CANCER EPIDEMIOLOGY AND PATHOGENESIS (EPID 770) FALL 2009 Tues/Thurs 12:30 1:45, McGavran Greenberg 1304 Instructor: Office: Melissa Troester, Ph.D., M.P.H. 2104H McGavran Greenberg Phone: (919) 966 7408 Email: troester@unc.edu COURSE OBJECTIVE The objective of this course is to provide fundamental knowledge about the epidemiologic and biological concepts of cancer epidemiology, and then to encourage critical thinking about these concepts. The course will cover cancer statistics, major risk factors for cancer, mechanisms of carcinogenesis, biomarkers in cancer research, as well as some current controversies in cancer research. Students will gain a background knowledge of cancer biology and epidemiology needed to interpret and critique cancer epidemiology research. RECOMMENDED TEXTBOOKS There is no assigned textbook for the course, but there are a few optional texts available in the bookstore that may be useful as references: Nasca and Pastides. Fundamentals of Cancer Epidemiology (2 nd Ed). Jones and Bartlett, Sudbury, MA 2008. Franco and Rohan. Cancer Precursors: Epidemiology, detection, and prevention. Springer Verlag, New York, NY 2002. Schottenfeld and Fraumeni. Cancer Epidemiology and Prevention, (2 nd or 3 rd Ed). Oxford, New York, NY 1996, 2006. ASSIGNED READINGS Assigned readings and study questions will be provided for each class. These readings and questions will be available through blackboard.
COURSE REQUIREMENTS Class participation & study questions (20%) Written Assignments (2 X 20% each) Final Exam (40%) WRITTEN ASSIGNMENTS Two peer review critiques will be written during the semester on an assigned article. The article will be taken from the current literature and the written critique should resemble a critique that would be written as a reviewer for a scientific journal. The review should begin with a summary of the purpose/scientific objective of the article and proceed to discuss strengths as well as areas for improvement. It is often helpful to divide the review into major and minor criticisms. Where appropriate, page, paragraph, and line numbers should be indicated for each major and minor point made in the critique. Students wishing to receive feedback on their first critique may submit the critique two weeks prior to the due date. FINAL EXAM A final exam will be administered on the last day of class during the regularly scheduled class time. The in class exam will cover readings and lectures from the semester and will consist of multiple choice, true false, and short answer questions. It will be open book, but timed and must be completed within the regular class period.
COURSE SCHEDULE DATE TOPIC 1 Tues Aug 25 Course Introduction CANCER STATISTICS 2 Thurs Aug 27 Cancer Statistics: Overview 3 Tues Sep 1 Cancer Statistics: Incidence 4 Thurs Sep 3 Cancer Statistics: Mortality 5 Tues Sep 8 Cancer Statistics: Survival 6 Thurs Sep 10 Induction and Latent Periods (Millikan) CANCER ETIOLOGY AND PROGRESSION 7 Tues Sep 15 Cancer Risk Factors: Age 8 Thurs Sep 17 Cancer Risk Factors: Family History 9 Tues Sep 22 Cancer Risk Factors: Tobacco 10 Thurs Sep 24 Cancer Risk Factors: Alcohol Assignment 1 due 11 Tues Sep 29 Cancer Risk Factors: Radiation (Richardson) 12 Thurs Oct 1 Cancer Risk Factors: Hormones 13 Tues Oct 6 Cancer Risk Factors: Obesity (Cleveland) 14 Thurs Oct 8 Cancer Risk Factors: Infectious Agents (Smith) MECHANISMS OF CARCINOGENESIS 15 Tues Oct 13 Animal Models (Millikan) 16 Thurs Oct 15 Mutations in Cancer 17 Tues Oct 20 Epigenetic Mechanisms Methylation (Swift Scanlan)
Thurs Oct 22 Fall Break 18 Tues Oct 27 Epigenetic Mechanisms microrna 19 Thurs Oct 29 Field cancerization/ intraepithelial neoplasia BIOMARKERS IN CANCER EPIDEMIOLOGY 20 Tues Nov 3 Biomarkers: Overview 21 Thurs Nov 5 Biomarker Example: In Class Group Discussion 22 Tues Nov 10 Biomarkers: Design and Biases (Ransohoff) Assignment 2 due CONTROVERSIES IN CANCER PATHOGENESIS 23 Thurs Nov 12 Observation vs. Experimentation 24 Tues Nov 17 Microarrays 25 Thurs Nov 19 Communicating Genomic Risks (Noel Brewer) 26 Tues Nov 24 Chemoprevention Thurs Nov 26 Thanksgiving Holiday 27 Tues Dec 1 Stem Cells 28 Thurs Dec 3 Course Summary and Future Directions 29 Tues Dec 8 Final Exam
READING LIST COURSE INTRODUCTION Proctor, Robert N. (1995) Cancer Wars. HarperCollins, New York. Greenwald P and Dunn BK. (2009) Landmarks in the History of Cancer Epidemiology. Cancer Res, 69: 2151 2162. Lippman and Hawk. (2009) Cancer Prevention: From 1727 to Milestones of the Past 100 Years. Cancer Res, 69, 5269 5284. CANCER STATISTICS Overview Incidence Mortality Survival Bailar JC and Gornik HL. (1997) Cancer Undefeated. New England Journal of Medicine, 336: 1569 1574. Jemal et al. (2008) Annual Report to the Nation on the Status of Cancer, 1975 2005, Featuring Trends in Lung Cancer, Tobacco Use, and Tobacco Control. Journal of the National Cancer Institute. 100: 1672 1694. Smith BD et al. (2009)Future of Cancer Incidence in the United States: Burdens Upon an Aging Changing Nation. J Clin Oncol. 27: 2758 2765. Clegg LX et al. (2002) Impact of Reporting Delay and Reporting Error on Cancer Incidence Rates and Trends. Journal of the National Cancer Institute. 94: 1537 45. Albano et al. (2007) Cancer Mortality in the United States by Education Level and Race. Journal of the National Cancer Institute, 99: 1384 1394. Wingo et al. (1998) Long Term Cancer Patient Survival in the United States. Cancer Epidemiology, Biomarkers & Prevention. 7: 271 282. Janssen Heijnen et al. (2007) Prognosis for long term survivors of cancer. Annals Oncology 18: 1408 1413.
Induction and Latent Periods Rothman K. (1981) Induction and latent periods. Am J Epid 114: 253 259. Giovannucci E. (2001) An updated review of the epidemiological evidence that cigarette smoking increases risk of colorectal cancer. Cancer Epidem Biomark Prev 10: 725 731. CANCER ETIOLOGY Age Family History Tobacco Alcohol REQUIRED: Ershler WB and Longo DL. (1997) Aging and Cancer: Issues of Basic and Clinical Science. JNCI 89:1489 97. REQUIRED: Anderson WF et al. (2007) Qualitative age interactions (or effect modification) suggest different cancer pathways for early onset and late onset breast cancers. Cancer Causes Control 18:1187 1998. RECOMMENDED: Ukraintseva SV and Yashlin AI. (2003) Individual Aging and Cancer Risk: How are they Related? Demographic Research, 9(8): 163 196. Murff et al. (2002) Does this patient have a family history of cancer? JAMA 292(12): 1480 1489. Khoury and Flanders (1995) Bias in using family history as a risk factor in case control studies of disease. 6:511 519. Murta Nascimento et al. (2007) Risk of bladder cancer associated with family history of cancer: do low penetrance polymorphisms account for increase in risk. 16:1595 1600. Burton, Adrian. Smoking out genetic components of lung cancer. (2008) The Lancet Oncology 9: 417 418. Thorgeirsson et al. (2008) A variant associated with nicotine dependence, lung cancer and peripheral arterial disease. Nature, 452: 638 642. Spitz et al. (2008) The CHRNA5 A3 region on chromosome 15q24 25.1 is a risk factor both for nicotine dependence and for lung cancer. J Natl Cancer Inst 100:1552 1556. Allen et al. (2009) Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst. 101(5): 296 305, and editorial responses in JNCI 101(15):1093 and JNCI 101(5):282 283. Boffetta and Hashibe (2007) Alcohol and cancer. Lancet Oncology 7:149 156.
Hormones Hsing et al. (2001) Hormones and Prostate Cancer: What s Next? Epidemiologic Reviews (23(1): 42 58. Endogenous Hormones and Prostate Cancer Collaborative Group. (2008) Endogenous Sex Hormones and Prostate Cancer: A Collaborative Analysis of 18 Prospective Studies. J Natl Cancer Inst. 100 (3) 170 183. And accompanying editorial by Carpenter et al in JNCI 100 (3): 158 159. Hsing et al. (2008) Androgen and prostate cancer: is the hypothesis dead? Cancer Epidemiol Biomarkers Prev 17 (10: 2525 2530.