models will be useful for recommending individually tailored screening and intervention strategies to prevent this common cancer. This abstract is also being presented as Poster B17. Citation Format: Jihyoun Jeon, Sonja I. Berndt, Hermann Brenner, Peter T. Campbell, Andrew T. Chan, Jenny Chang-Claude, Mengmeng Du, Graham Giles, Jian Gong, Stephen B. Gruber, Tabitha A. Harrison, Michael Hoffmeister, Loic LeMarchand, Li Li, John D. Potter, Gad Rennert, Robert E. Schoen, Martha L. Slattery, Emily White, Michael O. Woods, Ulrike Peters, Li Hsu. Comprehensive colorectal cancer risk prediction to inform personalized screening and intervention. [abstract]. In: Proceedings of the AACR Special Conference: I
背景与目的:通过筛查早期发现结直肠癌(CRC)是最容易预防和治疗的癌症之一。目前的CRC筛查指南建议仅根据年龄、家族史和以前的筛查结果进行检查。然而,多种环境和生活方式风险因素已被确定或怀疑为结直肠癌的风险因素,以及许多常见的遗传易感位点。利用这些信息更好地将个体划分为低危组和高危组,以优化和个性化筛查和干预建议是至关重要的。方法:使用来自两个大型联盟(8421例结直肠癌病例和9767例对照)的数据:结直肠癌遗传与流行病学联盟(GECCO)和结直肠癌跨学科研究(correct),我们基于家族史、环境和生活方式风险因素以及通过全基因组关联研究确定的已知结直肠癌易感位点,建立了男性和女性的风险预测模型。我们构建了一个环境风险评分(E-score),作为19个已知或潜在的结直肠癌环境和生活方式风险因素的加权和,其权重来自多变量logistic回归分析。同样,我们还使用64种与结直肠癌风险相关的常见变异构建了遗传风险评分(G-score)。我们通过计算接收者工作特征曲线(AUC)下的面积来评估风险预测模型的区分准确性,并使用训练数据集纠正潜在的高估。我们的模型还估计了在各种风险情况下发生CRC的绝对风险,并提供了首次内镜筛查检查的推荐年龄。结果:E-score和G-score都是结直肠癌风险的独立预测因子,与仅包含家族史的模型相比,包含这两种评分的模型显著提高了区分准确性。与仅包含家族史的模型相比,E-score显著提高了两种男性的区分准确性(AUC = 0.62 vs. 0.53, p值)。结论:我们的风险预测模型结合了综合环境和生活方式风险因素,以及已知的CRC常见遗传变异,可以更准确地估计CRC风险。这些模型将有助于推荐个体化筛查和干预策略,以预防这种常见癌症。此摘要也以海报B17的形式呈现。引文格式:Jihyoun Jeon, Sonja I. Berndt, Hermann Brenner, Peter T. Campbell, Andrew T. Chan, Jenny Chang-Claude, Du Mengmeng, Graham Giles, Jian Gong, Stephen B. Gruber, Tabitha . Harrison, Michael Hoffmeister, Loic LeMarchand, Li Li, John D. Potter, Gad Rennert, Robert E. Schoen, Martha L. Slattery, Emily White, Michael O. Woods, Ulrike Peters, Li Hsu。综合结肠直肠癌风险预测为个性化筛查和干预提供信息。[摘要]。摘自:AACR特别会议论文集:改进癌症风险预测以预防和早期发现;2016年11月16日至19日;费城(PA): AACR;Cancer epidemiology Biomarkers pre2017;26(5增刊):摘要nr PR17。
{"title":"Abstract PR17: Comprehensive colorectal cancer risk prediction to inform personalized screening and intervention","authors":"Jihyoun Jeon, S. Berndt, H. Brenner, P. Campbell, A. Chan, J. Chang-Claude, Mengmeng Du, G. Giles, Jian Gong, S. Gruber, T. Harrison, M. Hoffmeister, L. LeMarchand, Li Li, J. Potter, G. Rennert, R. Schoen, M. Slattery, E. White, M. Woods, U. Peters, L. Hsu","doi":"10.1158/1538-7755.CARISK16-PR17","DOIUrl":"https://doi.org/10.1158/1538-7755.CARISK16-PR17","url":null,"abstract":"Background and Aims: Colorectal cancer (CRC) is one of the most preventable and treatable cancers when detected early via screening. The current screening guidelines for CRC recommend exams only based on age, family history, and previous screening results. Multiple environmental and lifestyle risk factors, however, have been established or suspected for CRC, as have many common genetic susceptibility loci. It is critical to utilize this information to better stratify individuals into low- and high-risk groups for optimized and personalized screening and intervention recommendations. Methods: Using data from two large consortia (8421 CRC cases and 9767 controls): the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO) and the Colorectal Transdisciplinary study (CORECT), we developed risk prediction models for men and women based on family history, environmental and lifestyle risk factors, and known CRC susceptibility loci identified through genome-wide association studies. We constructed an environmental risk score (E-score) as a weighted sum of 19 established or potential environmental and lifestyle risk factors for CRC with weights obtained from a multivariate logistic regression analysis. Similarly, we also constructed a genetic risk score (G-score) using 64 common variants associated with CRC risk. We evaluated the discriminatory accuracy of risk prediction models by calculating the area under the Receiver Operating Characteristic curve (AUC), correcting for potential overestimating by using the training data set. Our models also estimate absolute risk of developing CRC given various risk profiles, and provide recommended ages for the first endoscopic screening exam. Results: Both the E-score and the G-score are independent predictors of CRC risk, and models that incorporate both scores improve the discriminatory accuracy significantly compared to family history-only models. Compared to the model that includes only family history, the E-score significantly improves the discriminatory accuracy for both men (AUC = 0.62 vs. 0.53, p-value Conclusions: Our risk prediction models incorporating both comprehensive environmental and lifestyle risk factors, and known CRC common genetic variants provide more accurate estimation of CRC risk. These models will be useful for recommending individually tailored screening and intervention strategies to prevent this common cancer. This abstract is also being presented as Poster B17. Citation Format: Jihyoun Jeon, Sonja I. Berndt, Hermann Brenner, Peter T. Campbell, Andrew T. Chan, Jenny Chang-Claude, Mengmeng Du, Graham Giles, Jian Gong, Stephen B. Gruber, Tabitha A. Harrison, Michael Hoffmeister, Loic LeMarchand, Li Li, John D. Potter, Gad Rennert, Robert E. Schoen, Martha L. Slattery, Emily White, Michael O. Woods, Ulrike Peters, Li Hsu. Comprehensive colorectal cancer risk prediction to inform personalized screening and intervention. [abstract]. In: Proceedings of the AACR Special Conference: I","PeriodicalId":9487,"journal":{"name":"Cancer Epidemiology and Prevention Biomarkers","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80916022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1158/1538-7755.CARISK16-B13
Jian-Yi Xu, J. Vena, H. Whelan, P. Robson
Background: The World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) published specific recommendations on food and nutrition, physical activity, body composition, and other modifiable risk factors in 2007 with the aim of reducing risk for cancer. However, inconsistent results have been reported regarding the impact of following these recommendations on cancer incidence and cancer mortality. Further, the impact of adhering to cancer-specific recommendations issued by WCRF/AICR has not been evaluated in a Canadian population. Objective: The objective of this study was to estimate the association between adherence to cancer-specific prevention recommendations and subsequent cancer risk in a prospective Canadian cohort; Alberta9s Tomorrow Project (ATP). Design: ATP is a large population-based cohort of 55,000 adults who will be followed for up to 50 years to study the etiology of cancer and chronic disease, providing information that will help establish targeted prevention strategies. In the present study, 25,100 adult Albertans (35-69 years) with no previous diagnosis of cancer were recruited into ATP from 2001 to 2009 by random digit dialing. Self-administered questionnaires (Health and Lifestyle Questionnaire, Canadian Diet History Questionnaire (past year food frequency questionnaire), and Past Year Total Physical Activity Questionnaire) were used to collect participants9 health and lifestyle information. A composite score was constructed to reflect each participant9s overall adherence to seven WCRF/AICR personal recommendations, including body fatness, physical activity, consumption of fruits and vegetables, consumption of red meat, alcoholic drinks, dietary supplements intake, and tobacco exposure (including second hand smoke). Incidence cancer cases (excluding non-melanoma skin cancer) were identified through linkage with the Alberta Cancer Registry in 2015. Multivariable Cox proportional hazard regression models were employed to assess the association (HRs and 95% CIs) between the adherence composite score and risk of developing cancer. Results: Over a median of 10.0 years (252,120 person-years) follow-up, 1,709 participants developed cancer. After adjustment for potential confounding covariates, participants who were most adherent to WCRF/AICR recommendations (composite score: 4-7) were 19% (HR 0.81, 95% CI: 0.71-0.91) less likely to develop cancer when compared to those who were least adherent to the same recommendations (composite score: 0-2). Each unit increase in the composite score corresponded to an 8% (HR 0.92, 95% CI: 0.88-0.96) reduction in risk of developing cancer. When stratified by sex, the associations remained significant for women, but not for men. Conclusions: Adherence to cancer-specific prevention recommendations may reduce the risk of developing cancer. The adherence composite score constructed in this study may serve as a surrogate lifestyle indictor for predicting those at high risk o
背景:世界癌症研究基金会(WCRF)和美国癌症研究所(AICR)在2007年发表了关于食物和营养、身体活动、身体成分和其他可改变的风险因素的具体建议,旨在降低癌症风险。然而,关于遵循这些建议对癌症发病率和癌症死亡率的影响,报告的结果不一致。此外,遵守WCRF/AICR发布的癌症特异性建议的影响尚未在加拿大人群中进行评估。目的:本研究的目的是评估加拿大前瞻性队列中遵守癌症特异性预防建议与随后癌症风险之间的关系;阿尔伯塔明天计划(ATP)。设计:ATP是一个以人群为基础的大型队列,将对55,000名成年人进行长达50年的随访,以研究癌症和慢性疾病的病因,提供有助于建立有针对性的预防策略的信息。在本研究中,从2001年到2009年,通过随机数字拨号,25,100名以前没有癌症诊断的成年阿尔伯塔人(35-69岁)被招募到ATP。采用自填问卷(健康与生活方式问卷、加拿大饮食史问卷(过去一年食物频率问卷)和过去一年总体力活动问卷)收集参与者的健康和生活方式信息。构建了一个综合评分,以反映每个参与者对七项WCRF/AICR个人建议的总体依从性,包括身体脂肪、身体活动、水果和蔬菜的消费、红肉的消费、酒精饮料、膳食补充剂的摄入和烟草暴露(包括二手烟)。2015年,通过与阿尔伯塔省癌症登记处的联系,确定了癌症病例(不包括非黑色素瘤皮肤癌)的发病率。采用多变量Cox比例风险回归模型评估依从性综合评分与癌症发生风险之间的相关性(hr和95% ci)。结果:在中位10.0年(252120人年)的随访中,1709名参与者患上了癌症。在调整了潜在的混杂协变量后,与那些最不遵守相同建议的参与者(综合评分:0-2)相比,最遵守WCRF/AICR建议的参与者(综合评分:4-7)患癌症的可能性要低19% (HR 0.81, 95% CI: 0.71-0.91)。综合评分每增加一个单位,患癌症的风险就降低8% (HR 0.92, 95% CI: 0.88-0.96)。当按性别分层时,这种联系在女性中仍然很明显,但在男性中却没有。结论:坚持针对癌症的预防建议可以降低患癌症的风险。本研究构建的依从性综合评分可作为预测癌症高危人群的替代生活方式指标。未来的工作应侧重于评估总体风险降低的每个组成部分在总分中的贡献。披露:本研究得到了阿尔伯塔癌症基金会、阿尔伯塔癌症预防遗产基金和加拿大抗癌伙伴关系的支持。引用格式:徐建义,Jennifer E Vena, Heather K Whelan, Paula J Robson。加拿大阿尔伯塔省阿尔伯塔明天项目的参与者坚持癌症预防建议可降低癌症风险。[摘要]。摘自:AACR特别会议论文集:改进癌症风险预测以预防和早期发现;2016年11月16日至19日;费城(PA): AACR;Cancer epidemiology Biomarkers pre2017;26(5增刊):摘要nr B13。
{"title":"Abstract B13: Adherence to cancer-specific prevention recommendations reduces risk of cancer in participants in Alberta's Tomorrow Project, Alberta, Canada","authors":"Jian-Yi Xu, J. Vena, H. Whelan, P. Robson","doi":"10.1158/1538-7755.CARISK16-B13","DOIUrl":"https://doi.org/10.1158/1538-7755.CARISK16-B13","url":null,"abstract":"Background: The World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) published specific recommendations on food and nutrition, physical activity, body composition, and other modifiable risk factors in 2007 with the aim of reducing risk for cancer. However, inconsistent results have been reported regarding the impact of following these recommendations on cancer incidence and cancer mortality. Further, the impact of adhering to cancer-specific recommendations issued by WCRF/AICR has not been evaluated in a Canadian population. Objective: The objective of this study was to estimate the association between adherence to cancer-specific prevention recommendations and subsequent cancer risk in a prospective Canadian cohort; Alberta9s Tomorrow Project (ATP). Design: ATP is a large population-based cohort of 55,000 adults who will be followed for up to 50 years to study the etiology of cancer and chronic disease, providing information that will help establish targeted prevention strategies. In the present study, 25,100 adult Albertans (35-69 years) with no previous diagnosis of cancer were recruited into ATP from 2001 to 2009 by random digit dialing. Self-administered questionnaires (Health and Lifestyle Questionnaire, Canadian Diet History Questionnaire (past year food frequency questionnaire), and Past Year Total Physical Activity Questionnaire) were used to collect participants9 health and lifestyle information. A composite score was constructed to reflect each participant9s overall adherence to seven WCRF/AICR personal recommendations, including body fatness, physical activity, consumption of fruits and vegetables, consumption of red meat, alcoholic drinks, dietary supplements intake, and tobacco exposure (including second hand smoke). Incidence cancer cases (excluding non-melanoma skin cancer) were identified through linkage with the Alberta Cancer Registry in 2015. Multivariable Cox proportional hazard regression models were employed to assess the association (HRs and 95% CIs) between the adherence composite score and risk of developing cancer. Results: Over a median of 10.0 years (252,120 person-years) follow-up, 1,709 participants developed cancer. After adjustment for potential confounding covariates, participants who were most adherent to WCRF/AICR recommendations (composite score: 4-7) were 19% (HR 0.81, 95% CI: 0.71-0.91) less likely to develop cancer when compared to those who were least adherent to the same recommendations (composite score: 0-2). Each unit increase in the composite score corresponded to an 8% (HR 0.92, 95% CI: 0.88-0.96) reduction in risk of developing cancer. When stratified by sex, the associations remained significant for women, but not for men. Conclusions: Adherence to cancer-specific prevention recommendations may reduce the risk of developing cancer. The adherence composite score constructed in this study may serve as a surrogate lifestyle indictor for predicting those at high risk o","PeriodicalId":9487,"journal":{"name":"Cancer Epidemiology and Prevention Biomarkers","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80926368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1158/1538-7755.CARISK16-PR06
Theodore Huang, D. Braun, M. Gorfine, G. Parmigiani
There are numerous statistical models used to identify individuals at high risk of cancer due to inherited mutations. We focus on models using Mendelian laws of inheritance to calculate the probability that a counselee is a mutation carrier and their future risk of cancer based on family history and known mutation prevalence and penetrance (the probability of having a disease at a certain age given the person9s genotype). Mendelian risk prediction models for various cancers have previously been developed. These models include BRCAPRO, which identifies individuals at high risk for breast or ovarian cancer by calculating the probabilities of germline deleterious mutations in BRCA1 and BRCA2. These models do not account for the heterogeneity of risk across families due to sources such as environmental or unobserved genetic risk factors. We aim to improve breast cancer risk prediction in the BRCAPRO model by incorporating a frailty model that contains a family-specific variate to account for this heterogeneity. We apply our proposed model to data from the Cancer Genetics Network, and preliminary results show that model calibration (measured by the ratio of observed to expected number of events) improves, while discrimination (measured by the area under the receiver operating characteristic (ROC) curve) remains the same. This abstract is also being presented as Poster A18. Citation Format: Theodore Huang, Danielle Braun, Malka Gorfine, Giovanni Parmigiani. Using frailty models to improve familial cancer risk prediction. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr PR06.
有许多统计模型用于识别由于遗传突变而具有癌症高风险的个体。我们将重点放在使用孟德尔遗传定律的模型上,根据家族史和已知的突变流行率和外显率(给定个人基因型的特定年龄患病的概率),计算咨询师是突变携带者的概率以及他们未来患癌症的风险。孟德尔癌症风险预测模型已经被开发出来。这些模型包括BRCAPRO,它通过计算BRCA1和BRCA2种系有害突变的概率来识别乳腺癌或卵巢癌的高风险个体。这些模型没有考虑到由于环境或未观察到的遗传风险因素等来源而导致的家庭间风险的异质性。我们的目标是通过纳入包含家族特异性变量的脆弱性模型来解释这种异质性,从而改善BRCAPRO模型中的乳腺癌风险预测。我们将我们提出的模型应用于来自癌症遗传网络的数据,初步结果表明,模型校准(通过观察到的事件数与预期事件数的比率来衡量)得到改善,而判别(通过受试者工作特征(ROC)曲线下的面积来衡量)保持不变。此摘要也以海报A18的形式呈现。引用格式:Theodore Huang, Danielle Braun, Malka Gorfine, Giovanni Parmigiani。利用脆弱性模型改进家族性癌症风险预测。[摘要]。摘自:AACR特别会议论文集:改进癌症风险预测以预防和早期发现;2016年11月16日至19日;费城(PA): AACR;癌症流行病学生物标志物pre2017;26(5增刊):摘要nr PR06。
{"title":"Abstract PR06: Using frailty models to improve familial cancer risk prediction","authors":"Theodore Huang, D. Braun, M. Gorfine, G. Parmigiani","doi":"10.1158/1538-7755.CARISK16-PR06","DOIUrl":"https://doi.org/10.1158/1538-7755.CARISK16-PR06","url":null,"abstract":"There are numerous statistical models used to identify individuals at high risk of cancer due to inherited mutations. We focus on models using Mendelian laws of inheritance to calculate the probability that a counselee is a mutation carrier and their future risk of cancer based on family history and known mutation prevalence and penetrance (the probability of having a disease at a certain age given the person9s genotype). Mendelian risk prediction models for various cancers have previously been developed. These models include BRCAPRO, which identifies individuals at high risk for breast or ovarian cancer by calculating the probabilities of germline deleterious mutations in BRCA1 and BRCA2. These models do not account for the heterogeneity of risk across families due to sources such as environmental or unobserved genetic risk factors. We aim to improve breast cancer risk prediction in the BRCAPRO model by incorporating a frailty model that contains a family-specific variate to account for this heterogeneity. We apply our proposed model to data from the Cancer Genetics Network, and preliminary results show that model calibration (measured by the ratio of observed to expected number of events) improves, while discrimination (measured by the area under the receiver operating characteristic (ROC) curve) remains the same. This abstract is also being presented as Poster A18. Citation Format: Theodore Huang, Danielle Braun, Malka Gorfine, Giovanni Parmigiani. Using frailty models to improve familial cancer risk prediction. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr PR06.","PeriodicalId":9487,"journal":{"name":"Cancer Epidemiology and Prevention Biomarkers","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87038849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1158/1538-7755.CARISK16-PR03
G. Kleinstern, Dennis P. Robinson, T. Call, M. Liebow, S. Sanjosé, Y. Benavente, J. Cerhan, S. Slager
Background: Chronic lymphocytic leukemia (CLL) is a lymphoid malignancy with a strong genetic component. There are over 30 common single nucleotide polymorphisms (SNPs) associated with the risk of CLL. Moreover, in the InterLymph Subtypes Project a number of non-genetic exposures have been found to be associated with CLL, including family history (FH), height, history of atopic conditions, UV radiation, and farming exposures. However there has not been a study evaluating the joint effects among these genetic and non-genetic factors with CLL risk. Methods: Using the Mayo Clinic CLL case-control study of 587 newly diagnosed CLL cases and 790 controls, we performed analyses evaluating joint effects of genetic and non-genetic factors. For genetic effects, we computed a polygenetic risk score (PRS), a weighted averaged of the number of risk alleles across 34 SNPs, with the weights being the log of the odds ratio for each SNP. Exposure data was available for 65% of the cases and 79% of the controls. We evaluated individual and joint associations of FH of any hematological malignancy, total sun exposure categorized by quartiles based on the controls, ever living or working on a farm, any atopy, any allergies, asthma, height, and PRSs categorized by quintiles based on the controls. Multivariate logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: In our preliminary results, the frequency of CLL cases in the upper PRS quintile was 49% while in the lowest quintile only 5%. The PRS has a strong evidence of association with CLL (OR= 3.04, CI =2.20-4.20 for highest versus the middle quintile). When adjusting for PRS, we still found a positive association with FH for any hematological malignancy (OR = 1.90, CI = 1.25-2.88), FH of non-Hodgkin lymphoma (OR = 2.02, CI = 1.08-3.79), and FH of leukemia (OR = 1.73, CI = 0.98-3.07). When stratifying by FH, the upper quintile of the PRS had a 5.85-fold (CI = 1.69-20.3) increased risk of CLL relative to those in the middle quintile in the FH strata, and a 2.65-fold (CI = 1.75-4.01) increased risk in the non-FH strata. After adjusting for PRS, FH and age, there remained an inverse association with sun exposure in the highest quartile (hours per week) (OR = 0.49, CI = 0.31-0.79) and a positive association with height (per 10 cm change) (OR = 1.37, CI = 1.17-1.62), but there were no associations with atopy, any allergies, history of asthma, or farming. No statistical evidence of an interaction among the variables was observed. Conclusions: We found evidence of independent effects among the genetic and non-genetic factors with risk of CLL. Among these factors, the PRS had the largest effect size. Although we did not observe any statistical interactions, larger sample sizes are warranted to fully evaluate these effects on risk of CLL. We are currently increasing our sample size through collaboration with other research groups. Final results will be presented in th
背景:慢性淋巴细胞白血病(CLL)是一种具有强烈遗传成分的淋巴细胞恶性肿瘤。有超过30种常见的单核苷酸多态性(snp)与CLL的风险相关。此外,在InterLymph Subtypes Project中,许多非遗传暴露已被发现与CLL相关,包括家族史(FH)、身高、特应性疾病史、紫外线辐射和农业暴露。然而,目前还没有研究评估这些遗传和非遗传因素对CLL风险的共同影响。方法:采用Mayo Clinic的CLL病例对照研究,对587例新诊断的CLL病例和790例对照进行分析,评估遗传和非遗传因素的联合影响。对于遗传效应,我们计算了多遗传风险评分(PRS),这是34个SNP中风险等位基因数量的加权平均值,权重为每个SNP的优势比的对数。65%的病例和79%的对照组可获得暴露数据。我们评估了FH与以下因素的个体和联合关联:任何血液恶性肿瘤、基于对照按四分位数分类的总日照、曾经在农场生活或工作、任何特应性反应、任何过敏、哮喘、身高和基于对照按五分位数分类的prs。多变量logistic回归分析用于估计优势比(ORs)和95%置信区间(ci)。结果:在我们的初步结果中,CLL病例在PRS上五分位数的频率为49%,而在最低五分位数的频率仅为5%。PRS与CLL有很强的相关性(OR= 3.04,最高五分位数与中五分位数的CI =2.20-4.20)。当调整PRS时,我们仍然发现任何血液恶性肿瘤的FH (OR = 1.90, CI = 1.25-2.88)、非霍奇金淋巴瘤的FH (OR = 2.02, CI = 1.08-3.79)和白血病的FH (OR = 1.73, CI = 0.98-3.07)与FH呈正相关。当按FH分层时,在FH层中,PRS的上五分之一相对于中间五分之一的CLL风险增加了5.85倍(CI = 1.69-20.3),在非FH层中增加了2.65倍(CI = 1.75-4.01)。在调整了PRS、FH和年龄后,在最高四分位数(每周小时数)中,与阳光照射仍然呈负相关(OR = 0.49, CI = 0.31-0.79),与身高(每10厘米变化)呈正相关(OR = 1.37, CI = 1.17-1.62),但与特应性、任何过敏、哮喘史或养殖无关。没有观察到变量之间相互作用的统计证据。结论:我们发现遗传和非遗传因素与CLL风险之间存在独立影响的证据。在这些因素中,PRS的效应量最大。虽然我们没有观察到任何统计学上的相互作用,但更大的样本量可以充分评估这些对CLL风险的影响。我们目前正在通过与其他研究小组的合作增加我们的样本量。最终结果将在会议上公布。此摘要也以海报A06的形式呈现。引用格式:Geffen Kleinstern, Dennis Robinson, Tim G. Call, Mark Liebow, Silvia de Sanjose, Yolanda Benavente, James R. Cerhan, Susan L. Slager。环境危险因素、家族史和多基因风险评分与慢性淋巴细胞白血病的关系。[摘要]。摘自:AACR特别会议论文集:改进癌症风险预测以预防和早期发现;2016年11月16日至19日;费城(PA): AACR;Cancer epidemiology Biomarkers pre2017;26(5增刊):摘要nr PR03。
{"title":"Abstract PR03: Association of environmental risk factors, family history, and polygenic risk scores with chronic lymphocytic leukemia","authors":"G. Kleinstern, Dennis P. Robinson, T. Call, M. Liebow, S. Sanjosé, Y. Benavente, J. Cerhan, S. Slager","doi":"10.1158/1538-7755.CARISK16-PR03","DOIUrl":"https://doi.org/10.1158/1538-7755.CARISK16-PR03","url":null,"abstract":"Background: Chronic lymphocytic leukemia (CLL) is a lymphoid malignancy with a strong genetic component. There are over 30 common single nucleotide polymorphisms (SNPs) associated with the risk of CLL. Moreover, in the InterLymph Subtypes Project a number of non-genetic exposures have been found to be associated with CLL, including family history (FH), height, history of atopic conditions, UV radiation, and farming exposures. However there has not been a study evaluating the joint effects among these genetic and non-genetic factors with CLL risk. Methods: Using the Mayo Clinic CLL case-control study of 587 newly diagnosed CLL cases and 790 controls, we performed analyses evaluating joint effects of genetic and non-genetic factors. For genetic effects, we computed a polygenetic risk score (PRS), a weighted averaged of the number of risk alleles across 34 SNPs, with the weights being the log of the odds ratio for each SNP. Exposure data was available for 65% of the cases and 79% of the controls. We evaluated individual and joint associations of FH of any hematological malignancy, total sun exposure categorized by quartiles based on the controls, ever living or working on a farm, any atopy, any allergies, asthma, height, and PRSs categorized by quintiles based on the controls. Multivariate logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: In our preliminary results, the frequency of CLL cases in the upper PRS quintile was 49% while in the lowest quintile only 5%. The PRS has a strong evidence of association with CLL (OR= 3.04, CI =2.20-4.20 for highest versus the middle quintile). When adjusting for PRS, we still found a positive association with FH for any hematological malignancy (OR = 1.90, CI = 1.25-2.88), FH of non-Hodgkin lymphoma (OR = 2.02, CI = 1.08-3.79), and FH of leukemia (OR = 1.73, CI = 0.98-3.07). When stratifying by FH, the upper quintile of the PRS had a 5.85-fold (CI = 1.69-20.3) increased risk of CLL relative to those in the middle quintile in the FH strata, and a 2.65-fold (CI = 1.75-4.01) increased risk in the non-FH strata. After adjusting for PRS, FH and age, there remained an inverse association with sun exposure in the highest quartile (hours per week) (OR = 0.49, CI = 0.31-0.79) and a positive association with height (per 10 cm change) (OR = 1.37, CI = 1.17-1.62), but there were no associations with atopy, any allergies, history of asthma, or farming. No statistical evidence of an interaction among the variables was observed. Conclusions: We found evidence of independent effects among the genetic and non-genetic factors with risk of CLL. Among these factors, the PRS had the largest effect size. Although we did not observe any statistical interactions, larger sample sizes are warranted to fully evaluate these effects on risk of CLL. We are currently increasing our sample size through collaboration with other research groups. Final results will be presented in th","PeriodicalId":9487,"journal":{"name":"Cancer Epidemiology and Prevention Biomarkers","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74390453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}