The Multiethnic Cohort Study: Studying Ethnic Diversity and Cancer. Laurence N. Kolonel, MD, PhD

Transcription

1 The Multiethnic Cohort Study: Studying Ethnic Diversity and Cancer Laurence N. Kolonel, MD, PhD

2 Background of the Multiethnic Cohort Study (MEC)

3 Features of the Design Multiethnic: Five groups in Hawaii and Los Angeles Japanese African Americans Native Hawaiians Hispanics Non-Hispanic whites

4 Incidence (per 100,000) * for Some Common Cancers in the Ethnic Groups of the Cohort, MEN (per 100,000) Prostate Colorectal Lung Latino African- American Japanese White Native Hawaiian WOMEN (per 100,000) Breast Colorectal Lung 0 Latino African- American Japanese White Native Hawaiian * Age-adjusted to 1970 U.S. standard population Source: Miller, BA et al. SEER Monograph, NIH 1996

5 Features of the Design Multiethnic: Five groups in Hawaii and Los Angeles Japanese Native Hawaiians Non-Hispanic whites Population-based sample African Americans Hispanics Main source: Drivers License files Supplemental sources: Voters Registration files & HCFA (CMM) files Adults: years of age

6 Features of the Design Self-administered questionnaire at baseline Emphasis on diet (17 of 26 pages) Included supplement use Additional categories: demographics anthropometrics physical activity smoking solar exposure medical history use of medications reproductive history family history

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8 Surveillance/Retention Passive Follow-up for Cancer Incidence SEER Cancer Registries in Hawaii and California National Death Index (NDI) Active Follow-up Interval Questionnaires Annual Newsletters (Retention)

9 Data Collection : Baseline Questionnaire : Brief Follow-up Questionnaire : Repeat of Baseline Questionnaire : Biological Specimens : Brief Follow-up Questionnaire

10 Biological Specimen Collection : Focus on Genetic Susceptibility Analyses Cases: 8,000 (breast, prostate, colorectum) Controls: 8,700 subjects (X-sectional) : Establish a Prospective Biorepository for Nutritional Biomarker Studies No. of Subjects: >67,000 Specimen Storage: Blood: 0.5 cc cryovials in LN2 freezers x 42 Urine: 2.0 cc nuncs in -80 C freezers x 10

11 University of Hawaii (UH) The Multiethnic Cohort (MEC) Questionnaire Administration (Diet/Lifestyle Factors) { Native Hawaiians Japanese Whites African Americans Latinos N = 215,251 Follow-up Lifestyle and Genomic Analyses of Cancer Follow-up University of Southern California (USC) Biospecimen Collection N = 67,000 { 2001

12 Distribution of the Cohort by Sex and Ethnicity Ethnicity Males Females Total Latino 22,818 24,620 47,438 African American 12,851 22,256 35,107 Japanese 26,964 29,957 56,921 White 22,857 26,502 49,359 Native Hawaiian 6,120 7,851 13,971 Other 5,200 7,255 12,455 Total 96, , ,251

13 Smoking, Drinking, Obesity, and Physical Activity in the Cohort by Sex & Ethnicity (%) * Current Current BMI > 30.0 Vigorous Ethnicity Smokers Drinkers Physical Activity MALES Latino African American Japanese White Native Hawaiian FEMALES Latino African American Japanese White Native Hawaiian * Standardized to the overall cohort age distribution > 1 beverage/week > 3 hrs of strenuous exercise or vigorous work/week

14 Energy and Nutrient Intakes * from the QFFQ among the Main Ethnic Groups in the Cohort Ethnicity Calories Total Dietary Vitamin C Calcium Fat (g) Fiber (g) (mg) (mg) MALES Latino African American Japanese White Native Hawaiian FEMALES Latino African American Japanese White Native Hawaiian * Mean daily intake, standardized to the overall cohort age distribution.

15 No. of Incident Cases* (complete through 2007) Site Males Females All sites 16,230 12,926 Breast Prostate Colorectum Lung Stomach Bladder Pancreas Ovary -- Endometrium * Invasive cases only

16 Mostly Consistent Findings across Ethnic Groups

17 Red Meat Consumption and Diabetes Risk by Ethnicity Men Red meat Caucasian Native Hawaiian Japanese American ALL MEN Processes red meat Caucasian Native Hawaiian Japanese American Women Red meat Caucasian Native Hawaiian Japanese American ALL WOMEN Processed meat Caucasian Native American Japanese American ALL WOMEN (Steinbrecher A et al. Public Health Nutr, 2010)

18 Dietary Fiber Intake and Diabetes Risk by Ethnicity Total Fiber Caucasian Japanese N. Hawaiian g/(4184kj.d) HR (95% CI) HR (95% CI) HR (95% CI) MEN < ( ) 0.96 ( ) 0.96 ( ) ( ) 0.92 ( ) 0.94 ( ) ( ) 1.04 ( ) 1.13 ( ) ( ) 0.84 ( ) 0.70 ( ) P-value < WOMEN < ( ) 1.03 ( ) 0.90 ( ) ( ) 0.90 ( ) 0.91 ( ) ( ) 0.88 ( ) 0.93 ( ) ( ) 1.04 ( ) 0.85 ( ) P-value (Hopping et al. J. Nutr., 2010)

19 Diabetes and Prostate Cancer Risk by Ethnicity RR (95% CI) ALL MEN 0.81 ( ) White 0.65 ( ) African American 0.89 ( ) Native Hawaiian 0.73 ( ) Japanese 0.81 ( ) Latino 0.78 ( ) P heterogeneity 0.32 (Waters K et al. Am J Epidemiol, 2008)

20 Urinary Phytoestrogen Excretion and Prostate Cancer by Ethnicity Overall By Ethnicity (Park S-Y et al. Br J Cancer, 2009)

21 Well-done Meat and Prostate Cancer Risk by Ethnicity Meat All Men African Amer. Japanese Latino Caucasian Preference OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Rare/none Medium 0.93 ( ) 0.68 ( ) 1.01 ( ) 0.67 ( ) 0.94 ( ) Well-done 0.84 ( ) 0.73 ( ) 0.87 ( ) 0.72 ( ) 0.84 ( ) P for trend (Sharma S et al. CEBP, 2010)

22 Risk of Breast Cancer by Hormone Therapy Use (per 5 years) and Ethnicity African Amer. N. Hawaiian Japanese Latino Caucasian HRT Use RR (95% CI) RR (95% CI) RR (95% CI) RR (95% CI) RR (95% CI) Never Current 1.19( ) 1.13( ) 1.33( ) 1.36( ) 1.26( ) EPT (Lee S et al. Int J Cancer, 2006)

23 Odds Ratios (75 th vs. 25 th Percentile) for Urinary Phytoestrogen Excretion and Breast Cancer (Goodman M et al. Cancer Prev Res, 2009)

24 BMI and Endometrial Cancer by Ethnicity (Park SL et al. Int J Cancer, 2010)

25 Relative Risk for Dietary Fiber and Colorectal Cancer by Ethnicity (Q5 vs. Q1) (Nomura et al. Cancer Causes Control, 2007)

26 Overall Plasma 25(OH)D and Colorectal Cancer By ethnicity (per doubling) (Woolcott et al. CEBP, 2010)

27 Little Consistency in Findings across Ethnic Groups

28 NSAID Use and Breast Cancer Risk by Ethnicity Overall By ethnicity (Gill J et al. Am J Epidemiol, 2007)

29 Body Size and Prostate Cancer Risk by Ethnicity (Hernandez B et al. CEBP, 2009)

30 Obesity Status and Plasma IGF-1 Levels BMI IGF-1 LEVEL kg/m 2 ) African Amer. N. Hawaiian Japanese Latino Caucasian < P trend (Henderson KD et al. CEBP, 2006)

31 Lung Cancer Incidence in Current Smokers by Age and Ethnicity cig./day Rate per 100, African-American Haw aiian Latino Japanese White Age (Haiman et al. NEJM, 2005)

32 Lung Cancer Incidence in Current Smokers by Age and Ethnicity 10 cig./day 20 cig./day Rate per 100, African-American Haw aiian Latino Japanese White Rate per 100, African-American Hawaiian Latino Japanese White Age Age (Haiman et al. NEJM, 2005)

33 Lung Cancer Incidence in Current Smokers by Age and Ethnicity 10 cig./day 20 cig./day Rate per 100, African-American Haw aiian Latino Japanese White Rate per 100, African-American Hawaiian Latino Japanese White Age Age cig./day Rate per 100, African-American Haw aiian Latino Japanese White Age (Haiman et al. NEJM, 2005)

34 Summary Both consistency and inconsistency in findings are seen among the population groups of the MEC. Consistency suggests common risk factors and mechanisms. It also strengthens confidence in the findings. Inconsistency indicates differences among groups, possibly related to effects of other exposure or genetic susceptibility factors.

35 Acknowledgments University of Hawaii Abraham Nomura Lynne Wilkens Jean Hankin Suzanne Murphy Loic Le Marchand Faye Nagamine Marc Goodman Brenda Hernandez Song-Yi Park Jasmeet Gill Astrid Steinbrecher Beth Hopping Lani Park Christy Woolcott University of Southern California Brian Henderson Malcolm Pike Daniel Stram Kristine Monroe Christopher Haiman Wendy Setiawan Kevin Waters Sulggi Lee Katie Henderson

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