cancer epi final

How to calculate odds ratio

(a/c)/(b/d) Create a 2x2 table with the top row being cases vs. controls (disease vs no disease) and the leftmost column being factor of interest vs. reference group

covid-19 in cancer patients in italy article - Stroppa et al. main points

-case control study design -previously diagnosed cancer patients with covid compared to control group positive for covid but w/o cancer -exposure of interest: diagnosis of cancer with covid; also impact of hydroxychloroquine with and w/o antiviral treatment -outcome of interest: mortality rate -36% of cancer w/covid died, 16.13% of covid only died. patients who died were usually older (cancer w/covid were usually women, covid only usually men), CRP produced by liver higher in dead group, pts with combination antiretroviral & hydroxy. had a better response and seemingly improved survival compared to pts treated w/hydroxy. alone -nothing of stat. significance

national criteria for state registries via CDC

-completeness: capture 95% of all cancers in the state -timeliness: capture within 6 months of diagnosis -quality: fewer than 5% discrepancies

Watts et al (suncreen use and melanoma risk) main ideas

-primary exposure: sunscreen use in childhood and early adulthood; self reported via questionnaire (also asked parents) -reported ORs stronger for cases to non-related cases bc more likely to differ on key factors like demographics, skin type, hair and eye color, sun exposure, etc. to cases than to related controls -related controls used to match participants on potential key factors -factors more strongly associated with using sunscreen at least half the time when outdoors: female, higher education, younger, more blistering sunburns

heritability of prostate cancer

-prostate cancer has one of the strongest heritable components of any cancer -men are at greater risk if they have a father/brother diagnosed with prostate cancer at a younger age -the more first-degree relatives a man has affected by prostate cancer, the greater his risk of also developing it

Zhang et al 2015 main points

-purpose: assess association b/w early life body fatness and development of CRC in comparison to adulthood body fatness & CRC -prospective cohort study -participants from two different studies (one for men, one for women); no one prior to 1988 to reduce recall bias -follow up time of 22 years (good bc CRC is long and affects older pops) -bad tools for measuring body fatness -lots of confounders included in analysis, not much description for inclusion reasoning -main finding: higher body fatness in early life could be a risk factor for CRC development in women independent of adulthood body fatness -same association in men is weaker

Dibaba et al. 2018 main points

-purpose: study relationship b/w metabolic syndrome and risk of developing invasive breast cancer -main exposure: presence of MetS -main outcome: incidence of invasive breast cancer -data via NIH-AARP Diet and Health Study; only black and white people, self-reported data; many assessed covariates -BC more likely to be incident in white women, those w/college education, those overweight/obese, current hormone therapy users, those w/family history -MetS associated with higher risk of BC in post-menopausal women but not pre-menopausal women -pre/postmenopausal subgroups could have been better (survey participants were often on the older side of the spectrum) -results validity: all data self reported, age groups were not always appropriate, exclusion of many race groups, possibly too much data to sift through (lots of covariates)

which behavior codes are not reportable by law for state registries except for brain tumors?

0/1 (benign; uncertain whether benign/malignant)

hyperplasia

1. Not considered cancerous, just an abnormal growth of tissue 2. Excessive rate of cell division 3. Cell structure is normal 4. Arrangement of cells in tissue(s) is normal

Cervical cancer was the leading cause of cancer death in women in the U.S. before the introduction of the most common cancer among women in the 1950's; it is now the _____ most common cancer in women in the U.S.

11th

what event led to the establishment of the National Cancer Database?

1956: American College of Surgeons formally adopts policy to encourage development of hospital-based cancer registries

when was the NPCR established?

1992 administered by CDC

An early goal of WHO Non-Communicable Diseases Global Action Plan for 2013-2020, is to reduce premature non-communicable diseases deaths. What is the percentage they propose to reduce?

25%

What proportion of cancer deaths is attributable to cancer smoking globally?

50%

what proportion of hereditary ovarian cancers are due to breast-ovarian cancer syndrome (caused by BRCA1/2 mutations)?

90%

what proportion of cancer does CDC mandate each state capture?

95%

Which of the following groups of women had the highest MORTALITY rate of breast cancer in the U.S. in the 2000s?

African American

TNM cancer staging

American Joint commission 1. T: the size of the original/primary tumor and whether it has invaded nearby tissue 2. N: nearby/regional lymph nodes that are involved 3. M: distant metastasis (spread of cancer from one part of the body to another)

The U.S. Preventative Task Force recommends (for lung cancer)...

Annual screening for lung cancer among adults 55 to 80 years old who have a 30 pack-year smoking history or who quit within the past 15 years until such time as their life expectancy is severely limited.

True statements about bias

Bias can either overestimate or underestimate the measure of association. Bias is systematic error. All study designs can be affected by bias.

what is the third most common cancer in the US?

CRC ~9% of all cancers

the most preferable method to use in lung cancer diagnosis is

CT scan

Which of the following regions/countries have the highest prevalence of HBsAg carriers?

China

what is melanoma staging based on?

Clark level (measure of tumor depth) tumor thickness presence of ulceration metastasis

where was the first population-based cancer registry in the US?

Connecticut, 1935

Which study design would you use to quantify the prevalence of an outcome in a certain group?

Cross-sectional key things: -prevalence -one group

another detection method for prostate cancer

DRE digital rectal exam

what pathways should you examine when dealing w/sporadic CRCs?

EGFR pathways (mutually exclusive) -K-ras signaling molecule (mutation in ~40% of CRCs) -BRAF signaling molecule (mutated in ~10% of CRCs, associated with poor prognosis)

what two public health bodies are responsible for Florida's Cancer Data System (legislatively mandated, pop.-based cancer surveillance registry)?

FDOH UM Miller School of Medicine -CDC-NPCR enhancement in 1995 (established in 1981) -second largest in nation -INCIDENCE ONLY surveillance system

which virus increases the risk of liver cancer?

HBV

which virus is the forerunner for liver cancer prevalance in the us?

HCV BUT, HBV is the forerunner WORLDWIDE!!

what are the cancer reporting standards established by the WHO?

International Classification of Diseases for Oncology (ICD-O-3) Used principally in tumor or cancer registries for coding the site (topography; the actual affected organ where the tumor arose) and the histology (morphology; type of cell that has become neoplastic & its biological activity) of neoplasms, often obtained from a pathology report

why it is difficult to compare epidemiologic results across populations for "total prostate cancer"?

It is difficult to compare epidemiologic results across populations for "total prostate cancer" because not all prostate cancers are of the same clinical significance; in other words, having a mix of aggressive and mild disease can vary how total prostate cancer is measured. Additionally, various populations across different time periods may demonstrate various epidemiologic results based on their adherence to use of PSA screening measures, which has been integral in the drastic reframing of prostate cancer epidemiology.

other genes that increase susceptibility to OC

MLH1, MSH2

what is molecular medicine?

Molecular medicine, otherwise known as personalized medicine, is a method of individualized healthcare based and focused on the molecular profile of the patient and the present tumor; in other words, molecular medicine allows for clinical decisions to be made using knowledge of a patient's molecular biological makeup.

data quality check organization

North American Association of Central Cancer Registries evaluate data based on quality indicators

Name one reason why the incidence of melanoma has increased over the past 40 years while mortality has remained relatively stable.

One reason for an increase in melanoma incidence despite stability in mortality may be due to increases in health education/screening, and therefore, improved preventative/surveillance methodologies. Melanomas that are caught and diagnosed in earlier stages are frequently curable. This fact, combined with the recording of melanomas in the SEER registry may supply evidence for increased health education & screening being the reason for incidence of melanoma increasing while mortality rates remain stable.

what is over-diagnosis? is it concerning?

Overdiagnosis occurs when an increase in screening methods (such as breast cancer screenings [ex: mammograms]) lead to an increase in diagnoses of a specific outcome, such as incident breast cancer. Epidemiologists should be concerned about overdiagnosis because it may falsely construe research results by indicating a false increase in incidence of early- or late-stage breast cancers, which may make it seem as though those increases are due to anything besides an increased rate of screening alone.

Why is the false-positive rate for PSA screening so high?

PSA is a marker for other benign prostate-related diseases in addition to prostate cancer.

erythro-

RBC

breast cancer age-related influences

Rapid rise in rates w/increasing age slows around age 50 (near menopause) showcasing role of reproductive hormones in disease etiology highest rates in Europe/NA, lowest in Asia

Which of the following cancer registries was started in response to the National Cancer Act of 1971?

SEER (surveillance, epidemiology, and end results)

what is detection/surveillance bias?

Surveillance bias, also known as detection bias, arises when patients in one exposure group have a higher probability of having the study outcome detected, due to increased surveillance, screening or testing of the outcome itself, or an associated symptom

hallmarks of cancer

Sustaining proliferative signaling Evading growth suppressors Activating invasion and metastasis Enabling replicative immortality (telomeres) Inducing angiogenesis (generating tumor-associated vasculature) Resisting cell death **emerging hallmarks: -reprogramming of energy metabolism -evading immune destruction

Which of the following cancer registries is the largest cancer surveillance system in the U.S., covering about 96% of the U.S. population?

The National Program of Cancer Registries

incessant ovulation hypothesis

The incessant ovulation hypothesis states that repeated trauma to the ovarian surface epithelium from recurrent ovulation increases the risk of ovarian cancer. The incessant ovulation hypothesis theorizes that a greater number of total ovulation cycles over a lifetime is associated with an increased risk of ovarian cancer, whereas having a lower number of total ovulation cycles over a lifetime is associated with a decreased risk of ovarian cancer.

how does the incidence of colorectal cancer change based on SES?

The incidence of colorectal cancer tends to increase as a county moves from low to high income, and eventually stabilizes at the end of the economic transition. This trend of increasing CRC incidence in higher-income countries as compared to lower-income countries may be attributed to differences in lifestyle and dietary habits between higher SES and lower SES countries, as well as an increase in more advanced screening methods that detect various stages of CRC earlier in adulthood (starting 45-50 y/o and continuing annually afterwards) in higher-income countries. This so-called "Western lifestyle" includes increased sedentary activities, such as office jobs comprised primarily of sitting and little regular exercise, which can lead to overweight and obesity, a known risk factor for CRC development.

Among women infected with HPV, what is the most important determinant of cervical cancer risk?

The most important determinant of cervical cancer risk for women infected with HIV is the number of sexual partners a woman has, particularly the number of high-risk partners.

What is responsible for the sharp increased incidence of prostate cancer around 1995?

The sharp increased incidence in prostate cancer around 1995 can be attested to the emergence of a new early detection test, the Prostate Specific Antigen assay (which was approved by the FDA in 1994). This new early detection mechanism allowed for more men to be tested for prostate cancer much earlier than what may be necessary, contributing to a sharp increase in incidence of prostate cancer overall.

name the strongest modifiable risk factor for all three types of skin cancer

UV (sun) exposure

why is valid and reliable cancer staging info critical?

Valid and reliable cancer staging information is critical because correct staging offers providers information about the current histology of the cancer, as well as indicate patient prognosis to allow providers to determine possible treatment plans and necessary care moving forward.

Description of confounding

When a third variable causes a distortion of the association between exposure and outcome

According to the study base principle presented by Wacholder et al., which of the following describes a secondary base?

When the base is defined as the source of the cases, and controls are selected from a group of people who would have become a case if they had developed the disease during the time of study

Why is the mortality curve for females in the US lagging behind that of men about 10-15 years despite following a similar pattern?

Women took up cigarette smoking later than men

main drawback to lung cancer screening

a high proportion of the CT scans (the preferred method for lung cancer screening) yielded false-positive results, indicating problems with the specificity of the screenings (as specificity is concerned with discovering the amount of true negative results) as many patients receive a diagnosis that may cause additional anxiety over a condition that does not truly exist

mild dysplasia

a precancerous lesion with an excessive rate of cell division and loss of normal cell structure

p53 is an example of

a tumor suppressor gene

hospital-based cancer registries

a. Aimed at improvement of cancer therapies b. Collect more detailed info about diagnoses and treatments

population-based cancer registries

a. Monitor frequency of new cancer cases every year in well-defined populations b. Recognize and reduce risks c. "incidence only"

What is a major risk factor for sporadic colorectal cancer?

age *sporadic is vs. hereditary -75% of CRCs are sporadic

what are the strongest risk factors for prostate cancer?

age, race/ethnicity, family history

what is the best established MODIFIABLE risk factor for breast cancer?

alcohol consumption

oncogene

alleles of genes that have become hyperactive and uncontrollably stimulate cellular replication

single nucleotide polymorphism

an inherited DNA sequence variation occur in over 1% of population

leukemias

arise from bloodstream

lymphomas

arise from lymph nodes

sarcoma

arises from cells of supporting tissues, connective tissues, etc.

carcinoma

arises from cells that cover external and internal organs

what is the most important occupational lung cancer carcinogen?

asbestos

the incidence of colorectal cancer among younger people in the US has recently...

been increasing As industrialization has furthered and our environmental and lifestyle habits have adapted, there have been changing interactions between various risk and protective factors in our day-to-day life that have led to the increasing incidence of CRC in the United States, particularly for younger populations. The obesity epidemic has continued to afflict many individuals in the U.S., and as mentioned in both the lecture and the readings, obesity/overweight is a significantly associated risk factor for CRC development (primarily adult obesity/overweight). This risk factor, compounded with modern lifestyle factors like consumption of alcohol, processed meat, and sedentary behaviors (leading to decreased physical activity) lead to an increase in incidence of CRC for younger populations who increasingly engage in these activities.

hemangio-

blood vessels

osteo-

bone

myelo-

bone marrow

Which cancer has the highest incidence rate in the US overall according to 2015 statistics?

breast

what is the most common type of cancer affecting women?

breast

carcinoma in situ

cancer in the early stage before invading surrounding tissue (also called severe dysplasia) tumor is confined to original location and has not broken through the basement membrane 1. Uncontrolled cell growth 2. Cell structure changes similar to invasive cancer, loss of normal tissue arrangement 3. High-grade pre-cancerous lesion that has characteristics similar to that of an invasive cancer, just hasn't invaded yet 4. Identified and tracked very closely, or removed altogether

chondro-

cartilage

Mills et al case control study vs Houghton et all cohort study

case control: improverished area with largely Hispanic population; cohort mostly white women w/o SES disclosure outcome in cohort study: OCs initially self reported and validated w/requested records outcome in case control: diagnoses via rapid case ascertainment procedure instead of self report exposure for both: perineal powder (talc) use cohort: assessed with self report (duration and areas of use) case control: compilation of info; more comprehensive eval. case control: excluded tubal ligation as covariate but found it had a sig. effect cohort: no stat. sig. associations b/w any powder use and OC risk case-control: ever use of powder in genital area/of increasing freq. associated with stat. sig increases in risk for epithelial OC

You are an epidemiologist with the Florida Department of Health and receive a phone call about a possible cancer cluster surrounding an Air Force base. Initial investigation reveals that all ill people have the same type of cancer. You determine there is a need to conduct an analytical epidemiologic study to determine possible causes. Out of the following study designs, which would be the most efficient to use to evaluate possible causes?

case-control key things: -assessment of causes (exposures) -two groups (ill cluster and matched healthy)

apoptosis

cell suicide

epigenetic

changes in a chromosome without alterations in the DNA sequence; stably inherited phenotype can occur at any point during the translation of a gene to a protein most commonly studied change: DNA methylation to alter gene expression

lung cancer diagnostics

ct scan CXR fine needle aspiration no formal diagnostic blood test PET scan

heteogeneity of ovarian cancer

epithelial OC is comprised of 4 main histologic subtypes -serous (main; 55-70%; predominant; most aggressive) -endometrioid -clear cell -mucinous etiologic differences exist b/w histologies; cellular origins may differ origins: -serous: ovary, fallopian tube -endo.: retrograde menstruation (uterus) -clear cell: uterus -mucinous: colon, appendix, stomach (represent more GI malignancies)

international agency for research of cancer (IARC)

established 1965 via resolution of World Health Assembly produce "Cancer Incidence on Five Continents" to compare cancer burden globally

chronic exposure to ________ is the major determinant of breast cancer

estrogen

Descriptive epidemiologic studies can be both observational and interventional

false

Hospital-based registries provide a snapshot while incidence-only registries follow people over time. true or false

false

If a woman has her first child when she is over 30, her risk of breast cancer remains elevated until about 20 years after that birth.

false

Melanoma skin cancer is not a reportable cancer to the Surveillance, Epidemiology and End Results Program (SEER) or state cancer registries, thus population estimates are based on care visits or skin procedures. true or false

false

The Summary Stage staging system is based T, N, and M components plus an assignment of a stage grouping (0-IV). true or false

false

most men die from, rather than with, prostate cancer. true or false?

false

What are established causes of early-onset colon cancer?

familiar adenomatous polyposis (FAP) -hereditary syndrome -people born with genetic mutation in APC, 50% risk of CRC as a result -typically lots of colon problems at a young age -pop. prevalance of this mutation is <0.1% lynch syndrome -alteration in DNA repari pathway -HNPCC -places persons at 80% risk of CRCs and other cancers

lipo-

fat

end-results cancer surveillance registry

follow cases over time; actively & robustly collect and monitor patient(s) and progression of disease

2001 Bethesda System

for cervical cancer two types of atypical squamous cells (ASC) -ASCUS -ASC-H squamous intraepithelial lesions (SIL) -LSIL --> CIN1 -HSIL --> CIN2/3, CIS used to be staged like other cancers, but this method is more descriptive

what are established risk factors for melanoma?

freckling (# of nevi, or moles) age

"adeno" prefix

glandular tissue

prostate cancer characteristics

hardly in pts younger than 50 y/o; risk increases w/age developed country disease lots of racial disparities diet is a modifiable risk factor (obesity, overweight)

Cancer survival in the US...

has been steadily increasing since 1975-77

for ovarian cancer, what factor can override the negatively influential factor of BMI?

hormone replacement therapy For women who ARE USING hormone replacement therapy, you have ORs that are about the same regardless of whether a woman gains/loses weight

increased risk factors for OC

hormone replacement therapy obesity smoking alcohol use talc family history/genetic factors (by far the most sig. factors for OC; UNMODIFIABLE)

cervical cancer age trends

incidence DECLINES with age

ovarian cancer trends

incidence higher in white women than black women same with mortality rates (mimics international variation) slight decline in incidence over the past decade; trends in mortality rlatively stable across races

in post-menopausal women, increasing BMI is associated with an _____________ risk of invasive breast cancer

increased

what is the strongest risk factor for cervical cancer?

infection with human papillomavirus (HPV)

do people with intermittent or chronic UV exposure run the higher risk of melanoma?

intermittent exposure!

other protective factors against OC

lactation oophorectomy hysterectomy tubal ligation

how does cervical cancer move?

laterally across the cervix

Which cancer has a mortality rate that's been increasing for both sexes in the US?

liver

hepato-

liver

though lung cancer is the leading cause of death for both genders (~30% of all cancer deaths in the US), what is its placement with regards to most common cancers?

lung cancer is the 2nd most common cancer in both M/W sharp peak in 90s (smoking) but incidence rates are starting to decline slightly

Which cancer has the highest mortality rate in the US overall according to 2015 stats?

lung/bronchus

lympho-

lymphocyte

two main types of skin cancer

melanomas -develop from melanocytes -can grow anywhere on skin but focus on trunk (men), legs (women), neck, face (areas of UV exposure) -almost always curable in early stages -more likely to metastasize than BCC/SCC -can vary in appearance non-melanomas -incidence rates NOT reported -basal cell carcinoma(BCC): 80%; sun-exposed areas; usually only on older people; slow-growing, rarely metastasizes; can recur in the same location; MOST COMMON TYPE OF SKIN CANCER IN THE US -squamous cell carcinoma (SCC): 20%; sun-exposed; can develop in scars/skin ulcers/genital area; more aggressive than BCC; often have clear precursor lesion IDd called actinic keratosis -Merkel cell carcinoma -Kaposi's sarcoma

most effective treatment for skni cancer

micrographic surgery best prevention tip is absolutely avoiding the sun and using sunscreen

common diagnostic test for colorectal cancers

microsatellite instability -microsatellites: small, short, repetitive sequences of DNA -if you can ID DNA alterations in these regions, that's sort of a surrogate for if you have alterations in your mismatch repair families -MSI therapy has been linked to favorable outcomes esp. for younger pts

adolescent females are more susceptible to HPV infection because of inadequate cervical...

mucous production (mature epithelial cells)

myo-

muscle

Is there a strong independent association between diet and risk of lung cancer after adjusting for cigarette smoking?

no

does the use of biomarkers prevent confounding?

no

has the 5-year survival rate for lung cancer improved significantly over the last 4 decades?

no

what is the most common histology of lung cancer?

non small cell. includes: -squamous cell carcinoma (common, bronchus; 30-40% of LCs, usually starts central and spreads to regional lymph nodes) -adenocarcinoma (common in women/nonsmokers, periphery, >40% of LCs) -large cell carcinoma (undifferentiated, 10-15% of LCs, can occur anywhere, usually a large peripheral lesion, tends to grow/metastasize faster than the other types)

The U.S. Preventive Services Task Force currently recommends what frequency skin cancer screening?

none

age adjusted rates

number of events / number of persons at risk in a given time period or place stratified by age group standard pop. applied removes age bias comparisons!

what are the strongest risk factors for liver cancer in DEVELOPED countries?

obesity alcohol consumption

somatic mutation

occurs in non-germline tumors noninheritable

what are stronger protective factors against ovarian cancer than reduced number of ovulatory cycles alone?

oral contraceptive use parity (having children overall lowers risk; however, for a short period of time after birth, risk is elevated)

Which cancer has the lowest survival rate overall?

pancreatic

cervical cancer screening tests

pap smear -recommended for all women 21-65 every three years -precancerous screening HPV reflex test -can be done w/pap test -recommended for ages 30+

what is the most accurate method for diagnosing cancer?

pathology

melano-

pigment cell

What is an independent risk factor of lung cancer after adjustment for an individual's cigarette smoking?

positive family history of lung cancer

germline mutations

present in egg/sperm heritable can cause cancer family syndrome

prostate cancer 5-year survival rates

pretty high, about 99% 10-year survival rates are somewhat lower (~70%)

HPV vaccination is an example of what stage of prevention?

primary

Which study design is most commonly used to study the risk of cancer in the presence of certain genotypes?

prospective cohort

what is the most common cancer among men

prostate (second leading cause of mortality after lung cancer)

PSA test

prostate specific antigen measures proteins generates from prostate discovered by Dr. Ablin in 1970, approved by FDA in 1994 sensitivity is over 70%, which is good; however, the false positive rate is astronomical, which is bad not cancer specific (value can be affected by other things, often benign)

other histology of lung cancer

small cell 15% of all LCs most aggressive pulmonary tumor; involved median survival of 2-4 months w/o treatment limited and extensive stage

incidence only cancer surveillance registry

snapshot of one particular point in time

crude rates

total number of events / total number of persons at risk (whole pop. at a given point in time in a given place) by convention multiplied by 100,000 or 1M

age-specific rates

total number of events in a given age stratum / total number of persons at risk in a given age stratum at a given time period/place -by convention multiplied by 100,000 or 1M

Case-control studies can be impacted by both selection and observation bias

true

Men with mutations in DNA repair genes including BRCA1 and BRCA2 are at increased risk of prostate cancer and have more severe disease.

true

Regardless of a woman's age at the birth of her first child, her risk of breast cancer is elevated in the first 10 years after the birth, but then decreases over time.

true

lung cancer is the leading cause of cancer death in the US, true or false?

true

Lawrenson et al. (2018) conducted a study called the "Impact of radiotherapy on cardiovascular health of women with breast cancer," and compared the risk of cardiovascular morbidity and mortality between breast cancer patients who received radiotherapy and those who did not, adjusting for several potential confounders. They reported the following result: HR=0.73, 95% CI: 0.59-0.92. The result was statistically significant.

true CI doesn't contain 0

what reduces the risk of ovarian cancer among women with the BRCA1 mutation?

tubal ligation

what is the main tumor marker for ovarian cancer?

tumor antigen CA-125 can often be high in women w/benign conditions; lacks some sensitivity/specificity confirmation should be done after ovary removal (look at resected specimen)

Which of the following groups of women had the highest INCIDENCE rate of breast cancer in the U.S. in the 2000s?

white

why is cervical cancer considered a disease of disparity in the US?

women with certain demographic groups are less likely to get screened and less likely to get treated

cigarette smoke components

~4500 compounds 1. Particulate phase ("Tar") a. ~4000 compounds b. Lots of the carcinogens occur here 2. Vapor phase a. ~500 compounds b. Lots of toxic chemicals occurring here