1
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Berg CD, Schiller JH, Boffetta P, Cai J, Connolly C, Kerpel-Fronius A, Kitts AB, Lam DCL, Mohan A, Myers R, Suri T, Tammemagi MC, Yang D, Lam S. Air Pollution and Lung Cancer: A Review by International Association for the Study of Lung Cancer Early Detection and Screening Committee. J Thorac Oncol 2023; 18:1277-1289. [PMID: 37277094 DOI: 10.1016/j.jtho.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The second leading cause of lung cancer is air pollution. Air pollution and smoking are synergistic. Air pollution can worsen lung cancer survival. METHODS The Early Detection and Screening Committee of the International Association for the Study of Lung Cancer formed a working group to better understand issues in air pollution and lung cancer. These included identification of air pollutants, their measurement, and proposed mechanisms of carcinogenesis. The burden of disease and the underlying epidemiologic evidence linking air pollution to lung cancer in individuals who never and ever smoked were summarized to quantify the problem, assess risk prediction models, and develop recommended actions. RESULTS The number of estimated attributable lung cancer deaths has increased by nearly 30% since 2007 as smoking has decreased and air pollution has increased. In 2013, the International Agency for Research on Cancer classified outdoor air pollution and particulate matter with aerodynamic diameter less than 2.5 microns in outdoor air pollution as carcinogenic to humans (International Agency for Research on Cancer group 1) and as a cause of lung cancer. Lung cancer risk models reviewed do not include air pollution. Estimation of cumulative exposure to air pollution exposure is complex which poses major challenges with accurately collecting long-term exposure to ambient air pollution for incorporation into risk prediction models in clinical practice. CONCLUSIONS Worldwide air pollution levels vary widely, and the exposed populations also differ. Advocacy to lower sources of exposure is important. Health care can lower its environmental footprint, becoming more sustainable and resilient. The International Association for the Study of Lung Cancer community can engage broadly on this topic.
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Affiliation(s)
| | - Joan H Schiller
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York
| | - Jing Cai
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China
| | - Casey Connolly
- The International Association for the Study of Lung Cancer, Denver, Colorado
| | - Anna Kerpel-Fronius
- Department of Radiology National Korányi Institute for Pulmonology, Budapest, Hungary
| | | | - David C L Lam
- University Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Anant Mohan
- Department of Pulmonary Medicine, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Renelle Myers
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Tejas Suri
- Department of Pulmonary Medicine, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Martin C Tammemagi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Dawei Yang
- Department of Pulmonary Medicine and Critical Care, Zhongshan Hospital Fudan University, Shanghai, People's Republic of China
| | - Stephen Lam
- Department of Medicine, British Columbia Cancer Agency and The University of British Columbia, Vancouver, British Columbia, Canada
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2
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Hill W, Lim EL, Weeden CE, Lee C, Augustine M, Chen K, Kuan FC, Marongiu F, Evans EJ, Moore DA, Rodrigues FS, Pich O, Bakker B, Cha H, Myers R, van Maldegem F, Boumelha J, Veeriah S, Rowan A, Naceur-Lombardelli C, Karasaki T, Sivakumar M, De S, Caswell DR, Nagano A, Black JRM, Martínez-Ruiz C, Ryu MH, Huff RD, Li S, Favé MJ, Magness A, Suárez-Bonnet A, Priestnall SL, Lüchtenborg M, Lavelle K, Pethick J, Hardy S, McRonald FE, Lin MH, Troccoli CI, Ghosh M, Miller YE, Merrick DT, Keith RL, Al Bakir M, Bailey C, Hill MS, Saal LH, Chen Y, George AM, Abbosh C, Kanu N, Lee SH, McGranahan N, Berg CD, Sasieni P, Houlston R, Turnbull C, Lam S, Awadalla P, Grönroos E, Downward J, Jacks T, Carlsten C, Malanchi I, Hackshaw A, Litchfield K, DeGregori J, Jamal-Hanjani M, Swanton C. Lung adenocarcinoma promotion by air pollutants. Nature 2023; 616:159-167. [PMID: 37020004 PMCID: PMC7614604 DOI: 10.1038/s41586-023-05874-3] [Citation(s) in RCA: 112] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 02/21/2023] [Indexed: 04/07/2023]
Abstract
A complete understanding of how exposure to environmental substances promotes cancer formation is lacking. More than 70 years ago, tumorigenesis was proposed to occur in a two-step process: an initiating step that induces mutations in healthy cells, followed by a promoter step that triggers cancer development1. Here we propose that environmental particulate matter measuring ≤2.5 μm (PM2.5), known to be associated with lung cancer risk, promotes lung cancer by acting on cells that harbour pre-existing oncogenic mutations in healthy lung tissue. Focusing on EGFR-driven lung cancer, which is more common in never-smokers or light smokers, we found a significant association between PM2.5 levels and the incidence of lung cancer for 32,957 EGFR-driven lung cancer cases in four within-country cohorts. Functional mouse models revealed that air pollutants cause an influx of macrophages into the lung and release of interleukin-1β. This process results in a progenitor-like cell state within EGFR mutant lung alveolar type II epithelial cells that fuels tumorigenesis. Ultradeep mutational profiling of histologically normal lung tissue from 295 individuals across 3 clinical cohorts revealed oncogenic EGFR and KRAS driver mutations in 18% and 53% of healthy tissue samples, respectively. These findings collectively support a tumour-promoting role for PM2.5 air pollutants and provide impetus for public health policy initiatives to address air pollution to reduce disease burden.
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Affiliation(s)
- William Hill
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Emilia L Lim
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Clare E Weeden
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Claudia Lee
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Division of Medicine, University College London, London, UK
| | - Marcellus Augustine
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Division of Medicine, University College London, London, UK
- Tumour Immunogenomics and Immunosurveillance Laboratory, University College London Cancer Institute, London, UK
| | - Kezhong Chen
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Department of Thoracic Surgery and Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Feng-Che Kuan
- Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang-Gung University, Taoyuan, Taiwan
| | - Fabio Marongiu
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Edward J Evans
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David A Moore
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Department of Cellular Pathology, University College London Hospitals, London, UK
| | - Felipe S Rodrigues
- Tumour-Host Interaction Laboratory, The Francis Crick Institute, London, UK
| | - Oriol Pich
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Bjorn Bakker
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Hongui Cha
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Renelle Myers
- BC Cancer Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Febe van Maldegem
- Oncogene Biology Laboratory, The Francis Crick Institute, London, UK
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jesse Boumelha
- Oncogene Biology Laboratory, The Francis Crick Institute, London, UK
| | - Selvaraju Veeriah
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Andrew Rowan
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | | | - Takahiro Karasaki
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK
| | - Monica Sivakumar
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Swapnanil De
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Deborah R Caswell
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Ai Nagano
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - James R M Black
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Carlos Martínez-Ruiz
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Min Hyung Ryu
- Department of Medicine, Division of Respiratory Medicine, Chan-Yeung Centre for Occupational and Environmental Respiratory Disease, Vancouver Coastal Health Research Institute, UBC, Vancouver, British Columbia, Canada
| | - Ryan D Huff
- Department of Medicine, Division of Respiratory Medicine, Chan-Yeung Centre for Occupational and Environmental Respiratory Disease, Vancouver Coastal Health Research Institute, UBC, Vancouver, British Columbia, Canada
| | - Shijia Li
- Department of Medicine, Division of Respiratory Medicine, Chan-Yeung Centre for Occupational and Environmental Respiratory Disease, Vancouver Coastal Health Research Institute, UBC, Vancouver, British Columbia, Canada
| | | | - Alastair Magness
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Alejandro Suárez-Bonnet
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
- Experimental Histopathology, The Francis Crick Institute, London, UK
| | - Simon L Priestnall
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
- Experimental Histopathology, The Francis Crick Institute, London, UK
| | - Margreet Lüchtenborg
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
- Centre for Cancer, Society and Public Health, Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Katrina Lavelle
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
| | - Joanna Pethick
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
| | - Steven Hardy
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
| | - Fiona E McRonald
- National Disease Registration Service (NDRS), NHS England, Leeds, UK
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Clara I Troccoli
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Flagship Biosciences, Boulder, CO, USA
| | - Moumita Ghosh
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - York E Miller
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Veterans Affairs Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Daniel T Merrick
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert L Keith
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Veterans Affairs Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Maise Al Bakir
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Chris Bailey
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Mark S Hill
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Lao H Saal
- SAGA Diagnostics, Lund, Sweden
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Yilun Chen
- SAGA Diagnostics, Lund, Sweden
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anthony M George
- SAGA Diagnostics, Lund, Sweden
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Christopher Abbosh
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Nnennaya Kanu
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nicholas McGranahan
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Genome Evolution Research Group, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | | | - Peter Sasieni
- Comprehensive Cancer Centre, King's College London, London, UK
| | - Richard Houlston
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Stephen Lam
- BC Cancer Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Eva Grönroos
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Julian Downward
- Oncogene Biology Laboratory, The Francis Crick Institute, London, UK
| | - Tyler Jacks
- David H. Koch Institute for Integrative Cancer Research, Cambridge, MA, USA
- Department of Biology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christopher Carlsten
- Department of Medicine, Division of Respiratory Medicine, Chan-Yeung Centre for Occupational and Environmental Respiratory Disease, Vancouver Coastal Health Research Institute, UBC, Vancouver, British Columbia, Canada
| | - Ilaria Malanchi
- Tumour-Host Interaction Laboratory, The Francis Crick Institute, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - Kevin Litchfield
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Tumour Immunogenomics and Immunosurveillance Laboratory, University College London Cancer Institute, London, UK
| | - James DeGregori
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mariam Jamal-Hanjani
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK
- Department of Oncology, University College London Hospitals, London, UK
| | - Charles Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK.
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK.
- Department of Oncology, University College London Hospitals, London, UK.
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3
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Robbins HA, Alcala K, Moez EK, Guida F, Thomas S, Zahed H, Warkentin MT, Smith-Byrne K, Brhane Y, Muller D, Feng X, Albanes D, Aldrich MC, Arslan AA, Bassett J, Berg CD, Cai Q, Chen C, Davies MPA, Diergaarde B, Field JK, Freedman ND, Huang WY, Johansson M, Jones M, Koh WP, Lam S, Lan Q, Langhammer A, Liao LM, Liu G, Malekzadeh R, Milne RL, Montuenga LM, Rohan T, Sesso HD, Severi G, Sheikh M, Sinha R, Shu XO, Stevens VL, Tammemägi MC, Tinker LF, Visvanathan K, Wang Y, Wang R, Weinstein SJ, White E, Wilson D, Yuan JM, Zhang X, Zheng W, Amos CI, Brennan P, Johansson M, Hung RJ. Design and methodological considerations for biomarker discovery and validation in the Integrative Analysis of Lung Cancer Etiology and Risk (INTEGRAL) Program. Ann Epidemiol 2023; 77:1-12. [PMID: 36404465 PMCID: PMC9835888 DOI: 10.1016/j.annepidem.2022.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 01/21/2023]
Abstract
The Integrative Analysis of Lung Cancer Etiology and Risk (INTEGRAL) program is an NCI-funded initiative with an objective to develop tools to optimize low-dose CT (LDCT) lung cancer screening. Here, we describe the rationale and design for the Risk Biomarker and Nodule Malignancy projects within INTEGRAL. The overarching goal of these projects is to systematically investigate circulating protein markers to include on a panel for use (i) pre-LDCT, to identify people likely to benefit from screening, and (ii) post-LDCT, to differentiate benign versus malignant nodules. To identify informative proteins, the Risk Biomarker project measured 1161 proteins in a nested-case control study within 2 prospective cohorts (n = 252 lung cancer cases and 252 controls) and replicated associations for a subset of proteins in 4 cohorts (n = 479 cases and 479 controls). Eligible participants had a current or former history of smoking and cases were diagnosed up to 3 years following blood draw. The Nodule Malignancy project measured 1078 proteins among participants with a heavy smoking history within four LDCT screening studies (n = 425 cases diagnosed up to 5 years following blood draw, 430 benign-nodule controls, and 398 nodule-free controls). The INTEGRAL panel will enable absolute quantification of 21 proteins. We will evaluate its performance in the Risk Biomarker project using a case-cohort study including 14 cohorts (n = 1696 cases and 2926 subcohort representatives), and in the Nodule Malignancy project within five LDCT screening studies (n = 675 cases, 680 benign-nodule controls, and 648 nodule-free controls). Future progress to advance lung cancer early detection biomarkers will require carefully designed validation, translational, and comparative studies.
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Affiliation(s)
- Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France.
| | - Karine Alcala
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Elham Khodayari Moez
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Florence Guida
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Sera Thomas
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Hana Zahed
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Matthew T Warkentin
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Yonathan Brhane
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - David Muller
- Division of Genetic Medicine, Imperial College London School of Public Health, London, UK
| | - Xiaoshuang Feng
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Melinda C Aldrich
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Alan A Arslan
- Departments of Obstetrics and Gynecology and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Julie Bassett
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | | | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Chu Chen
- Program in Epidemiology and the Women's Health Initiative Clinical Coordinating Center, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Michael P A Davies
- Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Brenda Diergaarde
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; UPMC Hillman Cancer Centre, Pittsburgh, PA
| | - John K Field
- Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Mikael Johansson
- Department of Radiation Sciences, Oncology, Umea University, Umea, Sweden
| | - Michael Jones
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Stephen Lam
- Integrative Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Arnulf Langhammer
- HUNT Research Center, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Geoffrey Liu
- Computational Biology and Medicine Program, Princess Margaret Cancer Center, Toronto, Canada
| | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Luis M Montuenga
- Center of Applied Medical Research (CIMA) and Schools of Sciences and Medicine, University of Navarra, Pamplona, Spain; IDISNA, Pamplona, Spain; CIBERONC, Madrid, Spain
| | - Thomas Rohan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Howard D Sesso
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Mahdi Sheikh
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St. Cathaarines, ON, Canada; Prevention and Cancer Control, Ontario Health, Toronto, ON, Canada
| | - Lesley F Tinker
- Women's Health Initiative Clinical Coordinating Center, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ying Wang
- American Cancer Society, Atlanta, GA
| | - Renwei Wang
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA
| | - Stephanie J Weinstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Emily White
- Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - David Wilson
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Jian-Min Yuan
- Department of Epidemiology, Graduate Schoolf of Public Health, University of Pittsburgh, Pittsburgh, PA; UPMC Hillman Cancer Centre, Pittsburgh, PA
| | - Xuehong Zhang
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher I Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX
| | - Paul Brennan
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Mattias Johansson
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France.
| | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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4
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Lichter KE, Anderson J, Sim AJ, Baniel CC, Thiel CL, Chuter R, Collins A, Carollo E, Berg CD, Coleman CN, Abdel-Wahab M, Grover S, Singer L, Mohamad O. Transitioning to Environmentally Sustainable, Climate-Smart Radiation Oncology Care. Int J Radiat Oncol Biol Phys 2022; 113:915-924. [PMID: 35841919 PMCID: PMC10024638 DOI: 10.1016/j.ijrobp.2022.04.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/28/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Katie E Lichter
- Department of Radiation Oncology, University of California, San Francisco, California.
| | - Justin Anderson
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Austin J Sim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida; Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Claire C Baniel
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Cassandra L Thiel
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Robert Chuter
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Amy Collins
- Health Care Without Harm, Reston, Virginia; Department of Emergency Medicine, MetroWest Medical Center, Framingham, Massachusetts
| | - Erin Carollo
- Loyola University Chicago-Stritch School of Medicine, Chicago, Illinois
| | | | - C Norman Coleman
- Radiation Research Program, National Cancer Institute, Bethesda, Maryland
| | - May Abdel-Wahab
- Division of Human Health, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Botswana-UPenn Partnership, Philadelphia, Pennsylvania
| | - Lisa Singer
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Osama Mohamad
- Department of Radiation Oncology, University of California, San Francisco, California; Department of Urology, University of California, San Francisco, California
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5
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Salem DP, Bortolin LT, Banerjee S, Biette KM, Byrne DM, Couvillon AD, Duff PA, Grosha J, Gusenleitner D, King MS, Sedlak CR, Zabroski IO, Copeland K, Winn-Deen ES, Huang EK, Berg CD, Sedlak JC. Abstract 2232: Preliminary results for a novel single extracellular vesicle assay for early lung cancer: The power of co-localized detection of surface biomarkers. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-2232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Screening for lung cancer (LC), the leading cause of cancer deaths, with helical computerized tomography lowers mortality but uptake is poor. Investigations into new approaches such as using circulating tumor cells and circulating tumor DNA for LC detection have soared in the last decade. However, the low abundance of these targets has limited the performance of these approaches as screening tools. We hypothesize that co-localization of biomarkers on the surface of individual extracellular vesicles (EVs), which are shed into the circulation by cancer cells, may lead to development of a blood test for early stage LC. We evaluated the potential of our approach in detecting early stage LC in clinical samples.
Methods: EVs were purified from plasma using size-exclusion chromatography and immunoaffinity capture, and biomarkers co-localized on the EV surface were detected with proximity ligation qPCR. We used antibody combinations comprising 1 capture antibody and 2 oligonucleotide-tagged detection antibodies, recognizing 1, 2 or 3 unique biomarkers. We evaluated this approach by testing plasma samples from early stage I/II lung adenocarcinoma (LUAD) patients (15 smokers, 19 non-smokers), late stage III/IV LUAD patients (16 smokers, 18 non-smokers), and healthy donors (34 smokers, 33 non-smokers). Samples were from one vendor, processed using a standardized protocol. LUAD samples were sourced from a cancer research center and healthy samples from a primary care facility. PCR cycle threshold (Ct) values were generated for each combination and data was evaluated using univariate analysis.
Results: Combinations recognizing 3 biomarkers were better in detecting all stages of LUAD (AUC=0.83, 95% CI 0.77-0.90), as compared to combinations recognizing 2 biomarkers (AUC=0.71, 95% CI 0.63-0.80) or 1 biomarker (AUC=0.50, 95% CI 0.35-0.55), demonstrating greater accuracy with an increasing number of co-localized biomarkers. In detecting LUAD (all stages) at a specificity of 0.80 (95% CI 0.69-0.88), sensitivity improved as the number of co-localized biomarkers increased from 1 (0.08, 95% CI 0.03-0.18) to 2 (0.60, 95% CI 0.48-0.72) to 3 (0.76, 95% CI 0.65-0.86). In detecting early stage I/II LUAD, the most effective combination used 3 biomarkers (STn, MUC1, CEACAM6) and had a sensitivity of 0.56 (95% CI 0.38-0.73).
Conclusions: These preliminary data highlight the potential of detecting biomarkers co-localized on the surface of single EVs as an effective tool for early stage LC detection, and the benefit of using 3 biomarkers simultaneously. Despite inherent challenges associated with commercial samples, our finding that detection of co-localized EV surface biomarkers distinguished LUAD is promising. Additional studies with LC cohorts beyond LUAD are underway to refine combinations and independently validate our assay for early stage LC detection.
Citation Format: Daniel P. Salem, Laura T. Bortolin, Sanchari Banerjee, Kelly M. Biette, Delaney M. Byrne, Anthony D. Couvillon, Peter A. Duff, Jonian Grosha, Daniel Gusenleitner, MacKenzie Sadie King, Christopher R. Sedlak, Ibukunoluwapo O. Zabroski, Karen Copeland, Emily S. Winn-Deen, Eric K. Huang, Christine D. Berg, Joseph C. Sedlak. Preliminary results for a novel single extracellular vesicle assay for early lung cancer: The power of co-localized detection of surface biomarkers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2232.
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Robbins HA, Cheung LC, Chaturvedi AK, Baldwin DR, Berg CD, Katki HA. Management of Lung Cancer Screening Results Based on Individual Prediction of Current and Future Lung Cancer Risks. J Thorac Oncol 2022; 17:252-263. [PMID: 34648946 PMCID: PMC10186153 DOI: 10.1016/j.jtho.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/03/2021] [Accepted: 10/04/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We propose a risk-tailored approach for management of lung cancer screening results. This approach incorporates individual risk factors and low-dose computed tomography (LDCT) image features into calculations of immediate and next-screen (1-y) risks of lung cancer detection, which in turn can recommend short-interval imaging or 1-year or 2-year screening intervals. METHODS We first extended the "LCRAT+CT" individualized risk calculator to predict lung cancer risk after either a negative or abnormal LDCT screen result. To develop the abnormal screen portion, we analyzed 18,129 abnormal LDCT results in the National Lung Screening Trial (NLST), including lung cancers detected immediately (n = 649) or at the next screen (n = 235). We estimated the potential impact of this approach among NLST participants with any screen result (negative or abnormal). RESULTS Applying the draft National Health Service (NHS) England protocol for lung screening to NLST participants referred 76% of participants to a 2-year interval, but delayed diagnosis for 40% of detectable cancers. The Lung Cancer Risk Assessment Tool+Computed Tomography (LCRAT+CT) risk model, with a threshold of less than 0.95% cumulative lung cancer risk, would also refer 76% of participants to a 2-year interval, but would delay diagnosis for only 30% of cancers, a 25% reduction versus the NHS protocol. Alternatively, LCRAT+CT, with a threshold of less than 1.7% cumulative lung cancer risk, would also delay diagnosis for 40% of cancers, but would refer 85% of participants for a 2-year interval, a 38% further reduction in the number of required 1-year screens beyond the NHS protocol. CONCLUSIONS Using individualized risk models to determine management in lung cancer screening could substantially reduce the number of screens or increase early detection.
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Affiliation(s)
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Anil K. Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | | | - Christine D. Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Hormuzd A. Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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Young CD, Cheung LC, Berg CD, Rivera P, Robbins HA, Chaturvedi AK, Katki HA, Landy R. Abstract PR-13: Potential effect on racial/ethnic disparities of removing racial/ethnic variables from risk models: The example of lung-cancer screening. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-pr-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Some uses of “race correction” in clinical algorithms and prediction models unfairly reduce access to care, resulting in calls to remove racial/ethnic variables from all models and algorithms. However, for models that are based on unbiased, high-quality, and plentiful data, removing racial/ethnic variables may reduce prediction accuracy for minorities. We model racial/ethnic disparities in screening eligibility from augmenting USPSTF-2021 guidelines (ages 50-80, ≥20 pack-years, ≤15 quit-years) to also include individuals selected by an NCCN-recommended risk model that includes race (PLCOM2012) versus the same model with race/ethnicity removed (PLCOM2012_NoRace). Methods: We used previously published methodology to model the performance of lung cancer screening using 6915 ever-smokers ages 50-80 from the US-representative 2015 National Health Interview Survey (NHIS). Individuals were considered eligible for screening if they are eligible by USPSTF-2021 guidelines or by PLCOM2012 (“USPSTF+PLCOM2012”), versus being eligible by USPSTF-2021 or PLCOM2012_NoRace (“USPSTF+PLCOM2012_NoRace”). Both models used the NCCN-recommended ≥1.3% 6-year risk-threshold for eligibility. We evaluated model accuracy (average percent over/under-estimation) by race/ethnicity, estimated the proportion of life-years gainable achieved by each eligible cohort (LYG), and evaluated the LYG disparity (difference in LYG between whites and each minority). Results: USPSTF+PLCOM2012 and USPSTF+PLCOM2012_NoRace identified similar numbers of minorities as eligible for screening (~2.7 million). However, USPSTF+PLCOM2012_NoRace selected 125% more Hispanic-Americans and 31% less African-Americans. LYG disparities decreased using USPSTF+PLCOM2012_NoRace versus USPSTF+PLCOM2012 for Hispanic Americans (LYG: 33% to 29%). However, LYG disparities for African Americans increased (LYG: 16% to 18%). PLCOM2012 underestimated lung cancer risk by 49% for Hispanic-Americans, whereas PLCOM2012_NoRace performed well (4% overestimation). However, PLCOM2012underestimated risk in African-Americans by only 6%, PLCOM2012_NoRace underestimated risk in African-Americans by 36%. Conclusion: The model that was most accurate for a minority group was projected to reduce disparities the most for that group. Removing race from the PLCOM2012 model substantially underestimated risk for African-Americans and may increase disparities. Inexplicably, PLCOM2012 substantially underestimated risk in Hispanic-Americans despite including race/ethnicity, which was alleviated by removing race/ethnicity. Great care must be taken when removing racial/ethnic variables from models, because this will assign minorities risk estimates that may be largely, or entirely, based on the majority population.
Citation Format: Corey D. Young, Li C. Cheung, Christine D. Berg, Patricia Rivera, Hilary A. Robbins, Anil K. Chaturvedi, Hormuzd A. Katki, Rebecca Landy. Potential effect on racial/ethnic disparities of removing racial/ethnic variables from risk models: The example of lung-cancer screening [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR-13.
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Affiliation(s)
| | - Li C. Cheung
- 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD,
| | - Christine D. Berg
- 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD,
| | - Patricia Rivera
- 3Division of Pulmonary and Critical Care Medicine University of North Carolina at Chapel Hill, Chapel Hill, NC,
| | | | - Anil K. Chaturvedi
- 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD,
| | - Hormuzd A. Katki
- 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD,
| | - Rebecca Landy
- 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD,
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Tammemägi MC, Ruparel M, Tremblay A, Myers R, Mayo J, Yee J, Atkar-Khattra S, Yuan R, Cressman S, English J, Bedard E, MacEachern P, Burrowes P, Quaife SL, Marshall H, Yang I, Bowman R, Passmore L, McWilliams A, Brims F, Lim KP, Mo L, Melsom S, Saffar B, Teh M, Sheehan R, Kuok Y, Manser R, Irving L, Steinfort D, McCusker M, Pascoe D, Fogarty P, Stone E, Lam DCL, Ng MY, Vardhanabhuti V, Berg CD, Hung RJ, Janes SM, Fong K, Lam S. USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort study. Lancet Oncol 2022; 23:138-148. [PMID: 34902336 PMCID: PMC8716337 DOI: 10.1016/s1470-2045(21)00590-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lung cancer is a major health problem. CT lung screening can reduce lung cancer mortality through early diagnosis by at least 20%. Screening high-risk individuals is most effective. Retrospective analyses suggest that identifying individuals for screening by accurate prediction models is more efficient than using categorical age-smoking criteria, such as the US Preventive Services Task Force (USPSTF) criteria. This study prospectively compared the effectiveness of the USPSTF2013 and PLCOm2012 model eligibility criteria. METHODS In this prospective cohort study, participants from the International Lung Screening Trial (ILST), aged 55-80 years, who were current or former smokers (ie, had ≥30 pack-years smoking history or ≤15 quit-years since last permanently quitting), and who met USPSTF2013 criteria or a PLCOm2012 risk threshold of at least 1·51% within 6 years of screening, were recruited from nine screening sites in Canada, Australia, Hong Kong, and the UK. After enrolment, patients were assessed with the USPSTF2013 criteria and the PLCOm2012 risk model with a threshold of at least 1·70% at 6 years. Data were collected locally and centralised. Main outcomes were the comparison of lung cancer detection rates and cumulative life expectancies in patients with lung cancer between USPSTF2013 criteria and the PLCOm2012 model. In this Article, we present data from an interim analysis. To estimate the incidence of lung cancers in individuals who were USPSTF2013-negative and had PLCOm2012 of less than 1·51% at 6 years, ever-smokers in the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO) who met these criteria and their lung cancer incidence were applied to the ILST sample size for the mean follow-up occurring in the ILST. This trial is registered at ClinicalTrials.gov, NCT02871856. Study enrolment is almost complete. FINDINGS Between June 17, 2015, and Dec 29, 2020, 5819 participants from the International Lung Screening Trial (ILST) were enrolled on the basis of meeting USPSTF2013 criteria or the PLCOm2012 risk threshold of at least 1·51% at 6 years. The same number of individuals was selected for the PLCOm2012 model as for the USPSTF2013 criteria (4540 [78%] of 5819). After a mean follow-up of 2·3 years (SD 1·0), 135 lung cancers occurred in 4540 USPSTF2013-positive participants and 162 in 4540 participants included in the PLCOm2012 of at least 1·70% at 6 years group (cancer sensitivity difference 15·8%, 95% CI 10·7-22·1%; absolute odds ratio 4·00, 95% CI 1·89-9·44; p<0·0001). Compared to USPSTF2013-positive individuals, PLCOm2012-selected participants were older (mean age 65·7 years [SD 5·9] vs 63·3 years [5·7]; p<0·0001), had more comorbidities (median 2 [IQR 1-3] vs 1 [1-2]; p<0·0001), and shorter life expectancy (13·9 years [95% CI 12·8-14·9] vs 14·8 [13·6-16·0] years). Model-based difference in cumulative life expectancies for those diagnosed with lung cancer were higher in those who had PLCOm2012 risk of at least 1·70% at 6 years than individuals who were USPSTF2013-positive (2248·6 years [95% CI 2089·6-2425·9] vs 2000·7 years [1841·2-2160·3]; difference 247·9 years, p=0·015). INTERPRETATION PLCOm2012 appears to be more efficient than the USPSTF2013 criteria for selecting individuals to enrol into lung cancer screening programmes and should be used for identifying high-risk individuals who benefit from the inclusion in these programmes. FUNDING Terry Fox Research Institute, The UBC-VGH Hospital Foundation and the BC Cancer Foundation, the Alberta Cancer Foundation, the Australian National Health and Medical Research Council, Cancer Research UK and a consortium of funders, and the Roy Castle Lung Cancer Foundation for the UK Lung Screen Uptake Trial.
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Affiliation(s)
- Martin C Tammemägi
- Department of Health Sciences, Brock University, St Catharines, ON, Canada.
| | - Mamta Ruparel
- Lungs for Living, UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Alain Tremblay
- Division of Respiratory Medicine & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Renelle Myers
- BC Cancer Research Centre, Integrative Oncology, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Mayo
- Department of Radiology, Vancouver, BC, Canada
| | - John Yee
- Department of Thoracic Surgery, Vancouver, BC, Canada
| | | | - Ren Yuan
- Vancouver Coastal Health, Vancouver, BC, Canada; Department of Radiology, BC Cancer, Vancouver, BC, Canada
| | - Sonya Cressman
- Centre for Epidemiology and Evaluation, SFU, Burnaby, BC, Canada
| | | | - Eric Bedard
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Paul MacEachern
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul Burrowes
- Department of Diagnostic Imaging, Foothills Medical Center, Calgary, AB, Canada
| | - Samantha L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Henry Marshall
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Ian Yang
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Rayleen Bowman
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Linda Passmore
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Fraser Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Curtin Medical School, National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, WA, Australia
| | - Kuan Pin Lim
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Lin Mo
- Royal Darwin Hospital, Tiwi, NT, Australia
| | - Stephen Melsom
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Bann Saffar
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Mark Teh
- Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Ramon Sheehan
- Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Yijin Kuok
- Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Renee Manser
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Mark McCusker
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Diane Pascoe
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Paul Fogarty
- Epworth Internal Medicine Clinical Institute, Melbourne VIC, Australia
| | - Emily Stone
- St Vincent's Hospital, Kinghorn Cancer Centre, University of New South Wales, Sydney, NSW, Australia
| | - David C L Lam
- Department of Medicine, University of Hong Kong, Hong Kong
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong
| | | | | | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Samuel M Janes
- Lungs for Living, UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Kwun Fong
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Stephen Lam
- BC Cancer Research Centre, Integrative Oncology, Vancouver, BC, Canada
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Landy R, Young CD, Skarzynski M, Cheung LC, Berg CD, Rivera MP, Robbins HA, Chaturvedi AK, Katki HA. Using Prediction Models to Reduce Persistent Racial and Ethnic Disparities in the Draft 2020 USPSTF Lung Cancer Screening Guidelines. J Natl Cancer Inst 2021; 113:1590-1594. [PMID: 33399825 PMCID: PMC8562965 DOI: 10.1093/jnci/djaa211] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 01/04/2023] Open
Abstract
We examined whether draft 2020 United States Preventive Services Task Force (USPSTF) lung cancer screening recommendations "partially ameliorate racial disparities in screening eligibility" compared with the 2013 guidelines, as claimed. Using data from the 2015 National Health Interview Survey, USPSTF-2020 increased eligibility by similar proportions for minorities (97.1%) and Whites (78.3%). Contrary to the intent of USPSTF-2020, the relative disparity (differences in percentages of model-estimated gainable life-years from National Lung Screening Trial-like screening by eligible Whites vs minorities) actually increased from USPSTF-2013 to USPSTF-2020 (African Americans: 48.3%-33.4% = 15.0% to 64.5%-48.5% = 16.0%; Asian Americans: 48.3%-35.6% = 12.7% to 64.5%-45.2% = 19.3%; Hispanic Americans: 48.3%-24.8% = 23.5% to 64.5%-37.0% = 27.5%). However, augmenting USPSTF-2020 with high-benefit individuals selected by the Life-Years From Screening with Computed Tomography (LYFS-CT) model nearly eliminated disparities for African Americans (76.8%-75.5% = 1.2%) and improved screening efficiency for Asian and Hispanic Americans, although disparities were reduced only slightly (Hispanic Americans) or unchanged (Asian Americans). The draft USPSTF-2020 guidelines increased the number of eligible minorities vs USPSTF-2013 but may inadvertently increase racial and ethnic disparities. LYFS-CT could reduce disparities in screening eligibility by identifying ineligible people with high predicted benefit regardless of race and ethnicity.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Corey D Young
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Martin Skarzynski
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Hackshaw A, Berg CD. An efficient randomised trial design for multi-cancer screening blood tests: nested enhanced mortality outcomes of screening trial. Lancet Oncol 2021; 22:1360-1362. [PMID: 34592178 DOI: 10.1016/s1470-2045(21)00204-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London W1T 4TJ, UK.
| | - Christine D Berg
- Division of Cancer Prevention, US National Cancer Institute, Bethesda, MD, USA; medical consultant, Bethesda, MD, USA
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Hubbell E, Clarke CA, Aravanis AM, Berg CD. Modeled Reductions in Late-stage Cancer with a Multi-Cancer Early Detection Test. Cancer Epidemiol Biomarkers Prev 2020; 30:460-468. [PMID: 33328254 DOI: 10.1158/1055-9965.epi-20-1134] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/23/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer is the second leading cause of death globally, with many cases detected at a late stage when prognosis is poor. New technologies enabling multi-cancer early detection (MCED) may make "universal cancer screening" possible. We extend single-cancer models to understand the potential public health effects of adding a MCED test to usual care. METHODS We obtained data on stage-specific incidence and survival of all invasive cancers diagnosed in persons aged 50-79 between 2006 and 2015 from the US Surveillance, Epidemiology, and End Results (SEER) program, and combined this with published performance of a MCED test in a state transition model (interception model) to predict diagnostic yield, stage shift, and potential mortality reductions. We model long-term (incident) performance, accou.
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Landy R, Young CD, Skarzynski M, Cheung LC, Berg CD, Rivera MP, Robbins HA, Chaturvedi AK, Katki HA. Abstract PO-247: Use of prediction models to reduce racial/ethnic disparities in eligibility for lung-cancer screening. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: For the same age and smoking history as whites, minorities have substantially different lung-cancer risk. However, current US Preventive Services Task Force (USPSTF) lung-cancer screening recommendations make no allowance for race/ethnicity and may induce health disparities. Incorporating individualized prediction-models into USPSTF guidelines may reduce racial/ethnic disparities in lung-cancer screening eligibility. We examine whether expanding current USPSTF lung cancer screening eligibility to include ever-smokers whose risk (calculated by an individualized prediction model) exceeded a threshold would reduce racial/ethnic disparities induced by current USPSTF guidelines. Methods: We used the US- representative 2015 National Health Interview Survey to examine screening eligibility. We identified the thresholds for each of 5 models: lung-cancer risk (Bach, PLCOM2012 and LCRAT models), lung-cancer death risk (LCDRAT model), and life- years gained by attending screening (LYFS-CT model), which select the same number of ever-smokers aged 50-80yrs as USPSTF guidelines. We defined 5 cohorts of ever- smokers as eligible for screening if they were eligible by each screening model or USPSTF guidelines. Among each race/ethnicity, we calculated the number eligible for screening, proportion of preventable lung-cancer deaths prevented (LCD sensitivity), proportion of gainable life-years gained (LYG sensitivity) and screening effectiveness (the number needed to screen to prevent one lung-cancer death). Results: USPSTF criteria performed best for whites (20% eligible, preventing 55% of preventable lung- cancer deaths). Asian-Americans had the least effective screening (NNS=419), only 13% of African-Americans were eligible despite having the most effective screening (NNS=135), and Hispanic-Americans had the lowest percentages eligible (9%) and deaths preventable (30%). Augmenting USPSTF criteria with LCDRAT or LYFS-CT prediction-models nearly equalized the performance of screening for African- Americans with that of whites, doubling the number of African-Americans eligible and increasing the number of preventable deaths and life-years gained by nearly 80%, although at a 25% loss in effectiveness. Prediction-models improved all screening metrics for Asian-Americans and Hispanic-Americans. However models estimated risk more accurately for whites than minorities. Conclusions: Augmenting USPSTF criteria with the LCDRAT or LYFS-CT prediction-models nearly eliminated the white/African-American disparity. All screening metrics were substantially improved for Asian/Hispanic-Americans.
Citation Format: Rebecca Landy, Corey D. Young, Martin Skarzynski, Li C. Cheung, Christine D. Berg, M. Patricia Rivera, Hilary A. Robbins, Anil K. Chaturvedi, Hormuzd A. Katki. Use of prediction models to reduce racial/ethnic disparities in eligibility for lung-cancer screening [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-247.
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Han Y, Albert PS, Berg CD, Wentzensen N, Katki HA, Liu D. Statistical approaches using longitudinal biomarkers for disease early detection: A comparison of methodologies. Stat Med 2020; 39:4405-4420. [PMID: 32939802 PMCID: PMC10086614 DOI: 10.1002/sim.8731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 03/25/2020] [Accepted: 07/24/2020] [Indexed: 11/06/2022]
Abstract
Early detection of clinical outcomes such as cancer may be predicted using longitudinal biomarker measurements. Tracking longitudinal biomarkers as a way to identify early disease onset may help to reduce mortality from diseases like ovarian cancer that are more treatable if detected early. Two disease risk prediction frameworks, the shared random effects model (SREM) and the pattern mixture model (PMM) could be used to assess longitudinal biomarkers on disease early detection. In this article, we studied the discrimination and calibration performances of SREM and PMM on disease early detection through an application to ovarian cancer, where early detection using the risk of ovarian cancer algorithm (ROCA) has been evaluated. Comparisons of the above three approaches were performed via analyses of the ovarian cancer data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Discrimination was evaluated by the time-dependent receiver operating characteristic curve and its area, while calibration was assessed using calibration plot and the ratio of observed to expected number of diseased subjects. The out-of-sample performances were calculated via using leave-one-out cross-validation, aiming to minimize potential model overfitting. A careful analysis of using the biomarker cancer antigen 125 for ovarian cancer early detection showed significantly improved discrimination performance of PMM as compared with SREM and ROCA, nevertheless all approaches were generally well calibrated. Robustness of all approaches was further investigated in extensive simulation studies. The improved performance of PMM relative to ROCA is in part due to the fact that the biomarker measurements were taken at a yearly interval, which is not frequent enough to reliably estimate the changepoint or the slope after changepoint in cases under ROCA.
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Affiliation(s)
- Yongli Han
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Paul S Albert
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Nicolas Wentzensen
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Hormuzd A Katki
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Danping Liu
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
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Robbins HA, Berg CD, Cheung LC, Chaturvedi AK, Katki HA. Identification of Candidates for Longer Lung Cancer Screening Intervals Following a Negative Low-Dose Computed Tomography Result. J Natl Cancer Inst 2020; 111:996-999. [PMID: 30976808 DOI: 10.1093/jnci/djz041] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/23/2019] [Accepted: 02/22/2019] [Indexed: 12/17/2022] Open
Abstract
Lengthening the annual low-dose computed tomography (CT) screening interval for individuals at lowest risk of lung cancer could reduce harms and improve efficiency. We analyzed 23 328 participants in the National Lung Screening Trial who had a negative CT screen (no ≥4-mm nodules) to develop an individualized model for lung cancer risk after a negative CT. The Lung Cancer Risk Assessment Tool + CT (LCRAT+CT) updates "prescreening risk" (calculated using traditional risk factors) with selected CT features. At the next annual screen following a negative CT, risk of cancer detection was reduced among the 70% of participants with neither CT-detected emphysema nor consolidation (median risk = 0.2%, interquartile range [IQR] = 0.1%-0.3%). However, risk increased for the 30% with CT emphysema (median risk = 0.5%, IQR = 0.3%-0.8%) and the 0.6% with consolidation (median = 1.6%, IQR = 1.0%-2.5%). As one example, a threshold of next-screen risk lower than 0.3% would lengthen the interval for 57.8% of screen-negatives, thus averting 49.8% of next-screen false-positives among screen-negatives but delaying diagnosis for 23.9% of cancers. Our results support that many, but not all, screen-negatives might reasonably lengthen their CT screening interval.
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Landy R, Houghton LC, Berg CD, Grubb RL, Katki HA, Black A. Risk of Prostate Cancer-related Death Following a Low PSA Level in the PLCO Trial. Cancer Prev Res (Phila) 2020; 13:367-376. [PMID: 31996370 DOI: 10.1158/1940-6207.capr-19-0397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/23/2019] [Accepted: 01/23/2020] [Indexed: 01/25/2023]
Abstract
Longer-than-annual screening intervals have been suggested to improve the balance of benefits and harms in prostate cancer screening. Many researchers, societies, and guideline committees have suggested that screening intervals could depend on the prostate-specific antigen (PSA) result. We analyzed data from men (N = 33,897) ages 55-74 years with a baseline PSA test in the intervention arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial (United States, 1993-2001). We estimated 5- and 10-year risks of aggressive cancer (Gleason ≥8 and/or stage III/IV) and 15-year risks of prostate cancer-related mortality for men with baseline PSA ≤ 0.5 ng/mL (N = 4,862), ≤1 ng/mL (N = 15,110), and 1.01-2.5 ng/mL (N = 12,422). A total of 217 men died from prostate cancer through 15 years, although no men with PSA ≤ 1 ng/mL died from prostate cancer within 5 years [95% confidence interval (CI), 0.00%-0.03%]. The 5-year incidence of aggressive disease was low (0.08%; 95% CI, 0.03%-0.12%) for men with PSA ≤ 1 ng/mL, and higher for men with baseline PSA 1.01-2.5 ng/mL (0.51%; 95% CI, 0.38%-0.74%). No men aged ≥65 years with PSA ≤ 0.5 ng/mL died from prostate cancer within 15 years (95% CI, 0.00%-0.32%), and their 10-year incidence of aggressive disease was low (0.25%; 95% CI, 0.00%-0.53%). Compared with white men, black men with PSA ≤ 1 ng/mL had higher 10-year rates of aggressive disease (1.6% vs. 0.4%; P < 0.01). Five-year screening intervals may be appropriate for the 45% of men with PSA ≤ 1 ng/mL. Men ages ≥65 years with PSA ≤ 0.5 ng/mL could consider stopping screening. Substantial risk disparities suggest appropriate screening intervals could depend on race/ethnicity.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
| | - Lauren C Houghton
- Mailman School of Public Health, Columbia University, New York, New York
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Robert L Grubb
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland.
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Abstract
BACKGROUND Although risk-based selection of ever-smokers for screening could prevent more lung cancer deaths than screening according to the U.S. Preventive Services Task Force (USPSTF) guidelines, it preferentially selects older ever-smokers with shorter life expectancies due to comorbidities. OBJECTIVE To compare selection of ever-smokers for screening based on gains in life expectancy versus lung cancer risk. DESIGN Cohort analyses and model-based projections. SETTING U.S. population of ever-smokers aged 40 to 84 years. PARTICIPANTS 130 964 National Health Interview Survey participants, representing about 60 million U.S. ever-smokers during 1997 to 2015. INTERVENTION Annual computed tomography (CT) screening for 3 years versus no screening. MEASUREMENTS Estimated number of lung cancer deaths averted and life-years gained after development of a mortality model. RESULTS Using the calibrated and validated mortality model in U.S. ever-smokers aged 40 to 84 years and selecting 8.3 million ever-smokers to match the number selected by the USPSTF criteria in 2013 to 2015, the analysis estimated that life-gained-based selection would increase the total life expectancy from CT screening (633 400 vs. 607 800 years) but prevent fewer lung cancer deaths (52 600 vs. 55 000) compared with risk-based selection. The 1.56 million persons selected by the life-gained-based strategy but not the risk-based strategy were younger (mean age, 59 vs. 75 years) and had fewer comorbidities (mean, 0.75 vs. 3.7). LIMITATION Estimates are model-based and assume implementation of lung cancer screening with short-term effectiveness similar to that from trials. CONCLUSION Life-gained-based selection could maximize the benefits of lung cancer screening in the U.S. population by including ever-smokers who have both high lung cancer risk and long life expectancy. PRIMARY FUNDING SOURCE Intramural Research Program of the National Cancer Institute, National Institutes of Health.
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Affiliation(s)
- Li C Cheung
- National Cancer Institute, Bethesda, Maryland (L.C.C., C.D.B., H.A.K., A.K.C.)
| | - Christine D Berg
- National Cancer Institute, Bethesda, Maryland (L.C.C., C.D.B., H.A.K., A.K.C.)
| | - Philip E Castle
- Albert Einstein School of Medicine, Bronx, New York (P.E.C.)
| | - Hormuzd A Katki
- National Cancer Institute, Bethesda, Maryland (L.C.C., C.D.B., H.A.K., A.K.C.)
| | - Anil K Chaturvedi
- National Cancer Institute, Bethesda, Maryland (L.C.C., C.D.B., H.A.K., A.K.C.)
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Bekelman JE, Lu H, Pugh S, Baker K, Berg CD, Berrington de González A, Braunstein LZ, Bosch W, Chauhan C, Ellenberg S, Fang LC, Freedman GM, Hahn EA, Haffty BG, Khan AJ, Jimenez RB, Kesslering C, Ky B, Lee C, Lu HM, Mishra MV, Mullins CD, Mutter RW, Nagda S, Pankuch M, Powell SN, Prior FW, Schupak K, Taghian AG, Wilkinson JB, MacDonald SM, Cahlon O. Pragmatic randomised clinical trial of proton versus photon therapy for patients with non-metastatic breast cancer: the Radiotherapy Comparative Effectiveness (RadComp) Consortium trial protocol. BMJ Open 2019; 9:e025556. [PMID: 31619413 PMCID: PMC6797426 DOI: 10.1136/bmjopen-2018-025556] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 02/07/2019] [Accepted: 07/26/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION A broad range of stakeholders have called for randomised evidence on the potential clinical benefits and harms of proton therapy, a type of radiation therapy, for patients with breast cancer. Radiation therapy is an important component of curative treatment, reducing cancer recurrence and extending survival. Compared with photon therapy, the international treatment standard, proton therapy reduces incidental radiation to the heart. Our overall objective is to evaluate whether the differences between proton and photon therapy cardiac radiation dose distributions lead to meaningful reductions in cardiac morbidity and mortality after treatment for breast cancer. METHODS We are conducting a large scale, multicentre pragmatic randomised clinical trial for patients with breast cancer who will be followed longitudinally for cardiovascular morbidity and mortality, health-related quality of life and cancer control outcomes. A total of 1278 patients with non-metastatic breast cancer will be randomly allocated to receive either photon or proton therapy. The primary outcomes are major cardiovascular events, defined as myocardial infarction, coronary revascularisation, cardiovascular death or hospitalisation for unstable angina, heart failure, valvular disease, arrhythmia or pericardial disease. Secondary endpoints are urgent or unanticipated outpatient or emergency room visits for heart failure, arrhythmia, valvular disease or pericardial disease. The Radiotherapy Comparative Effectiveness (RadComp) Clinical Events Centre will conduct centralised, blinded adjudication of primary outcome events. ETHICS AND DISSEMINATION The RadComp trial has been approved by the institutional review boards of all participating sites. Recruitment began in February 2016. Current version of the protocol is A3, dated 08 November 2018. Dissemination plans include presentations at scientific conferences, scientific publications, stakeholder engagement efforts and presentation to the public via lay media outlets. TRIAL REGISTRATION NUMBER NCT02603341.
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Affiliation(s)
- Justin E Bekelman
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hien Lu
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Stephanie Pugh
- American College of Radiology, Philadelphia, Pennsylvania, USA
| | - Kaysee Baker
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lior Z Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York city, New York, USA
| | - Walter Bosch
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Susan Ellenberg
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - L Christine Fang
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Gary M Freedman
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University, Evanston, Illinois, USA
| | - B G Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Atif J Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York city, New York, USA
| | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Bonnie Ky
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hsiao-Ming Lu
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark V Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - C Daniel Mullins
- PHSR, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Suneel Nagda
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark Pankuch
- Northwestern Medicine Chicago Proton Center, Warrenville, Illinois, USA
| | - Simon N Powell
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York city, New York, USA
| | - Fred W Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Karen Schupak
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York city, New York, USA
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York city, New York, USA
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Landy R, Cheung LC, Berg CD, Chaturvedi AK, Robbins HA, Katki HA. Contemporary Implications of U.S. Preventive Services Task Force and Risk-Based Guidelines for Lung Cancer Screening Eligibility in the United States. Ann Intern Med 2019; 171:384-386. [PMID: 31158854 PMCID: PMC6822170 DOI: 10.7326/m18-3617] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Rebecca Landy
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland (R.L., L.C.C., C.D.B., A.K.C., H.A.K.)
| | - Li C Cheung
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland (R.L., L.C.C., C.D.B., A.K.C., H.A.K.)
| | - Christine D Berg
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland (R.L., L.C.C., C.D.B., A.K.C., H.A.K.)
| | - Anil K Chaturvedi
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland (R.L., L.C.C., C.D.B., A.K.C., H.A.K.)
| | - Hilary A Robbins
- International Agency for Research on Cancer, Lyon, France (H.A.R.)
| | - Hormuzd A Katki
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland (R.L., L.C.C., C.D.B., A.K.C., H.A.K.)
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Robbins HA, Katki HA, Cheung LC, Landy R, Berg CD. Insights for Management of Ground-Glass Opacities From the National Lung Screening Trial. J Thorac Oncol 2019; 14:1662-1665. [PMID: 31125735 PMCID: PMC6909540 DOI: 10.1016/j.jtho.2019.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/12/2019] [Accepted: 05/11/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the National Lung Screening Trial (NLST), screen-detected cancers that would not have been identified by the Lung Computed Tomographic Screening Reporting and Data System (Lung-RADS) nodule management guidelines were frequently ground-glass opacities (GGOs). Lung-RADS suggests that GGOs with diameter less than 20 mm return for annual screening, and GGOs greater than or equal to 20 mm receive 6-month follow-up. We examined whether this 20-mm threshold gives consistent management of GGOs compared with solid nodules. METHODS First, we calculated diameter-specific malignancy probabilities for GGOs and solid nodules in the NLST. Using the solid-nodule malignancy risks as benchmarks, we suggested risk-based management categories for GGOs based on their probability of malignancy. Second, we compared lung-cancer mortality between GGOs and solid nodules in the same risk-based category. RESULTS Using the Lung-RADS v1.0 classifications, malignancy probability is higher for GGOs than solid nodules within the same category. A risk-based classification of GGOs would assign annual screening for GGOs 4 to 5 mm (0.4% malignancy risk); 6-month follow-up for GGOs 6 to 7 mm (1.1%), 8 to 14 mm (3.0%), and 15 to 19 mm (5.2%); and 3-month follow-up for greater than or equal to 20 mm (10.9%). This reclassification would have assigned similarly fatal cancers to 3-month follow-up (hazard ratio = 2.0 for lung-cancer death in GGOs versus solid-nodule cancers, 95% confidence interval: 0.4-8.7), but for 6-month follow-up, mortality was lower in GGO cancers (hazard ratio = 0.18, 95% confidence interval: 0.05-0.67). CONCLUSIONS If Lung-RADS categories for GGOs were based on malignancy probability, then 6- to 19-mm GGOs would receive 6-month follow-up and greater than or equal to 20-mm GGOs would receive 3-month follow-up. Such risk-based management for GGOs could improve the sensitivity of Lung-RADS, especially for large GGO cancers. However, small GGO cancers were less aggressive than their solid-nodule counterparts.
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Affiliation(s)
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Robbins HA, Callister M, Sasieni P, Quaife SL, Cheung LC, Brennan P, Katki HA, Berg CD, Baldwin D, Johansson M. Benefits and harms in the National Lung Screening Trial: expected outcomes with a modern management protocol. The Lancet Respiratory Medicine 2019; 7:655-656. [PMID: 31076382 PMCID: PMC6992839 DOI: 10.1016/s2213-2600(19)30136-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | | | - Li C Cheung
- National Cancer Institute, Rockville, MD, USA
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
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Wentzensen N, Berg CD. Population Testing for High Penetrance Genes: Are We There Yet? J Natl Cancer Inst 2019; 110:687-689. [PMID: 29401305 DOI: 10.1093/jnci/djx282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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Prorok PC, Wright P, Riley TR, Kramer BS, Berg CD, Gohagan JK. Overall and Multiphasic Findings of the Prostate, Lung, Colorectal and Ovarian (PLCO) Randomized Cancer Screening Trial. Rev Recent Clin Trials 2019; 13:257-273. [PMID: 29629665 DOI: 10.2174/1574887113666180409153059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Screening tests are typically evaluated for a single disease, but multiple tests for multiple diseases are performed in practice. The Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial assessed testing for four cancers simultaneously and can be viewed as a multiphasic cancer intervention. This paper presents overall and multiphasic findings of this trial. METHODS The PLCO trial was a randomized multi-center trial conducted at ten screening centers in the US. Participants were 76,682 men and 78,215 women ages 55 - 74 and free of the target cancers at trial entry. Screening tests were PSA and digital rectal examination for prostate cancer, chest x-ray for lung cancer, flexible sigmoidoscopy for colorectal cancer, CA125 and transvaginal ultrasound for ovarian cancer. Outcomes and harms of screening were assessed including compliance, test results, incidence, mortality, false positives and overdiagnosis. RESULTS Screening compliance was 82%, 72,820 (8%) of 906,064 exams were positive, the overall PPV was 4.2% and the cancer detection rate was 3.38/1000. A mortality reduction was observed only for colorectal cancer (RR 0.72, 95% CI 0.61 - 0.85) with no effect on all-cause mortality. Ninety-six percent of positive exams were falsely positive and there was a suggestion of overdiagnosis of prostate and possibly ovarian cancers. Multiphasic testing resulted in 7374 men and 2748 women experiencing multiple false positive results from multiple types of tests. CONCLUSION Multiphasic cancer screening led to reduced mortality for one target cancer and imposed a burden on the health care system that included substantial false positives and likely overdiagnosis.
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Affiliation(s)
| | - Patrick Wright
- Information Management Services, Inc., Rockville, MD, United States
| | - Thomas R Riley
- Information Management Services, Inc., Rockville, MD, United States
| | | | | | - John K Gohagan
- National Institutes of Health, Bethesda, MD, United States
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Berg CD. Abstract IA08: Individualized risk based lung cancer screening: The way forward. Clin Cancer Res 2018. [DOI: 10.1158/1557-3265.aacriaslc18-ia08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The United States Preventive Services Task Force (USPSTF) recommends annual low-dose computed tomography (CT) lung-cancer screening, as does the Center for Medicare and Medicaid Services (CMS) and many major medical organizations. The USPSTF criteria, similar to those used for entry into the definitive National Lung Screening Trial, are for persons aged 55-80 years, who currently smoke or quit within the past 15 years, and who have accumulated at least 30 pack-years of cigarette smoking. Risk calculators as compared to micro-simulation modeling as used for the USPSTF can more specifically account for demographic, clinical, and smoking characteristics and personalize risk. The USPSTF criteria may miss smokers at high risk for lung cancer who would have been selected for CT screening by individual risk calculators. Recently, the National Comprehensive Cancer Network guidelines for lung cancer screening added consideration of use of risk models to select ever-smokers for screening. Online risk tools are available to assist individuals and health care providers as to whether lung cancer screening may be helpful.
Several lung cancer risk models are available, and comparisons across them have been done. In this presentation, a comparison we performed of the statistical predictive properties of 8 published risk models in 2 large prospective U.S. cohorts will be presented. Identifying a consensus cost-effective risk threshold to define screening eligibility is crucial. Another issue is how best to account for competing morbidities that might make screening less useful. Perhaps a life-years gained approach could help to adjust for this. Additionally, risk models require accurate risk factor data, which are rarely available in electronic health records and may require special collection. It also poses challenges in the health care delivery setting given its complexity.
To better capture high-risk smokers and prevent premature deaths from lung cancer, eligibility for lung cancer screening should be based on exceeding a cost-effective risk threshold that balances CT screening benefits and harms, using a lung cancer risk tool validated in the U.S. population.
Citation Format: Christine D. Berg. Individualized risk based lung cancer screening: The way forward [abstract]. In: Proceedings of the Fifth AACR-IASLC International Joint Conference: Lung Cancer Translational Science from the Bench to the Clinic; Jan 8-11, 2018; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(17_Suppl):Abstract nr IA08.
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Katki HA, Kovalchik SA, Petito LC, Cheung LC, Jacobs E, Jemal A, Berg CD, Chaturvedi AK. Implications of Nine Risk Prediction Models for Selecting Ever-Smokers for Computed Tomography Lung Cancer Screening. Ann Intern Med 2018; 169:10-19. [PMID: 29800127 PMCID: PMC6557386 DOI: 10.7326/m17-2701] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lung cancer screening guidelines recommend using individualized risk models to refer ever-smokers for screening. However, different models select different screening populations. The performance of each model in selecting ever-smokers for screening is unknown. OBJECTIVE To compare the U.S. screening populations selected by 9 lung cancer risk models (the Bach model; the Spitz model; the Liverpool Lung Project [LLP] model; the LLP Incidence Risk Model [LLPi]; the Hoggart model; the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Model 2012 [PLCOM2012]; the Pittsburgh Predictor; the Lung Cancer Risk Assessment Tool [LCRAT]; and the Lung Cancer Death Risk Assessment Tool [LCDRAT]) and to examine their predictive performance in 2 cohorts. DESIGN Population-based prospective studies. SETTING United States. PARTICIPANTS Models selected U.S. screening populations by using data from the National Health Interview Survey from 2010 to 2012. Model performance was evaluated using data from 337 388 ever-smokers in the National Institutes of Health-AARP Diet and Health Study and 72 338 ever-smokers in the CPS-II (Cancer Prevention Study II) Nutrition Survey cohort. MEASUREMENTS Model calibration (ratio of model-predicted to observed cases [expected-observed ratio]) and discrimination (area under the curve [AUC]). RESULTS At a 5-year risk threshold of 2.0%, the models chose U.S. screening populations ranging from 7.6 million to 26 million ever-smokers. These disagreements occurred because, in both validation cohorts, 4 models (the Bach model, PLCOM2012, LCRAT, and LCDRAT) were well-calibrated (expected-observed ratio range, 0.92 to 1.12) and had higher AUCs (range, 0.75 to 0.79) than 5 models that generally overestimated risk (expected-observed ratio range, 0.83 to 3.69) and had lower AUCs (range, 0.62 to 0.75). The 4 best-performing models also had the highest sensitivity at a fixed specificity (and vice versa) and similar discrimination at a fixed risk threshold. These models showed better agreement on size of the screening population (7.6 million to 10.9 million) and achieved consensus on 73% of persons chosen. LIMITATION No consensus on risk thresholds for screening. CONCLUSION The 9 lung cancer risk models chose widely differing U.S. screening populations. However, 4 models (the Bach model, PLCOM2012, LCRAT, and LCDRAT) most accurately predicted risk and performed best in selecting ever-smokers for screening. PRIMARY FUNDING SOURCE Intramural Research Program of the National Institutes of Health/National Cancer Institute.
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Affiliation(s)
- Hormuzd A Katki
- National Cancer Institute, Bethesda, Maryland (H.A.K., S.A.K., L.C.P., L.C.C., C.D.B., A.K.C.)
| | - Stephanie A Kovalchik
- National Cancer Institute, Bethesda, Maryland (H.A.K., S.A.K., L.C.P., L.C.C., C.D.B., A.K.C.)
| | - Lucia C Petito
- National Cancer Institute, Bethesda, Maryland (H.A.K., S.A.K., L.C.P., L.C.C., C.D.B., A.K.C.)
| | - Li C Cheung
- National Cancer Institute, Bethesda, Maryland (H.A.K., S.A.K., L.C.P., L.C.C., C.D.B., A.K.C.)
| | - Eric Jacobs
- American Cancer Society, Atlanta, Georgia (E.J., A.J.)
| | - Ahmedin Jemal
- American Cancer Society, Atlanta, Georgia (E.J., A.J.)
| | - Christine D Berg
- National Cancer Institute, Bethesda, Maryland (H.A.K., S.A.K., L.C.P., L.C.C., C.D.B., A.K.C.)
| | - Anil K Chaturvedi
- National Cancer Institute, Bethesda, Maryland (H.A.K., S.A.K., L.C.P., L.C.C., C.D.B., A.K.C.)
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Cheung LC, Katki HA, Chaturvedi AK, Jemal A, Berg CD. Preventing Lung Cancer Mortality by Computed Tomography Screening: The Effect of Risk-Based Versus U.S. Preventive Services Task Force Eligibility Criteria, 2005-2015. Ann Intern Med 2018; 168:229-232. [PMID: 29297008 PMCID: PMC6785198 DOI: 10.7326/m17-2067] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Li C Cheung
- National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland (L.C.C., H.A.K., A.K.C., C.D.B.)
| | - Hormuzd A Katki
- National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland (L.C.C., H.A.K., A.K.C., C.D.B.)
| | - Anil K Chaturvedi
- National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland (L.C.C., H.A.K., A.K.C., C.D.B.)
| | | | - Christine D Berg
- National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland (L.C.C., H.A.K., A.K.C., C.D.B.)
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27
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Warkentin MT, Tammemägi MC, Freedman MT, Ragard LR, Hocking WG, Kvale PA, Brenner DR, Hu P, Riley TL, Commins J, Church TR, Berg CD. Factors Associated With Small Aggressive Non-Small Cell Lung Cancers in the National Lung Screening Trial: A Validation Study. JNCI Cancer Spectr 2018; 2:pkx010. [PMID: 31360836 PMCID: PMC6649725 DOI: 10.1093/jncics/pkx010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/17/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022] Open
Abstract
Background A small proportion of non-small cell lung cancers (NSCLCs) have been observed to spread to distant lymph nodes (N3) or metastasize (M1) or both, while the primary tumor is small (≤3 cm, T1). These small aggressive NSCLCs (SA-NSLSC) are important as they are clinically significant, may identify unique biologic pathways, and warrant aggressive follow-up and treatment. This study identifies factors associated with SA-NSCLC and attempts to validate a previous finding that women with a family history of lung cancer are at particularly elevated risk of SA-NSCLC. Methods This study used a case-case design within the National Cancer Institute's National Lung Screening Trial (NLST) cohort. Case patients and "control" patients were selected based on TNM staging parameters. Case patients (n = 64) had T1 NSCLCs that were N3 or M1 or both, while "control" patients (n = 206) had T2 or T3, N0 to N2, and M0 NSCLCs. Univariate and multivariable logistic regression were used to identify factors associated with SA-NSCLC. Results In bootstrap bias-corrected multivariable logistic regression models, small aggressive adenocarcinomas were associated with a positive history of emphysema (odds ratio [OR] = 5.15, 95% confidence interval [CI] = 1.63 to 23.00) and the interaction of female sex and a positive family history of lung cancer (OR = 6.55, 95% CI = 1.06 to 50.80). Conclusions Emphysema may play a role in early lung cancer progression. Females with a family history of lung cancer are at increased risk of having small aggressive lung adenocarcinomas. These results validate previous findings and encourage research on the role of female hormones interacting with family history and genetic factors in lung carcinogenesis and progression.
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Affiliation(s)
- Matthew T Warkentin
- Department of Health Sciences, Brock University, St. Catharine's, Ontario, Canada.,Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St. Catharine's, Ontario, Canada
| | - Matthew T Freedman
- Cancer Prevention and Control, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | | | - William G Hocking
- Department of Clinical Oncology, Marshfield Clinic Health System, Marshfield, WI
| | - Paul A Kvale
- Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI
| | - Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Community Health Sciences and Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ping Hu
- Biometry Research Group, National Cancer Institute, Bethesda, MD
| | | | - John Commins
- Information Management Services, Inc., Rockville, MD
| | - Timothy R Church
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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28
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de Koning HJ, Gulati R, Moss SM, Hugosson J, Pinsky PF, Berg CD, Auvinen A, Andriole GL, Roobol MJ, Crawford ED, Nelen V, Kwiatkowski M, Zappa M, Luján M, Villers A, de Carvalho TM, Feuer EJ, Tsodikov A, Mariotto AB, Heijnsdijk EAM, Etzioni R. The efficacy of prostate-specific antigen screening: Impact of key components in the ERSPC and PLCO trials. Cancer 2017; 124:1197-1206. [PMID: 29211316 DOI: 10.1002/cncr.31178] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND The European Randomized Study of Screening for Prostate Cancer (ERSPC) demonstrated that prostate-specific antigen (PSA) screening significantly reduced prostate cancer mortality (rate ratio, 0.79; 95% confidence interval, 0.69-0.91). The US Prostate, Lung, Colorectal, and Ovarian (PLCO) trial indicated no such reduction but had a wide 95% CI (rate ratio for prostate cancer mortality, 1.09; 95% CI, 0.87-1.36). Standard meta-analyses are unable to account for key differences between the trials that can impact the estimated effects of screening and the trials' point estimates. METHODS The authors calibrated 2 microsimulation models to individual-level incidence and mortality data from 238,936 men participating in the ERSPC and PLCO trials. A cure parameter for the underlying efficacy of screening was estimated by the models separately for each trial. The authors changed step-by-step major known differences in trial settings, including enrollment and attendance patterns, screening intervals, PSA thresholds, biopsy receipt, control arm contamination, and primary treatment, to reflect a more ideal protocol situation and differences between the trials. RESULTS Using the cure parameter estimated for the ERSPC, the models projected 19% to 21% and 6% to 8%, respectively, prostate cancer mortality reductions in the ERSPC and PLCO settings. Using this cure parameter, the models projected a reduction of 37% to 43% under annual screening with 100% attendance and biopsy compliance and no contamination. The cure parameter estimated for the PLCO trial was 0. CONCLUSIONS The observed cancer mortality reduction in screening trials appears to be highly sensitive to trial protocol and practice settings. Accounting for these differences, the efficacy of PSA screening in the PLCO setting is not necessarily inconsistent with ERSPC results. Cancer 2018;124:1197-206. © 2017 American Cancer Society.
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Affiliation(s)
- Harry J de Koning
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, Washington
| | - Sue M Moss
- Wolfson Institute, Queen Mary University of London, London, United Kingdom
| | - Jonas Hugosson
- Department of Urology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Christine D Berg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, Maryland
| | - Anssi Auvinen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Gerald L Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Monique J Roobol
- Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Vera Nelen
- Provinciaal Instituut voor Hygiene, Antwerp, Belgium
| | | | - Marco Zappa
- Unit of Epidemiology, Institute for Cancer Prevention, Florence, Italy
| | - Marcos Luján
- Urology Service, Infanta Cristina University Hospital, Complutense University of Madrid, Parla, Madrid, Spain
| | - Arnauld Villers
- Department of Urology, Regional University Hospital Center, Lille, France
| | - Tiago M de Carvalho
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Alex Tsodikov
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, Washington
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29
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Guo Q, Burgess S, Turman C, Bolla MK, Wang Q, Lush M, Abraham J, Aittomäki K, Andrulis IL, Apicella C, Arndt V, Barrdahl M, Benitez J, Berg CD, Blomqvist C, Bojesen SE, Bonanni B, Brand JS, Brenner H, Broeks A, Burwinkel B, Caldas C, Campa D, Canzian F, Chang-Claude J, Chanock SJ, Chin SF, Couch FJ, Cox A, Cross SS, Cybulski C, Czene K, Darabi H, Devilee P, Diver WR, Dunning AM, Earl HM, Eccles DM, Ekici AB, Eriksson M, Evans DG, Fasching PA, Figueroa J, Flesch-Janys D, Flyger H, Gapstur SM, Gaudet MM, Giles GG, Glendon G, Grip M, Gronwald J, Haeberle L, Haiman CA, Hall P, Hamann U, Hankinson S, Hartikainen JM, Hein A, Hiller L, Hogervorst FB, Holleczek B, Hooning MJ, Hoover RN, Humphreys K, Hunter DJ, Hüsing A, Jakubowska A, Jukkola-Vuorinen A, Kaaks R, Kabisch M, Kataja V, Knight JA, Koppert LB, Kosma VM, Kristensen VN, Lambrechts D, Le Marchand L, Li J, Lindblom A, Lindström S, Lissowska J, Lubinski J, Machiela MJ, Mannermaa A, Manoukian S, Margolin S, Marme F, Martens JWM, McLean C, Menéndez P, Milne RL, Marie Mulligan A, Muranen TA, Nevanlinna H, Neven P, Nielsen SF, Nordestgaard BG, Olson JE, Perez JIA, Peterlongo P, Phillips KA, Poole CJ, Pylkäs K, Radice P, Rahman N, Rüdiger T, Rudolph A, Sawyer EJ, Schumacher F, Seibold P, Seynaeve C, Shah M, Smeets A, Southey MC, Tollenaar RAEM, Tomlinson I, Tsimiklis H, Ulmer HU, Vachon C, van den Ouweland AMW, Van’t Veer LJ, Wildiers H, Willett W, Winqvist R, Zamora MP, Chenevix-Trench G, Dörk T, Easton DF, García-Closas M, Kraft P, Hopper JL, Zheng W, Schmidt MK, Pharoah PDP. Body mass index and breast cancer survival: a Mendelian randomization analysis. Int J Epidemiol 2017; 46:1814-1822. [PMID: 29232439 PMCID: PMC5837506 DOI: 10.1093/ije/dyx131] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/21/2017] [Accepted: 06/29/2017] [Indexed: 11/26/2022] Open
Abstract
Background There is increasing evidence that elevated body mass index (BMI) is associated with reduced survival for women with breast cancer. However, the underlying reasons remain unclear. We conducted a Mendelian randomization analysis to investigate a possible causal role of BMI in survival from breast cancer. Methods We used individual-level data from six large breast cancer case-cohorts including a total of 36 210 individuals (2475 events) of European ancestry. We created a BMI genetic risk score (GRS) based on genotypes at 94 known BMI-associated genetic variants. Association between the BMI genetic score and breast cancer survival was analysed by Cox regression for each study separately. Study-specific hazard ratios were pooled using fixed-effect meta-analysis. Results BMI genetic score was found to be associated with reduced breast cancer-specific survival for estrogen receptor (ER)-positive cases [hazard ratio (HR) = 1.11, per one-unit increment of GRS, 95% confidence interval (CI) 1.01-1.22, P = 0.03). We observed no association for ER-negative cases (HR = 1.00, per one-unit increment of GRS, 95% CI 0.89-1.13, P = 0.95). Conclusions Our findings suggest a causal effect of increased BMI on reduced breast cancer survival for ER-positive breast cancer. There is no evidence of a causal effect of higher BMI on survival for ER-negative breast cancer cases.
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Affiliation(s)
- Qi Guo
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Burgess
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Constance Turman
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Michael Lush
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jean Abraham
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Cambridge Experimental Cancer Medicine Centre, Cambridge, UK
| | - Kristiina Aittomäki
- Department of Clinical Genetics, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Irene L Andrulis
- Fred A. Litwin Center for Cancer Genetics, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Carmel Apicella
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Myrto Barrdahl
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Javier Benitez
- Human Cancer Genetics Program, Spanish National Cancer Research Centre, Madrid, Spain
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Carl Blomqvist
- Department of Oncology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Stig E Bojesen
- Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia, Milan, Italy
| | - Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annegien Broeks
- Division of Molecular Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Barbara Burwinkel
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
- Molecular Epidemiology Group, C080, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Carlos Caldas
- Cambridge Experimental Cancer Medicine Centre, Cambridge, UK
- Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, University of Cambridge NHS Foundation Hospitals, Cambridge, UK
- Breast Cancer Functional Genomics Laboratory, Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, UK
| | - Daniele Campa
- Department of Biology, University of Pisa, Pisa, Italy
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Suet-Feung Chin
- Breast Cancer Functional Genomics Laboratory, Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, UK
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Angela Cox
- Academic Unit of Molecular Oncology, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Simon S Cross
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Cezary Cybulski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hatef Darabi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Devilee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - W Ryan Diver
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Helena M Earl
- Cambridge Experimental Cancer Medicine Centre, Cambridge, UK
- Cambridge Breast Unit and NIHR Cambridge Biomedical Research Centre, University of Cambridge NHS Foundation Hospitals, Cambridge, UK
| | - Diana M Eccles
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - D Gareth Evans
- Genomic Medicine, Manchester Academic Health Science Centre, University of Manchester, Central Manchester Foundation Trust, St. Mary's Hospital, Manchester, UK
| | - Peter A Fasching
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jonine Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, UK
| | - Dieter Flesch-Janys
- Institute for Medical Biometrics and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Cancer Epidemiology, Clinical Cancer Registry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henrik Flyger
- Department of Breast Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Mia M Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, Australia
| | - Gord Glendon
- Fred A. Litwin Center for Cancer Genetics, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Canada
| | - Mervi Grip
- Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jacek Gronwald
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Lothar Haeberle
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Susan Hankinson
- Department of Biostatistics & Epidemiology, University of Massachusetts, Amherst, Amherst, MA, USA
| | - Jaana M Hartikainen
- Translational Cancer Research Area, University of Eastern Finland, Kuopio, Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Alexander Hein
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Louise Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Frans B Hogervorst
- Family Cancer Clinic, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Maartje J Hooning
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Robert N Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David J Hunter
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | | | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maria Kabisch
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Vesa Kataja
- Translational Cancer Research Area, University of Eastern Finland, Kuopio, Finland
- Central Finland Health Care District, Jyväskylä Central Hospital, Jyväskylä, Finland
| | | | - Julia A Knight
- Prosserman Centre for Health Research, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Linetta B Koppert
- Department of Surgical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Veli-Matti Kosma
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Vessela N Kristensen
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital Radiumhospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Molecular Biology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Diether Lambrechts
- VIB Center for Cancer Biology, VIB, Leuven, Belgium
- Laboratory for Translational Genetics, Department of Human Genetics, University of Leuven, Leuven, Belgium
| | | | - Jingmei Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sara Lindström
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center – Oncology Institute, Warsaw, Poland
| | - Jan Lubinski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Mitchell J Machiela
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Arto Mannermaa
- Translational Cancer Research Area, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Sara Margolin
- Department of Oncology – Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Federik Marme
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - John WM Martens
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Catriona McLean
- Anatomical Pathology, The Alfred Hospital, Melbourne, Australia
| | | | - Roger L Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, Australia
| | - Anna Marie Mulligan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Laboratory Medicine Program, University Health Network, Toronto, Canada
| | - Taru A Muranen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Patrick Neven
- Leuven Multidisciplinary Breast Center, Department of Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Sune F Nielsen
- Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Børge G Nordestgaard
- Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jose IA Perez
- Servicio de Cirugía General y Especialidades, Hospital Monte Naranco, Oviedo, Spain
| | - Paolo Peterlongo
- IFOM, The FIRC (Italian Foundation for Cancer Research) Institute of Molecular Oncology, Milan, Italy
| | - Kelly-Anne Phillips
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Division of Cancer Medicine, Peter MacCallum Cancer Center, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Australia
| | | | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit, Biocenter Oulu, University of Oulu, Oulu, Finland
- Laboratory of Cancer Genetics and Tumor Biology, Northern Finland Laboratory Centre Oulu, Oulu, Finland
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Research, Fondazione IRCCS (Istituto Di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Nazneen Rahman
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Thomas Rüdiger
- Institute of Pathology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elinor J Sawyer
- Research Oncology, Guy's Hospital, King's College London, London, UK
| | - Fredrick Schumacher
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Caroline Seynaeve
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Ann Smeets
- Leuven Multidisciplinary Breast Center, Department of Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Melissa C Southey
- Department of Pathology, The University of Melbourne, Melbourne, Australia
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ian Tomlinson
- Wellcome Trust Centre for Human Genetics and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Helen Tsimiklis
- Department of Pathology, The University of Melbourne, Melbourne, Australia
| | | | - Celine Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ans MW van den Ouweland
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Laura J Van’t Veer
- Division of Molecular Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hans Wildiers
- Leuven Multidisciplinary Breast Center, Department of Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Walter Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Robert Winqvist
- Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit, Biocenter Oulu, University of Oulu, Oulu, Finland
- Laboratory of Cancer Genetics and Tumor Biology, Northern Finland Laboratory Centre Oulu, Oulu, Finland
| | - M Pilar Zamora
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid, Spain
| | - Georgia Chenevix-Trench
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Thilo Dörk
- Gynaecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | | | - Peter Kraft
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA and
| | - Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Paul DP Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
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Temkin SM, Miller EA, Samimi G, Berg CD, Pinsky P, Minasian L. Outcomes from ovarian cancer screening in the PLCO trial: Histologic heterogeneity impacts detection, overdiagnosis and survival. Eur J Cancer 2017; 87:182-188. [PMID: 29156299 DOI: 10.1016/j.ejca.2017.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/30/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
AIM A mortality benefit from screening for ovarian cancer has never been demonstrated. The aim of this study was to evaluate the screening outcomes for different histologic subtypes of ovarian cancers. METHODS Women in the screening arm of the Prostate, Lung, Colorectal and Ovarian Screening Trial underwent CA-125 and transvaginal ultrasound annually for 3-5 years. We compared screening test characteristics (including overdiagnosis) and outcomes by tumour type (type II versus other) and study arm (screening versus usual care). RESULTS Of 78,215 women randomised, 496 women were diagnosed with ovarian cancer. Of the tumours that were characterised (n = 413; 83%), 74% (n = 305) were type II versus 26% other (n = 108). Among screened patients, 70% of tumours were type II compared to 78% in usual care (p = 0.09). Within the screening arm, 29% of type II tumours were screen detected compared to 54% of the others (p < 0.01). The sensitivity of screening was 65% for type II tumours versus 86% for other types (p = 0.02). 15% of type II screen-detected tumours were stage I/II, compared to 81% of other tumours (p < 0.01). The overdiagnosis rate was lower for type II compared to other tumours (28.2% versus 72.2%; p < 0.01). Ovarian cancer-specific survival was worse for type II tumours compared to others (p < 0.01). Survival was similar for type II (p = 0.74) or other types (p = 0.32) regardless of study arm. CONCLUSIONS Test characteristics of screening for ovarian cancer differed for type II tumours compared to other ovarian tumours. Type II tumours were less likely to be screen diagnosed, early stage at diagnosis or overdiagnosed.
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Affiliation(s)
- Sarah M Temkin
- Division of Gynecologic Oncology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Eric A Miller
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Goli Samimi
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paul Pinsky
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lori Minasian
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Tsodikov A, Gulati R, Heijnsdijk EAM, Pinsky PF, Moss SM, Qiu S, de Carvalho TM, Hugosson J, Berg CD, Auvinen A, Andriole GL, Roobol MJ, Crawford ED, Nelen V, Kwiatkowski M, Zappa M, Luján M, Villers A, Feuer EJ, de Koning HJ, Mariotto AB, Etzioni R. Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials. Ann Intern Med 2017; 167:449-455. [PMID: 28869989 PMCID: PMC5734053 DOI: 10.7326/m16-2586] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The ERSPC (European Randomized Study of Screening for Prostate Cancer) found that screening reduced prostate cancer mortality, but the PLCO (Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial) found no reduction. OBJECTIVE To evaluate whether effects of screening on prostate cancer mortality relative to no screening differed between the ERSPC and PLCO. DESIGN Cox regression of prostate cancer death in each trial group, adjusted for age and trial. Extended analyses accounted for increased incidence due to screening and diagnostic work-up in each group via mean lead times (MLTs), which were estimated empirically and using analytic or microsimulation models. SETTING Randomized controlled trials in Europe and the United States. PARTICIPANTS Men aged 55 to 69 (ERSPC) or 55 to 74 (PLCO) years at randomization. INTERVENTION Prostate cancer screening. MEASUREMENTS Prostate cancer incidence and survival from randomization; prostate cancer incidence in the United States before screening began. RESULTS Estimated MLTs were similar in the ERSPC and PLCO intervention groups but were longer in the PLCO control group than the ERSPC control group. Extended analyses found no evidence that effects of screening differed between trials (P = 0.37 to 0.47 [range across MLT estimation approaches]) but strong evidence that benefit increased with MLT (P = 0.0027 to 0.0032). Screening was estimated to confer a 7% to 9% reduction in the risk for prostate cancer death per year of MLT. This translated into estimates of 25% to 31% and 27% to 32% lower risk for prostate cancer death with screening as performed in the ERSPC and PLCO intervention groups, respectively, compared with no screening. LIMITATION The MLT is a simple metric of screening and diagnostic work-up. CONCLUSION After differences in implementation and settings are accounted for, the ERSPC and PLCO provide compatible evidence that screening reduces prostate cancer mortality. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Alex Tsodikov
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Roman Gulati
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Eveline A M Heijnsdijk
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Paul F Pinsky
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Sue M Moss
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Sheng Qiu
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Tiago M de Carvalho
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Jonas Hugosson
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Christine D Berg
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Anssi Auvinen
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Gerald L Andriole
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Monique J Roobol
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - E David Crawford
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Vera Nelen
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Maciej Kwiatkowski
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Marco Zappa
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Marcos Luján
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Arnauld Villers
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Eric J Feuer
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Harry J de Koning
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Angela B Mariotto
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
| | - Ruth Etzioni
- From University of Michigan, Ann Arbor, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Erasmus Medical Center, Rotterdam, the Netherlands; National Cancer Institute, Bethesda, Maryland; Queen Mary University of London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Johns Hopkins Medicine, Baltimore, Maryland; University of Tampere, Tampere, Finland; Washington University School of Medicine, St. Louis, Missouri; University of Colorado, Denver, Colorado; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Kantonsspital Aarau, Aarau, Switzerland; Institute for Cancer Prevention, Florence, Italy; Universidad Complutense de Madrid, Parla, Madrid, Spain; and Université de Lille, Lille, France
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Dyke ALV, Berg CD, Caporaso NE, Katki HA, Chaturvedi AK, Engels EA. Abstract 5298: Lung cancer risk and scarring on imaging and histology in the National Lung Screening Trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The contribution of pulmonary scars to lung cancer development and the degree to which lung cancers cause a scarring response are unclear. Also unknown is how lung scarring impacts lung cancer screening.
Methods: We evaluated associations between scarring and lung cancer in the National Lung Screening Trial (NLST), a lung cancer screening trial among current or former, heavy smokers, 55-74 years-old. Baseline scarring (presence vs. absence) on screening low dose computed tomography (LDCT) scan was assessed at baseline (T0). Associations of T0 scarring with screen-detected lung cancers and with interval-detected lung cancers missed on screening within 3 years of T0 screen were analyzed using multinomial logistic regression. Cox proportional hazards models were used to analyze the relationship between T0 scarring and incident lung cancers diagnosed >3 years after T0. Regression models included age, sex, race, smoking history, chronic obstructive pulmonary disease, history of pneumonia, and family history of lung cancer. A thoracic pathologist (first author) evaluated lung cancer pathology slides from the Lung Screening Study (LSS) subset of NLST for scar grade (none, sparse, dense) and maturity (none, immature, intermediate, mature). Associations between T0 scarring on LDCT and histological scarring were examined by logistic regression.
Results: NLST’s LDCT arm enrolled 26,722 participants (65% from the LSS). T0 scars were present in 132 (22%) screen-detected, 12 (29%) interval-detected, and 94 (26%) incident lung cancer cases. T0 scarring did not increase or decrease screen-detection of cancers [odds ratio (OR) 95% CI: 1.03 (0.84-1.26)]. However, scarring might increase the chance of an interval-detected cancer [OR (95% CI): 1.54 (0.76-3.12)]. After screening stopped, T0 scarring was associated with increased incident lung cancer risk [hazard ratio (HR) (95% CI): 1.27 (1.00-1.62); P=0.048]. Pathology slides were available for 258 (38%) lung cancers in LSS. Lung scarring was found in 172 (67%) of these cancers with 58 (22%) being characterized as mature scars. On microscopic review, scars were found in 80 (66%) ADC, 46 (82%) squamous cell carcinomas, and 20 (51%) bronchioloalveolar carcinomas. Microscopic scarring tended to be more frequent among cases with T0 scarring than those without T0 scarring (75% vs. 64%; P=0.10) [OR (95% CI): 1.89 (0.98-3.86)].
Conclusion: The association between T0 scarring and incident lung cancer over a period of more than 3 years is consistent with an etiologic contribution of scarring to development of lung cancer. The relationship between T0 scarring and scarring on microscopic evaluation suggests that scarring preceded the cancer, further supporting an etiologic relationship. Finally, the borderline association of T0 scarring and interval cancers suggests that scarring may decrease the sensitivity of screening.
Citation Format: Alison L. Van Dyke, Christine D. Berg, Neil E. Caporaso, Hormuzd A. Katki, Anil K. Chaturvedi, Eric A. Engels. Lung cancer risk and scarring on imaging and histology in the National Lung Screening Trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5298. doi:10.1158/1538-7445.AM2017-5298
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Robbins HA, Berg CD, Cheung LC, Chaturvedi AK, Katki HA. Abstract 5291: Effect of screening CT results and features on lung cancer risk prediction within the National Lung Screening Trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: In the course of screening, individual risk of disease evolves based on screening results. We calculated how individual lung cancer risk changes based on screening CT findings using data from the National Lung Screening Trial (NLST), which conducted annual screening for 3 years.
METHODS: We calculated lung cancer risks by combining CT findings with individual predicted 1-year “pre-screening risk.” Pre-screening risk r(x) was predicted in the absence of screening using a validated risk model (Katki et al., JAMA 2016) with covariates (x): age, education, sex, race, smoking intensity/duration/quit-years, body mass index, family history of lung cancer, and self-reported emphysema. We used log-binomial regression to calculate the risk of an “interval” lung cancer (within 1 year of a negative screen) or a “screen-detected” cancer detected at the next annual screen. For each, covariates included log-transformed 1-year pre-screening risk and CT findings including classification as negative or false-positive and other specific features.
RESULTS: The median 1-year pre-screening risk at the first NLST screen was 0.32% (interquartile range 0.19-0.53%). Among CT-negatives, risk over the next year was substantially reduced as r(x)1.32 (median interval cancer risk 0.05%), but risk at the next screen reverted to pre-screening risk as r(x)1. Risk at the next screen was higher for those whose CT noted either emphysema (r(x)0.95, median risk 0.53%) or consolidation (r(x)0.76, median risk 1.6%).
Among CT-false-positives, overall risk at the next screen increased as r(x)0.74 (median risk 1.5%). Risk was higher among those with nodule(s) that were larger, had spiculated margins (median risk 4.1%), were located in the upper lobes (median risk 1.4%), or grew during the most recent screening interval (median risk 7.9%), while nodules with smooth margins indicated lower risk (median risk 0.71%). Those with a smooth-margins nodule and no risk-increasing factors essentially reverted to their pre-screening risk at the next screen as r(x)1.01 (median risk 0.29%), as if they had screened negative. Overall, only the immediately prior screen result, and not earlier screens, predicted lung cancer risk (all p>0.2). Exponents were similar for each interval and at each screen (all p>0.07).
CONCLUSIONS: CT-negatives experienced reduced lung cancer risk over the next year, but reverted to their pre-screening risk at the next screen. CT-false-positives experienced substantially increased lung cancer detection at the next annual screen, with most risks exceeding 1%. These risk increases were explained by specific CT features including nodule size, location, margins, and growth.
Citation Format: Hilary A. Robbins, Christine D. Berg, Li C. Cheung, Anil K. Chaturvedi, Hormuzd A. Katki. Effect of screening CT results and features on lung cancer risk prediction within the National Lung Screening Trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5291. doi:10.1158/1538-7445.AM2017-5291
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Temkin SM, Miller EA, Samimi G, Berg CD, Pinsky P, Minasian LM. A re-analysis of the prostate, lung, colorectal, and ovarian (PLCO) cancer screening trial accounting for ovarian cancer (OVCA) heterogeneity. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5564 Background: A mortality benefit from screening for OVCA has not been demonstrated, but screening efficacy could differ for histologic subtypes. We re-analyzed PLCO evaluating whether OVCA detection and outcomes were affected by the heterogeneous biologic behavior of this disease. Methods: Type 2 tumors (moderately/poorly differentiated serous and adenocarcinoma) were compared to all other tumor (OT) types (low grade serous and endometrioid, clear cell, other, low malignancy potential) (LMP). We examined differences in the distribution of tumor types and stage by study arm and method of diagnosis [screen detected (SD) and interval detected (ID) (i.e. assigned to screening but diagnosed between screening tests)]. Stage distribution and survival were analyzed. Results: Among the entire PLCO population, 531 women were diagnosed with OVCA during the study; 282 (53%) in the screening arm and 249 (47%) in the usual care arm. Of the tumors able to be characterized (n=408; 77%), 74% (n=300) were Type 2 and 26% OT (n=108). In the screening arm, 70% of tumors diagnosed were Type 2 compared to 78% in usual care (p=0.07). Overall, survival was significantly better for OT tumors compared to Type 2 tumors (p<0.01) but there was no difference in survival by study arm for either tumor type separately (Type 2: p=0.50; OT: p=0.23). Within the screening arm, 30% of Type 2 tumors were SD compared to 54% of OT tumors (p=0.02) (see Table). Only 15% of Type 2 SD tumors were Stage I/II, compared to 82% of SD OT tumors (p<0.01). Stage at diagnosis was similar among Type 2 patients whether they were SD or ID (p=0.56) and there was no difference in survival (p=0.56). Conclusions: A significant difference in tumor types by study arm was not observed. However, within the screening arm, Type 2 tumors were less likely to be SD or Stage I/II compared to OT tumors. Survival for Type 2 tumors was similar regardless of method of diagnosis. [Table: see text]
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Affiliation(s)
| | - Eric A Miller
- Division of Cancer Prevention, National Cancer Institute at the National Institutes of Health, Rockville, MD
| | - Goli Samimi
- Division of Cancer Prevention, National Cancer Institute at the National Institutes of Health, Rockville, MD
| | | | - Paul Pinsky
- Division of Cancer Prevention, National Cancer Institute at the National Institutes of Health, Bethesda, MD
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Abstract
Paul Pinsky of the US National Cancer Institute and colleagues describe the implementation and outcomes of web-based data sharing from the PLCO and NLST cancer screening trials.
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Affiliation(s)
- Claire S. Zhu
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Paul F. Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, United States of America
| | - James E. Moler
- Information Management Services, Inc., Rockville, Maryland, United States of America
| | - Andrew Kukwa
- Information Management Services, Inc., Rockville, Maryland, United States of America
| | - Jerome Mabie
- Information Management Services, Inc., Rockville, Maryland, United States of America
| | - Joshua M. Rathmell
- Information Management Services, Inc., Rockville, Maryland, United States of America
| | - Tom Riley
- Information Management Services, Inc., Rockville, Maryland, United States of America
| | - Philip C. Prorok
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Christine D. Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
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Katki HA, Kovalchik SA, Berg CD, Cheung LC, Chaturvedi AK. Abstract IA18: Development and validation of risk models to select ever-smokers for CT lung-cancer screening. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.carisk16-ia18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The US Preventive Services Task Force (USPSTF) recommends computed-tomography (CT) lung-cancer screening for ever-smokers ages 55-80 years who smoked at least 30 pack-years with no more than 15 years since quitting. However, selecting ever-smokers for screening using individualized lung-cancer risk calculations may be more effective and efficient than current USPSTF recommendations. We compare of modeled outcomes from risk-based CT lung-screening strategies versus USPSTF recommendations. We developed empirical risk models for lung-cancer incidence and death in the absence of CT screening using data on ever-smokers from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO; 1993-2009) control group. Covariates included age, education, sex, race, smoking intensity/duration/quit-years, Body Mass Index, family history of lung-cancer, and self-reported emphysema. Models were validated in the chest radiography groups of the PLCO and the National Lung Screening Trial (NLST; 2002-2009), with additional validation of the death model in the National Health Interview Survey (NHIS; 1997-2001), a representative sample of the US. Models applied to US ever-smokers ages 50-80 (NHIS 2010-2012) to estimate outcomes of risk-based selection for annual CT lung-screening for 3 years, assuming screening for all ever-smokers yields the percent changes in lung-cancer detection and death observed in the NLST. Lung-cancer incidence and death risk models were well-calibrated in PLCO and NLST. The lung-cancer death model calibrated and discriminated well for US ever-smokers ages 50-80 (NHIS 1997-2001: Estimated/Observed=0.94, 95%CI=0.84-1.05; AUC=0.78, 95%CI=0.76-0.80). Under USPSTF recommendations, the models estimated 9.0 million US ever-smokers would qualify for lung-cancer screening and 46,488 (95%CI=43,924-49,053) lung-cancer deaths were estimated as screen-avertable over 5 years (estimated NNS=194, 95%CI=187-201). In contrast, risk-based selection screened the same number of ever-smokers (9.0 million) at highest 5-year lung-cancer risk (≥1.9%), was estimated to avert 20% more deaths (55,717; 95%CI=53,033-58,400) and was estimated to reduce the estimated NNS by 17% (NNS=162, 95%CI=157-166). Among a cohort of US ever-smokers age 50-80 years, application of a risk-based model for CT screening for lung cancer compared with a model based on USPSTF recommendations was estimated to be associated with a greater number of lung-cancer deaths prevented over 5 years along with a lower NNS to prevent 1 lung-cancer death.
Citation Format: Hormuzd A. Katki, Stephanie A. Kovalchik, Christine D. Berg, Li C. Cheung, Anil K. Chaturvedi. Development and validation of risk models to select ever-smokers for CT lung-cancer screening. [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 IA18.
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Affiliation(s)
- Hormuzd A. Katki
- 1National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD,
| | | | - Christine D. Berg
- 1National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD,
| | - Li C. Cheung
- 3Information Management Services Inc., Calverton, MD
| | - Anil K. Chaturvedi
- 1National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD,
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Berg CD. Breast Cancer Screening Interval: Risk Level May Matter. Ann Intern Med 2016; 165:737-738. [PMID: 27548697 DOI: 10.7326/m16-1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Pinsky PF, Yu K, Kramer BS, Black A, Buys SS, Partridge E, Gohagan J, Berg CD, Prorok PC. Extended mortality results for ovarian cancer screening in the PLCO trial with median 15years follow-up. Gynecol Oncol 2016; 143:270-275. [PMID: 27615399 PMCID: PMC5077651 DOI: 10.1016/j.ygyno.2016.08.334] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/24/2016] [Accepted: 08/28/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial originally reported no mortality benefit of ovarian cancer screening after a median of 12.4years of follow-up. The UKCTOCS screening trial failed to show a statistically significant mortality reduction in the primary analysis but reported an apparent increased mortality benefit in trial years 7-14 compared to 0-7. Here we report an updated analysis of PLCO with extended mortality follow-up. METHODS Participants were randomized from 1993 to 2001 at ten U.S. centers to an intervention or usual care arm. Intervention arm women were screened for ovarian cancer with annual trans-vaginal ultrasound (TVU) (4years) and CA-125 (6years), with a fixed cutoff at 35U/mL for CA-125. The original follow-up period was for up to 13years (median follow-up 12.4years); in this analysis follow-up for mortality was extended by up to 6years. RESULTS 39,105 (intervention) and 39,111 (usual care) women were randomized, of which 34,253 and 34,304, respectively, had at least one ovary at baseline. Median follow-up was 14.7years in each arm and maximum follow-up 19.2years in each arm. A total of 187 (intervention) and 176 (usual care) deaths from ovarian cancer were observed, for a risk-ratio of 1.06 (95% CI: 0.87-1.30). Risk-ratios were similar for study years 0-7 (RR=1.04), 7-14 (RR=1.06) and 14+ (RR=1.09). The risk ratio for all-cause mortality was 1.01 (95% CI: 0.97-1.05). Ovarian cancer specific survival was not significantly different across trial arms (p=0.16). CONCLUSION Extended follow-up of PLCO indicated no mortality benefit from screening for ovarian cancer with CA-125 and TVU.
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Affiliation(s)
- Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, United States.
| | - Kelly Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, United States
| | - Barnett S Kramer
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, United States
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, United States
| | | | - Edward Partridge
- University of Alabama at Birmingham School of Medicine, United States
| | - John Gohagan
- Office of Disease Prevention, National Institutes of Health, United States
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, United States
| | - Philip C Prorok
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, United States
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Maas P, Barrdahl M, Joshi AD, Auer PL, Gaudet MM, Milne RL, Schumacher FR, Anderson WF, Check D, Chattopadhyay S, Baglietto L, Berg CD, Chanock SJ, Cox DG, Figueroa JD, Gail MH, Graubard BI, Haiman CA, Hankinson SE, Hoover RN, Isaacs C, Kolonel LN, Le Marchand L, Lee IM, Lindström S, Overvad K, Romieu I, Sanchez MJ, Southey MC, Stram DO, Tumino R, VanderWeele TJ, Willett WC, Zhang S, Buring JE, Canzian F, Gapstur SM, Henderson BE, Hunter DJ, Giles GG, Prentice RL, Ziegler RG, Kraft P, Garcia-Closas M, Chatterjee N. Breast Cancer Risk From Modifiable and Nonmodifiable Risk Factors Among White Women in the United States. JAMA Oncol 2016; 2:1295-1302. [PMID: 27228256 PMCID: PMC5719876 DOI: 10.1001/jamaoncol.2016.1025] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE An improved model for risk stratification can be useful for guiding public health strategies of breast cancer prevention. OBJECTIVE To evaluate combined risk stratification utility of common low penetrant single nucleotide polymorphisms (SNPs) and epidemiologic risk factors. DESIGN, SETTING, AND PARTICIPANTS Using a total of 17 171 cases and 19 862 controls sampled from the Breast and Prostate Cancer Cohort Consortium (BPC3) and 5879 women participating in the 2010 National Health Interview Survey, a model for predicting absolute risk of breast cancer was developed combining information on individual level data on epidemiologic risk factors and 24 genotyped SNPs from prospective cohort studies, published estimate of odds ratios for 68 additional SNPs, population incidence rate from the National Cancer Institute-Surveillance, Epidemiology, and End Results Program cancer registry and data on risk factor distribution from nationally representative health survey. The model is used to project the distribution of absolute risk for the population of white women in the United States after adjustment for competing cause of mortality. EXPOSURES Single nucleotide polymorphisms, family history, anthropometric factors, menstrual and/or reproductive factors, and lifestyle factors. MAIN OUTCOMES AND MEASURES Degree of stratification of absolute risk owing to nonmodifiable (SNPs, family history, height, and some components of menstrual and/or reproductive history) and modifiable factors (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared], menopausal hormone therapy [MHT], alcohol, and smoking). RESULTS The average absolute risk for a 30-year-old white woman in the United States developing invasive breast cancer by age 80 years is 11.3%. A model that includes all risk factors provided a range of average absolute risk from 4.4% to 23.5% for women in the bottom and top deciles of the risk distribution, respectively. For women who were at the lowest and highest deciles of nonmodifiable risks, the 5th and 95th percentile range of the risk distribution associated with 4 modifiable factors was 2.9% to 5.0% and 15.5% to 25.0%, respectively. For women in the highest decile of risk owing to nonmodifiable factors, those who had low BMI, did not drink or smoke, and did not use MHT had risks comparable to an average woman in the general population. CONCLUSIONS AND RELEVANCE This model for absolute risk of breast cancer including SNPs can provide stratification for the population of white women in the United States. The model can also identify subsets of the population at an elevated risk that would benefit most from risk-reduction strategies based on altering modifiable factors. The effectiveness of this model for individual risk communication needs further investigation.
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Affiliation(s)
- Paige Maas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Myrto Barrdahl
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Amit D Joshi
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Paul L Auer
- Fred Hutchinson Cancer Research Center, Seattle, Washington5School of Public Health, University of Wisconsin-Milwaukee, Milwaukee
| | - Mia M Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta Georgia
| | - Roger L Milne
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia8Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Fredrick R Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - William F Anderson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - David Check
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Subham Chattopadhyay
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Laura Baglietto
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia8Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Christine D Berg
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - David G Cox
- INSERM U1052 - Cancer Research Center of Lyon, Centre Léon Bérard, Lyon, France12Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, England
| | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mitchell H Gail
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Susan E Hankinson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst14Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert N Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Laurence N Kolonel
- Epidemiology Program, Cancer Research Center, University of Hawaii, Honolulu
| | | | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sara Lindström
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Isabelle Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Maria-Jose Sanchez
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain22CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Melbourne, Australia
| | - Daniel O Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic- M.P.Arezzo" Hospital, ASP Ragusa, Italy
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts26Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Walter C Willett
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Shumin Zhang
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Julie E Buring
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta Georgia
| | - Brian E Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - David J Hunter
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia8Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia29Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ross L Prentice
- Fred Hutchinson Cancer Research Center, Seattle, Washington30University of Washington, School of Public Health and Community Medicine, Seattle
| | - Regina G Ziegler
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter Kraft
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Montse Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland31Breakthrough Breast Cancer Research Centre, Division of Genetics and Epidemiology, The Institute of Cancer Research, London, England
| | - Nilanjan Chatterjee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland32Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland33Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Zhu CS, Huang WY, Pinsky PF, Berg CD, Sherman M, Yu KJ, Carrick DM, Black A, Hoover R, Lenz P, Williams C, Hawkins L, Chaloux M, Yurgalevitch S, Mathew S, Miller A, Olivo V, Khan A, Pretzel SM, Multerer D, Beckmann P, Broski KG, Freedman ND. The Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial Pathology Tissue Resource. Cancer Epidemiol Biomarkers Prev 2016; 25:1635-1642. [PMID: 27635065 DOI: 10.1158/1055-9965.epi-16-0506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/18/2016] [Accepted: 08/21/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pathology tissue specimens with associated epidemiologic and clinical data are valuable for cancer research. The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial undertook a large-scale effort to create a public resource of pathology tissues from PLCO participants who developed a cancer during the trial. METHODS Formalin-fixed paraffin-embedded tissue blocks were obtained from pathology laboratories on a loan basis for central processing of tissue microarrays, with additional free-standing tissue cores collected for nucleic acid extraction. RESULTS Pathology tissue specimens were obtained for prostate cancer (n = 1,052), lung cancer (n = 434), colorectal cancer (n = 675) and adenoma (n = 658), ovarian cancer and borderline tumors (n = 212), breast cancer (n = 870), and bladder cancer (n = 204). The process of creating this resource was complex, involving multidisciplinary teams with expertise in pathology, epidemiology, information technology, project management, and specialized laboratories. CONCLUSIONS Creating the PLCO tissue resource required a multistep process, including obtaining medical records and contacting pathology departments where pathology materials were stored after obtaining necessary patient consent and authorization. The potential to link tissue biomarkers to prospectively collected epidemiologic information, screening and clinical data, and matched blood or buccal samples offers valuable opportunities to study etiologic heterogeneity, mechanisms of carcinogenesis, and biomarkers for early detection and prognosis. IMPACT The methods and protocols developed for this effort, and the detailed description of this resource provided here, will be useful for those seeking to use PLCO pathology tissue specimens for their research and may also inform future tissue collection efforts in other settings. Cancer Epidemiol Biomarkers Prev; 25(12); 1635-42. ©2016 AACR.
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Affiliation(s)
- Claire S Zhu
- Division of Cancer Prevention, NCI, Bethesda, Maryland.
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Paul F Pinsky
- Division of Cancer Prevention, NCI, Bethesda, Maryland
| | - Christine D Berg
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Mark Sherman
- Division of Cancer Prevention, NCI, Bethesda, Maryland
| | - Kelly J Yu
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Danielle M Carrick
- Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Robert Hoover
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Petra Lenz
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, Maryland
| | - Craig Williams
- Information Management Services, Inc., Rockville, Maryland
| | - Laura Hawkins
- Information Management Services, Inc., Rockville, Maryland
| | | | | | | | | | | | | | | | | | | | | | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
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Abstract
IMPORTANCE The US Preventive Services Task Force (USPSTF) recommends computed tomography (CT) lung cancer screening for ever-smokers aged 55 to 80 years who have smoked at least 30 pack-years with no more than 15 years since quitting. However, selecting ever-smokers for screening using individualized lung cancer risk calculations may be more effective and efficient than current USPSTF recommendations. OBJECTIVE Comparison of modeled outcomes from risk-based CT lung-screening strategies vs USPSTF recommendations. DESIGN, SETTING, AND PARTICIPANTS Empirical risk models for lung cancer incidence and death in the absence of CT screening using data on ever-smokers from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO; 1993-2009) control group. Covariates included age; education; sex; race; smoking intensity, duration, and quit-years; body mass index; family history of lung cancer; and self-reported emphysema. Model validation in the chest radiography groups of the PLCO and the National Lung Screening Trial (NLST; 2002-2009), with additional validation of the death model in the National Health Interview Survey (NHIS; 1997-2001), a representative sample of the United States. Models were applied to US ever-smokers aged 50 to 80 years (NHIS 2010-2012) to estimate outcomes of risk-based selection for CT lung screening, assuming screening for all ever-smokers, yield the percent changes in lung cancer detection and death observed in the NLST. EXPOSURES Annual CT lung screening for 3 years beginning at age 50 years. MAIN OUTCOMES AND MEASURES For model validity: calibration (number of model-predicted cases divided by number of observed cases [estimated/observed]) and discrimination (area under curve [AUC]). For modeled screening outcomes: estimated number of screen-avertable lung cancer deaths and estimated screening effectiveness (number needed to screen [NNS] to prevent 1 lung cancer death). RESULTS Lung cancer incidence and death risk models were well calibrated in PLCO and NLST. The lung cancer death model calibrated and discriminated well for US ever-smokers aged 50 to 80 years (NHIS 1997-2001: estimated/observed = 0.94 [95%CI, 0.84-1.05]; AUC, 0.78 [95%CI, 0.76-0.80]). Under USPSTF recommendations, the models estimated 9.0 million US ever-smokers would qualify for lung cancer screening and 46,488 (95% CI, 43,924-49,053) lung cancer deaths were estimated as screen-avertable over 5 years (estimated NNS, 194 [95% CI, 187-201]). In contrast, risk-based selection screening of the same number of ever-smokers (9.0 million) at highest 5-year lung cancer risk (≥1.9%) was estimated to avert 20% more deaths (55,717 [95% CI, 53,033-58,400]) and was estimated to reduce the estimated NNS by 17% (NNS, 162 [95% CI, 157-166]). CONCLUSIONS AND RELEVANCE Among a cohort of US ever-smokers aged 50 to 80 years, application of a risk-based model for CT screening for lung cancer compared with a model based on USPSTF recommendations was estimated to be associated with a greater number of lung cancer deaths prevented over 5 years, along with a lower NNS to prevent 1 lung cancer death.
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Affiliation(s)
- Hormuzd A. Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
- Corresponding authors:HAK: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Room 7E606, Bethesda, MD 20892, Phone: 240-276-7423, Fax: 240-276-7838, ; AKC: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Room 6E238, Bethesda, MD 20892, Phone: 240-276-7193,
| | - Stephanie A. Kovalchik
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
| | - Christine D. Berg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Li C. Cheung
- Information Management Services Inc., Calverton, MD, USA
| | - Anil K. Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
- Corresponding authors:HAK: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Room 7E606, Bethesda, MD 20892, Phone: 240-276-7423, Fax: 240-276-7838, ; AKC: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr., Room 6E238, Bethesda, MD 20892, Phone: 240-276-7193,
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Abstract
The results of the National Lung Screening Trial (NLST) have provided the medical community and American public with considerable optimism about the potential to reduce lung cancer mortality with imaging-based screening. Designed as a randomized trial, the NLST has provided the first evidence of screening benefit by showing a 20% reduction in lung cancer mortality and a 6.7% reduction in all-cause mortality with low dose helical computed tomography (LDCT) screening relative to chest X-ray. The major harms of LDCT screening include the potential for radiation-induced carcinogenesis; high false-positivity rates in individuals without lung cancer, and overdiagnosis. Following the results of the NLST, the National Comprehensive Cancer Network (NCCN) published the first of multiple lung cancer screening guidelines under development by major medical organizations. These recommendations amalgamated screening cohorts, practices, interpretations, and diagnostic follow-up based on the NLST and other published studies to provide guidance for the implementation of LDCT screening. There are major areas of opportunity to optimize implementation. These include standardizing practices in the screening setting, optimizing risk profiles for screening and for managing diagnostic evaluation in individuals with indeterminate nodules, developing interdisciplinary screening programs in conjunction with smoking cessation, and approaching all stakeholders systematically to ensure the broadest education and dissemination of screening benefits relative to risks. The incorporation of validated biomarkers of risk and preclinical lung cancer can substantially enhance the effectiveness screening programs.
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Affiliation(s)
- Christine D Berg
- From the Early Detection Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiothoracic Surgery, University of Washington, Seattle, WA
| | - Denise R Aberle
- From the Early Detection Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiothoracic Surgery, University of Washington, Seattle, WA
| | - Douglas E Wood
- From the Early Detection Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiothoracic Surgery, University of Washington, Seattle, WA
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Berg CD. Just Say No! Smoking Abstinence Works. Am J Respir Crit Care Med 2016; 193:476-7. [DOI: 10.1164/rccm.201511-2270ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Christine D. Berg
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimore, Marylandand
- Division of Cancer Epidemiology and PreventionNational Cancer InstituteBethesda, Maryland
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Markt SC, Shui IM, Unger RH, Urun Y, Berg CD, Black A, Brennan P, Bueno-de-Mesquita HB, Gapstur SM, Giovannucci E, Haiman C, Henderson B, Hoover RN, Hunter DJ, Key TJ, Khaw KT, Canzian F, Larranga N, Le Marchand L, Ma J, Naccarati A, Siddiq A, Stampfer MJ, Stattin P, Stevens VL, Stram DO, Tjønneland A, Travis RC, Trichopoulos D, Ziegler RG, Lindstrom S, Kraft P, Mucci LA, Choueiri TK, Wilson KM. ABO blood group alleles and prostate cancer risk: Results from the breast and prostate cancer cohort consortium (BPC3). Prostate 2015; 75:1677-81. [PMID: 26268879 PMCID: PMC4578997 DOI: 10.1002/pros.23035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/22/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND ABO blood group has been associated with risk of cancers of the pancreas, stomach, ovary, kidney, and skin, but has not been evaluated in relation to risk of aggressive prostate cancer. METHODS We used three single nucleotide polymorphisms (SNPs) (rs8176746, rs505922, and rs8176704) to determine ABO genotype in 2,774 aggressive prostate cancer cases and 4,443 controls from the Breast and Prostate Cancer Cohort Consortium (BPC3). Unconditional logistic regression was used to calculate age and study-adjusted odds ratios and 95% confidence intervals for the association between blood type, genotype, and risk of aggressive prostate cancer (Gleason score ≥8 or locally advanced/metastatic disease (stage T3/T4/N1/M1). RESULTS We found no association between ABO blood type and risk of aggressive prostate cancer (Type A: OR = 0.97, 95%CI = 0.87-1.08; Type B: OR = 0.92, 95%CI =n0.77-1.09; Type AB: OR = 1.25, 95%CI = 0.98-1.59, compared to Type O, respectively). Similarly, there was no association between "dose" of A or B alleles and aggressive prostate cancer risk. CONCLUSIONS ABO blood type was not associated with risk of aggressive prostate cancer.
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Affiliation(s)
- Sarah C. Markt
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Irene M. Shui
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Robert H. Unger
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yuksel Urun
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Christine D. Berg
- Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - H. Bas Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Susan M. Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Edward Giovannucci
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Christopher Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Brian Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robert N. Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - David J. Hunter
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Timothy J. Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kay-Tee Khaw
- School of Clinical Medicine, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nerea Larranga
- Public Health Division of Gipuzkoa, BIODonostia Research Institute, Basque Health Department, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Spain
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI
| | - Jing Ma
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School
| | - Alessio Naccarati
- HuGeF Foundation Molecular and Genetic Epidemiology Unit, Torino, Italy
| | - Afshan Siddiq
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, London, UK
| | - Meir J. Stampfer
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School
| | - Par Stattin
- Department of Surgery and Perioperative sciences, Urology and Andrology, Umeå University, Sweden
| | | | - Daniel O. Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Ruth C. Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Dimitrios Trichopoulos
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - Regina G. Ziegler
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Sara Lindstrom
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Peter Kraft
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lorelei A. Mucci
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School
| | - Toni K. Choueiri
- Department of Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Kathryn M. Wilson
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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45
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Urban N, Hawley S, Janes H, Karlan BY, Berg CD, Drescher CW, Manson JE, Palomares MR, Daly MB, Wactawski-Wende J, O'Sullivan MJ, Thorpe J, Robinson RD, Lane D, Li CI, Anderson GL. Identifying post-menopausal women at elevated risk for epithelial ovarian cancer. Gynecol Oncol 2015; 139:253-60. [PMID: 26343159 DOI: 10.1016/j.ygyno.2015.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/26/2015] [Accepted: 08/29/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We developed and validated a hybrid risk classifier combining serum markers and epidemiologic risk factors to identify post-menopausal women at elevated risk for invasive fallopian tube, primary peritoneal, and ovarian epithelial carcinoma. METHODS To select epidemiologic risk factors for use in the classifier, Cox proportional hazards analyses were conducted using 74,786 Women's Health Initiative (WHI) Observational Study (OS) participants. To construct a combination classifier, 210 WHI OS cases and 536 matched controls with serum marker measurements were analyzed; validation employed 143 cases and 725 matched controls from the WHI Clinical Trial (CT) with similar data. RESULTS Analyses identified a combination risk classifier composed of two elevated-risk groups: 1) women with CA125 or HE4 exceeding a 98% specificity threshold; and 2) women with intact fallopian tubes, prior use of menopausal hormone therapy for at least two years, and either a first degree relative with breast or ovarian cancer or a personal history of breast cancer. In the WHI OS population, it classified 13% of women as elevated risk, identifying 30% of ovarian cancers diagnosed up to 7.8years post-enrollment (Hazard Ratio [HR]=2.6, p<0.001). In the WHI CT validation population, it classified 8% of women as elevated risk, identifying 31% of cancers diagnosed within 7years of enrollment (HR=4.6, p<0.001). CONCLUSION CA125 and HE4 contributed significantly to a risk prediction classifier combining serum markers with epidemiologic risk factors. The hybrid risk classifier may be useful to identify post-menopausal women who would benefit from timely surgical intervention to prevent epithelial ovarian cancer.
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Affiliation(s)
- Nicole Urban
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
| | - Sarah Hawley
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Holly Janes
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Beth Y Karlan
- Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | | | | | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Melanie R Palomares
- Cancer Prevention, Inc., Las Vegas NV and Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mary B Daly
- Fox Chase Cancer Center, Philadelphia PA, United States
| | | | | | - Jason Thorpe
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Randal D Robinson
- University of Texas Health Science Center, San Antonio TX, United States
| | - Dorothy Lane
- Stony Brook University, Stony Brook, NY, United States
| | - Christopher I Li
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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46
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Michailidou K, Beesley J, Lindstrom S, Canisius S, Dennis J, Lush MJ, Maranian MJ, Bolla MK, Wang Q, Shah M, Perkins BJ, Czene K, Eriksson M, Darabi H, Brand JS, Bojesen SE, Nordestgaard BG, Flyger H, Nielsen SF, Rahman N, Turnbull C, Fletcher O, Peto J, Gibson L, dos-Santos-Silva I, Chang-Claude J, Flesch-Janys D, Rudolph A, Eilber U, Behrens S, Nevanlinna H, Muranen TA, Aittomäki K, Blomqvist C, Khan S, Aaltonen K, Ahsan H, Kibriya MG, Whittemore AS, John EM, Malone KE, Gammon MD, Santella RM, Ursin G, Makalic E, Schmidt DF, Casey G, Hunter DJ, Gapstur SM, Gaudet MM, Diver WR, Haiman CA, Schumacher F, Henderson BE, Le Marchand L, Berg CD, Chanock SJ, Figueroa J, Hoover RN, Lambrechts D, Neven P, Wildiers H, van Limbergen E, Schmidt MK, Broeks A, Verhoef S, Cornelissen S, Couch FJ, Olson JE, Hallberg E, Vachon C, Waisfisz Q, Meijers-Heijboer H, Adank MA, van der Luijt RB, Li J, Liu J, Humphreys K, Kang D, Choi JY, Park SK, Yoo KY, Matsuo K, Ito H, Iwata H, Tajima K, Guénel P, Truong T, Mulot C, Sanchez M, Burwinkel B, Marme F, Surowy H, Sohn C, Wu AH, Tseng CC, Van Den Berg D, Stram DO, González-Neira A, Benitez J, Zamora MP, Perez JIA, Shu XO, Lu W, Gao YT, Cai H, Cox A, Cross SS, Reed MWR, Andrulis IL, Knight JA, Glendon G, Mulligan AM, Sawyer EJ, Tomlinson I, Kerin MJ, Miller N, Lindblom A, Margolin S, Teo SH, Yip CH, Taib NAM, Tan GH, Hooning MJ, Hollestelle A, Martens JWM, Collée JM, Blot W, Signorello LB, Cai Q, Hopper JL, Southey MC, Tsimiklis H, Apicella C, Shen CY, Hsiung CN, Wu PE, Hou MF, Kristensen VN, Nord S, Alnaes GIG, Giles GG, Milne RL, McLean C, Canzian F, Trichopoulos D, Peeters P, Lund E, Sund M, Khaw KT, Gunter MJ, Palli D, Mortensen LM, Dossus L, Huerta JM, Meindl A, Schmutzler RK, Sutter C, Yang R, Muir K, Lophatananon A, Stewart-Brown S, Siriwanarangsan P, Hartman M, Miao H, Chia KS, Chan CW, Fasching PA, Hein A, Beckmann MW, Haeberle L, Brenner H, Dieffenbach AK, Arndt V, Stegmaier C, Ashworth A, Orr N, Schoemaker MJ, Swerdlow AJ, Brinton L, Garcia-Closas M, Zheng W, Halverson SL, Shrubsole M, Long J, Goldberg MS, Labrèche F, Dumont M, Winqvist R, Pylkäs K, Jukkola-Vuorinen A, Grip M, Brauch H, Hamann U, Brüning T, Radice P, Peterlongo P, Manoukian S, Bernard L, Bogdanova NV, Dörk T, Mannermaa A, Kataja V, Kosma VM, Hartikainen JM, Devilee P, Tollenaar RAEM, Seynaeve C, Van Asperen CJ, Jakubowska A, Lubinski J, Jaworska K, Huzarski T, Sangrajrang S, Gaborieau V, Brennan P, McKay J, Slager S, Toland AE, Ambrosone CB, Yannoukakos D, Kabisch M, Torres D, Neuhausen SL, Anton-Culver H, Luccarini C, Baynes C, Ahmed S, Healey CS, Tessier DC, Vincent D, Bacot F, Pita G, Alonso MR, Álvarez N, Herrero D, Simard J, Pharoah PPDP, Kraft P, Dunning AM, Chenevix-Trench G, Hall P, Easton DF. Genome-wide association analysis of more than 120,000 individuals identifies 15 new susceptibility loci for breast cancer. Nat Genet 2015; 47:373-80. [PMID: 25751625 PMCID: PMC4549775 DOI: 10.1038/ng.3242] [Citation(s) in RCA: 427] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/11/2015] [Indexed: 02/06/2023]
Abstract
Genome-wide association studies (GWAS) and large-scale replication studies have identified common variants in 79 loci associated with breast cancer, explaining ∼14% of the familial risk of the disease. To identify new susceptibility loci, we performed a meta-analysis of 11 GWAS, comprising 15,748 breast cancer cases and 18,084 controls together with 46,785 cases and 42,892 controls from 41 studies genotyped on a 211,155-marker custom array (iCOGS). Analyses were restricted to women of European ancestry. We generated genotypes for more than 11 million SNPs by imputation using the 1000 Genomes Project reference panel, and we identified 15 new loci associated with breast cancer at P < 5 × 10(-8). Combining association analysis with ChIP-seq chromatin binding data in mammary cell lines and ChIA-PET chromatin interaction data from ENCODE, we identified likely target genes in two regions: SETBP1 at 18q12.3 and RNF115 and PDZK1 at 1q21.1. One association appears to be driven by an amino acid substitution encoded in EXO1.
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Affiliation(s)
- Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jonathan Beesley
- Department of Genetics, QIMR (Queensland Institute for Medical Research) Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sara Lindstrom
- Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Sander Canisius
- Division of Molecular Carcinogenesis, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Michael J Lush
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mel J Maranian
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Barbara J Perkins
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hatef Darabi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Stig E Bojesen
- 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark. [3] Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Børge G Nordestgaard
- 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark. [3] Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Sune F Nielsen
- 1] Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark. [2] Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Nazneen Rahman
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Olivia Fletcher
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Julian Peto
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Lorna Gibson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Isabel dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dieter Flesch-Janys
- 1] Department of Cancer Epidemiology/Clinical Cancer Registry, University Clinic Hamburg-Eppendorf, Hamburg, Germany. [2] Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ursula Eilber
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Taru A Muranen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Kristiina Aittomäki
- Department of Clinical Genetics, Helsinki University Central Hospital, Helsinki, Finland
| | - Carl Blomqvist
- Department of Oncology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Sofia Khan
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Kirsimari Aaltonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Habibul Ahsan
- 1] Center for Cancer Epidemiology and Prevention, University of Chicago, Chicago, Illinois, USA. [2] Department of Health Studies, University of Chicago, Chicago, Illinois, USA. [3] Department of Medicine, University of Chicago, Chicago, Illinois, USA. [4] Department of Human Genetics, University of Chicago, Chicago, Illinois, USA. [5] Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | - Muhammad G Kibriya
- 1] Center for Cancer Epidemiology and Prevention, University of Chicago, Chicago, Illinois, USA. [2] Department of Health Studies, University of Chicago, Chicago, Illinois, USA
| | - Alice S Whittemore
- 1] Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, Stanford, California, USA. [2] Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Esther M John
- 1] Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, Stanford, California, USA. [2] Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA. [3] Department of Epidemiology, Cancer Prevention Institute of California, Fremont, California, USA
| | - Kathleen E Malone
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Marilie D Gammon
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Regina M Santella
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | | | - Enes Makalic
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Melbourne School of Population Health, Melbourne, Victoria, Australia
| | - Daniel F Schmidt
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Melbourne School of Population Health, Melbourne, Victoria, Australia
| | - Graham Casey
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David J Hunter
- Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia, USA
| | - Mia M Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia, USA
| | - W Ryan Diver
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia, USA
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Fredrick Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Brian E Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Christine D Berg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Jonine Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Robert N Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Diether Lambrechts
- 1] Vesalius Research Center, VIB, Leuven, Belgium. [2] Laboratory for Translational Genetics, Department of Oncology, University of Leuven, Leuven, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium
| | - Erik van Limbergen
- Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium
| | - Marjanka K Schmidt
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Annegien Broeks
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Senno Verhoef
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Sten Cornelissen
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily Hallberg
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Celine Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Quinten Waisfisz
- Department of Clinical Genetics, Section Oncogenetics, VU University Medical Center, Amsterdam, the Netherlands
| | - Hanne Meijers-Heijboer
- Department of Clinical Genetics, Section Oncogenetics, VU University Medical Center, Amsterdam, the Netherlands
| | - Muriel A Adank
- Department of Clinical Genetics, Section Oncogenetics, VU University Medical Center, Amsterdam, the Netherlands
| | - Rob B van der Luijt
- Division of Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jingmei Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jianjun Liu
- Human Genetics Division, Genome Institute of Singapore, Singapore
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Daehee Kang
- 1] Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. [2] Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea. [3] Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Ji-Yeob Choi
- 1] Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea. [2] Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Sue K Park
- 1] Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. [2] Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea. [3] Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Keun-Young Yoo
- Seoul National University College of Medicine, Seoul, Korea
| | - Keitaro Matsuo
- Department of Preventive Medicine, Kyushu University Faculty of Medical Sciences, Fukuoka, Japan
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kazuo Tajima
- Epidemiology Center for Disease Control and Prevention, Mie University Hospital, Tsu, Japan
| | - Pascal Guénel
- 1] INSERM), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France. [2] University Paris-Sud, UMRS 1018, Villejuif, France
| | - Thérèse Truong
- 1] INSERM), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France. [2] University Paris-Sud, UMRS 1018, Villejuif, France
| | - Claire Mulot
- Université Paris Sorbonne Cité, UMRS 775, INSERM, Paris, France
| | - Marie Sanchez
- 1] INSERM), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France. [2] University Paris-Sud, UMRS 1018, Villejuif, France
| | - Barbara Burwinkel
- 1] Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany. [2] Molecular Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik Marme
- 1] Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany. [2] National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Harald Surowy
- 1] Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany. [2] Molecular Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Chiu-chen Tseng
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David Van Den Berg
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Daniel O Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anna González-Neira
- Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Javier Benitez
- 1] Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain. [2] Centro de Investigación en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | - M Pilar Zamora
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Xiao-Ou Shu
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Wei Lu
- Shanghai Center for Disease Control and Prevention, Changning, China
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Hui Cai
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Angela Cox
- 1] Sheffield Cancer Research Centre, University of Sheffield, Sheffield, UK. [2] Department of Oncology, University of Sheffield, Sheffield, UK
| | - Simon S Cross
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Malcolm W R Reed
- 1] Sheffield Cancer Research Centre, University of Sheffield, Sheffield, UK. [2] Department of Oncology, University of Sheffield, Sheffield, UK
| | - Irene L Andrulis
- 1] Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada. [2] Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Julia A Knight
- 1] Prosserman Centre for Health Research, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada. [2] Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anna Marie Mulligan
- 1] Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. [2] Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Elinor J Sawyer
- Research Oncology, Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
| | - Ian Tomlinson
- 1] Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. [2] Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Michael J Kerin
- Department of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
| | - Nicola Miller
- Department of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sara Margolin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Soo Hwang Teo
- 1] Cancer Research Initiatives Foundation, Sime Darby Medical Centre, Subang Jaya, Malaysia. [2] Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
| | - Cheng Har Yip
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
| | - Nur Aishah Mohd Taib
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
| | - Gie-Hooi Tan
- Breast Cancer Research Unit, University Malaya Cancer Research Institute, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - John W M Martens
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J Margriet Collée
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - William Blot
- 1] Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. [2] International Epidemiology Institute, Rockville, Maryland, USA
| | - Lisa B Signorello
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Qiuyin Cai
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa C Southey
- Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen Tsimiklis
- Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia
| | - Carmel Apicella
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Chen-Yang Shen
- 1] Taiwan Biobank, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan. [2] Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan. [3] School of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Ni Hsiung
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Pei-Ei Wu
- 1] Taiwan Biobank, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan. [2] Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Ming-Feng Hou
- 1] Cancer Center, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan. [2] Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Vessela N Kristensen
- 1] Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo, Norway. [2] Institute of Clinical Medicine, University of Oslo, Oslo, Norway. [3] Department of Clinical Molecular Biology (EpiGen), University of Oslo, Oslo, Norway
| | - Silje Nord
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Grethe I Grenaker Alnaes
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Graham G Giles
- 1] Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. [2] Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Roger L Milne
- 1] Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. [2] Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Catriona McLean
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dimitrios Trichopoulos
- 1] Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA. [2] Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece. [3] Hellenic Health Foundation, Athens, Greece
| | - Petra Peeters
- 1] Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands. [2] Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Eiliv Lund
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Arctic University of Norway, Tromsø, Norway
| | - Malin Sund
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - Kay-Tee Khaw
- School of Clinical Medicine, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy
| | | | - Laure Dossus
- 1] INSERM Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France. [2] Université Paris-Sud, Villejuif, France
| | - Jose-Maria Huerta
- Department of Epidemiology, Consejería de Sanidad y Política Social, CIBER de Epidemiología y Salud Pública, Murcia, Spain
| | - Alfons Meindl
- Division of Gynaecology and Obstetrics, Technische Universität München, Munich, Germany
| | - Rita K Schmutzler
- 1] Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany. [2] Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany. [3] Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Christian Sutter
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Rongxi Yang
- 1] Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany. [2] Molecular Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kenneth Muir
- 1] Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK. [2] Institute of Population Health, University of Manchester, Manchester, UK
| | - Artitaya Lophatananon
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK
| | - Sarah Stewart-Brown
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK
| | | | - Mikael Hartman
- 1] Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore. [2] Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Hui Miao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Ching Wan Chan
- Division of General Surgery, National University Health System, Singapore
| | - Peter A Fasching
- 1] Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center of the Erlangen-Nuremberg Metropolitan Region, Erlangen, Germany. [2] Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander Hein
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center of the Erlangen-Nuremberg Metropolitan Region, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center of the Erlangen-Nuremberg Metropolitan Region, Erlangen, Germany
| | - Lothar Haeberle
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center of the Erlangen-Nuremberg Metropolitan Region, Erlangen, Germany
| | - Hermann Brenner
- 1] Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany. [2] German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Aida Karina Dieffenbach
- 1] Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany. [2] German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Alan Ashworth
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Nick Orr
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Anthony J Swerdlow
- 1] Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK. [2] Division of Breast Cancer Research, Institute of Cancer Research, London, UK
| | - Louise Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Montserrat Garcia-Closas
- 1] Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK. [2] Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Wei Zheng
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sandra L Halverson
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Martha Shrubsole
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jirong Long
- Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Mark S Goldberg
- 1] Department of Medicine, McGill University, Montreal, Quebec, Canada. [2] Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - France Labrèche
- 1] Département de Santé Environnementale et Santé au Travail, Ecole de Santé Publique, Université de Montréal, Montreal, Quebec, Canada. [2] Département de Médecine Sociale et Préventive, Ecole de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Martine Dumont
- 1] Centre Hospitalier Universitaire de Québec Research Center, Quebec City, Quebec, Canada. [2] Department of Molecular Medicine, Laval University, Quebec City, Quebec, Canada
| | - Robert Winqvist
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, NordLab Oulu/Oulu University Hospital, Oulu, Finland
| | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology, Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, NordLab Oulu/Oulu University Hospital, Oulu, Finland
| | | | - Mervi Grip
- Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Hiltrud Brauch
- 1] German Cancer Consortium (DKTK), Heidelberg, Germany. [2] Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany. [3] University of Tübingen, Tübingen, Germany. [4] German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale Tumori (INT), Milan, Italy
| | - Paolo Peterlongo
- Fondazione Istituto FIRC (Italian Foundation for Cancer Research) di Oncologia Molecolare (IFOM), Milan, Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Preventive and Predictive Medicine, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Nazionale Tumori (INT), Milan, Italy
| | - Loris Bernard
- 1] Department of Experimental Oncology, Istituto Europeo di Oncologia, Milan, Italy. [2] Cogentech Cancer Genetic Test Laboratory, Milan, Italy
| | - Natalia V Bogdanova
- Department of Radiation Oncology, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Gynaecology Research Unit, Hannover Medical School, Hannover, Germany
| | - Arto Mannermaa
- 1] School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland. [2] Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland. [3] Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Vesa Kataja
- 1] Cancer Center, Kuopio University Hospital, Kuopio, Finland. [2] Central Finland Hospital District, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Veli-Matti Kosma
- 1] School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland. [2] Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland. [3] Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Jaana M Hartikainen
- 1] School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland. [2] Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland. [3] Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Peter Devilee
- 1] Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands. [2] Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert A E M Tollenaar
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Caroline Seynaeve
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Christi J Van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Jan Lubinski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Jaworska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Huzarski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | | | | | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - James McKay
- International Agency for Research on Cancer, Lyon, France
| | - Susan Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda E Toland
- Department of Molecular Virology, Immunology and Medical Genetics, Ohio State University, Columbus, Ohio, USA
| | | | - Drakoulis Yannoukakos
- Molecular Diagnostics Laboratory, Institute of Radioisotopes and Radiodiagnostic Products (IRRP), National Centre for Scientific Research 'Demokritos', Aghia Paraskevi Attikis, Athens, Greece
| | - Maria Kabisch
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Diana Torres
- 1] Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany. [2] Institute of Human Genetics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California, USA
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California-Irvine, Irvine, California, USA
| | - Craig Luccarini
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Caroline Baynes
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Shahana Ahmed
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Catherine S Healey
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Daniel C Tessier
- McGill University and Génome Québec Innovation Centre, Montreal, Quebec, Canada
| | - Daniel Vincent
- McGill University and Génome Québec Innovation Centre, Montreal, Quebec, Canada
| | - Francois Bacot
- McGill University and Génome Québec Innovation Centre, Montreal, Quebec, Canada
| | - Guillermo Pita
- Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - M Rosario Alonso
- Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Nuria Álvarez
- Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Daniel Herrero
- Human Genotyping (CEGEN) Unit, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Jacques Simard
- 1] Centre Hospitalier Universitaire de Québec Research Center, Quebec City, Quebec, Canada. [2] Department of Molecular Medicine, Laval University, Quebec City, Quebec, Canada
| | - Paul P D P Pharoah
- 1] Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. [2] Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Peter Kraft
- Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Georgia Chenevix-Trench
- Department of Genetics, QIMR (Queensland Institute for Medical Research) Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Douglas F Easton
- 1] Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. [2] Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
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Schully SD, Carrick DM, Mechanic LE, Srivastava S, Anderson GL, Baron JA, Berg CD, Cullen J, Diamandis EP, Doria-Rose VP, Goddard KAB, Hankinson SE, Kushi LH, Larson EB, McShane LM, Schilsky RL, Shak S, Skates SJ, Urban N, Kramer BS, Khoury MJ, Ransohoff DF. Leveraging biospecimen resources for discovery or validation of markers for early cancer detection. J Natl Cancer Inst 2015; 107:djv012. [PMID: 25688116 DOI: 10.1093/jnci/djv012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Validation of early detection cancer biomarkers has proven to be disappointing when initial promising claims have often not been reproducible in diagnostic samples or did not extend to prediagnostic samples. The previously reported lack of rigorous internal validity (systematic differences between compared groups) and external validity (lack of generalizability beyond compared groups) may be effectively addressed by utilizing blood specimens and data collected within well-conducted cohort studies. Cohort studies with prediagnostic specimens (eg, blood specimens collected prior to development of clinical symptoms) and clinical data have recently been used to assess the validity of some early detection biomarkers. With this background, the Division of Cancer Control and Population Sciences (DCCPS) and the Division of Cancer Prevention (DCP) of the National Cancer Institute (NCI) held a joint workshop in August 2013. The goal was to advance early detection cancer research by considering how the infrastructure of cohort studies that already exist or are being developed might be leveraged to include appropriate blood specimens, including prediagnostic specimens, ideally collected at periodic intervals, along with clinical data about symptom status and cancer diagnosis. Three overarching recommendations emerged from the discussions: 1) facilitate sharing of existing specimens and data, 2) encourage collaboration among scientists developing biomarkers and those conducting observational cohort studies or managing healthcare systems with cohorts followed over time, and 3) conduct pilot projects that identify and address key logistic and feasibility issues regarding how appropriate specimens and clinical data might be collected at reasonable effort and cost within existing or future cohorts.
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Affiliation(s)
- Sheri D Schully
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK).
| | - Danielle M Carrick
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Leah E Mechanic
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Sudhir Srivastava
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Garnet L Anderson
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - John A Baron
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Christine D Berg
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Jennifer Cullen
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Eleftherios P Diamandis
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - V Paul Doria-Rose
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Katrina A B Goddard
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Susan E Hankinson
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Lawrence H Kushi
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Eric B Larson
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Lisa M McShane
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Richard L Schilsky
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Steven Shak
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Steven J Skates
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Nicole Urban
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Barnett S Kramer
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - Muin J Khoury
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
| | - David F Ransohoff
- : Division of Cancer Control and Population Sciences (SDS, DMC, LEM, VPDR, MJK), Division of Cancer Prevention (SuS, BSK), and Division of Cancer Treatment and Diagnosis (LMM), National Cancer Institute, Bethesda, MD; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (GLA, NU); Department of Medicine, University of North Carolina, Chapel Hill, NC (JAB, DFR); Department of Radiation Oncology, Johns Hopkins Medicine, Baltimore, MD (CDB); Center for Prostate Disease Research, Department of Defense, Rockville, MD (JC); Mount Sinai Hospital, Toronto, Ontario, Canada (EPD); Center for Health Research, Kaiser Permanente, Northwest, Portland, OR (KABG); Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA (SEH); Division of Research, Kaiser Permanente, Oakland, CA (LHK); Group Health Research Institute, Seattle, WA (EBL); American Society of Clinical Oncology, Alexandria, VA (RLS); Genomic Health, Inc., Redwood City, CA (StS); Biostatistics Center, Massachusetts General Hospital, Boston, MA (SJS); Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (MJK)
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Mondul AM, Shui IM, Yu K, Weinstein SJ, Tsilidis KK, Joshi AD, Agudo A, Berg CD, Black A, Buring JE, Chasman DI, Gaudet MM, Haiman C, Hankinson SE, Henderson BE, Hoover RN, Hunter DJ, Khaw KT, Kühn T, Kvaskoff M, Le Marchand L, Lindström S, McCullough ML, Overvad K, Peeters PH, Riboli E, Ridker PM, Stram DO, Sund M, Trichopoulos D, Tumino R, Weiderpass E, Willett W, Kraft P, Ziegler RG, Albanes D. Vitamin D-associated genetic variation and risk of breast cancer in the breast and prostate cancer cohort consortium (BPC3). Cancer Epidemiol Biomarkers Prev 2014; 24:627-30. [PMID: 25542828 DOI: 10.1158/1055-9965.epi-14-1127] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Two recent genome-wide association studies (GWAS) identified SNPs in or near four genes related to circulating 25-hydroxyvitamin D [25(OH)D] concentration. To examine the hypothesized inverse relationship between vitamin D status and breast cancer, we studied the associations between SNPs in these genes and breast cancer risk in a large pooled study of 9,456 cases and 10,816 controls from six cohorts. METHODS SNP markers localized to each of four genes (GC, CYP24A1, CYP2R1, and DHCR7) previously associated with 25(OH)D were genotyped and examined both individually and as a 4-SNP polygenic score. Logistic regression was used to estimate the associations between the genetic variants and risk of breast cancer. RESULTS We found no association between any of the four SNPs or their polygenic score and breast cancer risk. CONCLUSIONS Our findings do not support an association between vitamin D status, as reflected by 25(OH)D-related genotypes, and breast cancer risk. IMPACT These findings may contribute to future meta-analyses and scientific review articles, and provide new data about the association between vitamin D-related genes and breast cancer. Cancer Epidemiol Biomarkers Prev; 24(3); 627-30. ©2014 AACR.
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Affiliation(s)
- Alison M Mondul
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland.
| | - Irene M Shui
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Kai Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - Stephanie J Weinstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - Konstantinos K Tsilidis
- Nuffield Department of Clinical Medicine, Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom. Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Amit D Joshi
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Antonio Agudo
- Unit of Nutrition, Environment, and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christine D Berg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, Maryland
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - Julie E Buring
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mia M Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - Christopher Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Susan E Hankinson
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Department of Epidemiology, University of Massachusetts, Amherst School of Public Health and Health Sciences, Amherst, Massachusetts. Cancer Research Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brian E Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Robert N Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - David J Hunter
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Marina Kvaskoff
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Sara Lindström
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | | | - Kim Overvad
- Department of Public Health Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Petra H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, Imperial College School of Public Health, London, United Kingdom
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel O Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Malin Sund
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - Dimitrios Trichopoulos
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece. Hellenic Health Foundation, Athens, Greece
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic-M.P. Arezzo" Hospital, ASP Ragusa, Italy
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway. Cancer Registry of Norway, Oslo, Norway. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland
| | - Walter Willett
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Peter Kraft
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Regina G Ziegler
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, Maryland
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Wang Z, Zhu B, Zhang M, Parikh H, Jia J, Chung CC, Sampson JN, Hoskins JW, Hutchinson A, Burdette L, Ibrahim A, Hautman C, Raj PS, Abnet CC, Adjei AA, Ahlbom A, Albanes D, Allen NE, Ambrosone CB, Aldrich M, Amiano P, Amos C, Andersson U, Andriole G, Andrulis IL, Arici C, Arslan AA, Austin MA, Baris D, Barkauskas DA, Bassig BA, Beane Freeman LE, Berg CD, Berndt SI, Bertazzi PA, Biritwum RB, Black A, Blot W, Boeing H, Boffetta P, Bolton K, Boutron-Ruault MC, Bracci PM, Brennan P, Brinton LA, Brotzman M, Bueno-de-Mesquita HB, Buring JE, Butler MA, Cai Q, Cancel-Tassin G, Canzian F, Cao G, Caporaso NE, Carrato A, Carreon T, Carta A, Chang GC, Chang IS, Chang-Claude J, Che X, Chen CJ, Chen CY, Chen CH, Chen C, Chen KY, Chen YM, Chokkalingam AP, Chu LW, Clavel-Chapelon F, Colditz GA, Colt JS, Conti D, Cook MB, Cortessis VK, Crawford ED, Cussenot O, Davis FG, De Vivo I, Deng X, Ding T, Dinney CP, Di Stefano AL, Diver WR, Duell EJ, Elena JW, Fan JH, Feigelson HS, Feychting M, Figueroa JD, Flanagan AM, Fraumeni JF, Freedman ND, Fridley BL, Fuchs CS, Gago-Dominguez M, Gallinger S, Gao YT, Gapstur SM, Garcia-Closas M, Garcia-Closas R, Gastier-Foster JM, Gaziano JM, Gerhard DS, Giffen CA, Giles GG, Gillanders EM, Giovannucci EL, Goggins M, Gokgoz N, Goldstein AM, Gonzalez C, Gorlick R, Greene MH, Gross M, Grossman HB, Grubb R, Gu J, Guan P, Haiman CA, Hallmans G, Hankinson SE, Harris CC, Hartge P, Hattinger C, Hayes RB, He Q, Helman L, Henderson BE, Henriksson R, Hoffman-Bolton J, Hohensee C, Holly EA, Hong YC, Hoover RN, Hosgood HD, Hsiao CF, Hsing AW, Hsiung CA, Hu N, Hu W, Hu Z, Huang MS, Hunter DJ, Inskip PD, Ito H, Jacobs EJ, Jacobs KB, Jenab M, Ji BT, Johansen C, Johansson M, Johnson A, Kaaks R, Kamat AM, Kamineni A, Karagas M, Khanna C, Khaw KT, Kim C, Kim IS, Kim JH, Kim YH, Kim YC, Kim YT, Kang CH, Jung YJ, Kitahara CM, Klein AP, Klein R, Kogevinas M, Koh WP, Kohno T, Kolonel LN, Kooperberg C, Kratz CP, Krogh V, Kunitoh H, Kurtz RC, Kurucu N, Lan Q, Lathrop M, Lau CC, Lecanda F, Lee KM, Lee MP, Le Marchand L, Lerner SP, Li D, Liao LM, Lim WY, Lin D, Lin J, Lindstrom S, Linet MS, Lissowska J, Liu J, Ljungberg B, Lloreta J, Lu D, Ma J, Malats N, Mannisto S, Marina N, Mastrangelo G, Matsuo K, McGlynn KA, McKean-Cowdin R, McNeill LH, McWilliams RR, Melin BS, Meltzer PS, Mensah JE, Miao X, Michaud DS, Mondul AM, Moore LE, Muir K, Niwa S, Olson SH, Orr N, Panico S, Park JY, Patel AV, Patino-Garcia A, Pavanello S, Peeters PHM, Peplonska B, Peters U, Petersen GM, Picci P, Pike MC, Porru S, Prescott J, Pu X, Purdue MP, Qiao YL, Rajaraman P, Riboli E, Risch HA, Rodabough RJ, Rothman N, Ruder AM, Ryu JS, Sanson M, Schned A, Schumacher FR, Schwartz AG, Schwartz KL, Schwenn M, Scotlandi K, Seow A, Serra C, Serra M, Sesso HD, Severi G, Shen H, Shen M, Shete S, Shiraishi K, Shu XO, Siddiq A, Sierrasesumaga L, Sierri S, Loon Sihoe AD, Silverman DT, Simon M, Southey MC, Spector L, Spitz M, Stampfer M, Stattin P, Stern MC, Stevens VL, Stolzenberg-Solomon RZ, Stram DO, Strom SS, Su WC, Sund M, Sung SW, Swerdlow A, Tan W, Tanaka H, Tang W, Tang ZZ, Tardon A, Tay E, Taylor PR, Tettey Y, Thomas DM, Tirabosco R, Tjonneland A, Tobias GS, Toro JR, Travis RC, Trichopoulos D, Troisi R, Truelove A, Tsai YH, Tucker MA, Tumino R, Van Den Berg D, Van Den Eeden SK, Vermeulen R, Vineis P, Visvanathan K, Vogel U, Wang C, Wang C, Wang J, Wang SS, Weiderpass E, Weinstein SJ, Wentzensen N, Wheeler W, White E, Wiencke JK, Wolk A, Wolpin BM, Wong MP, Wrensch M, Wu C, Wu T, Wu X, Wu YL, Wunder JS, Xiang YB, Xu J, Yang HP, Yang PC, Yatabe Y, Ye Y, Yeboah ED, Yin Z, Ying C, Yu CJ, Yu K, Yuan JM, Zanetti KA, Zeleniuch-Jacquotte A, Zheng W, Zhou B, Mirabello L, Savage SA, Kraft P, Chanock SJ, Yeager M, Landi MT, Shi J, Chatterjee N, Amundadottir LT. Imputation and subset-based association analysis across different cancer types identifies multiple independent risk loci in the TERT-CLPTM1L region on chromosome 5p15.33. Hum Mol Genet 2014; 23:6616-33. [PMID: 25027329 PMCID: PMC4240198 DOI: 10.1093/hmg/ddu363] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/30/2014] [Accepted: 07/08/2014] [Indexed: 02/03/2023] Open
Abstract
Genome-wide association studies (GWAS) have mapped risk alleles for at least 10 distinct cancers to a small region of 63 000 bp on chromosome 5p15.33. This region harbors the TERT and CLPTM1L genes; the former encodes the catalytic subunit of telomerase reverse transcriptase and the latter may play a role in apoptosis. To investigate further the genetic architecture of common susceptibility alleles in this region, we conducted an agnostic subset-based meta-analysis (association analysis based on subsets) across six distinct cancers in 34 248 cases and 45 036 controls. Based on sequential conditional analysis, we identified as many as six independent risk loci marked by common single-nucleotide polymorphisms: five in the TERT gene (Region 1: rs7726159, P = 2.10 × 10(-39); Region 3: rs2853677, P = 3.30 × 10(-36) and PConditional = 2.36 × 10(-8); Region 4: rs2736098, P = 3.87 × 10(-12) and PConditional = 5.19 × 10(-6), Region 5: rs13172201, P = 0.041 and PConditional = 2.04 × 10(-6); and Region 6: rs10069690, P = 7.49 × 10(-15) and PConditional = 5.35 × 10(-7)) and one in the neighboring CLPTM1L gene (Region 2: rs451360; P = 1.90 × 10(-18) and PConditional = 7.06 × 10(-16)). Between three and five cancers mapped to each independent locus with both risk-enhancing and protective effects. Allele-specific effects on DNA methylation were seen for a subset of risk loci, indicating that methylation and subsequent effects on gene expression may contribute to the biology of risk variants on 5p15.33. Our results provide strong support for extensive pleiotropy across this region of 5p15.33, to an extent not previously observed in other cancer susceptibility loci.
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Affiliation(s)
- Zhaoming Wang
- Division of Cancer Epidemiology and Genetics, Cancer Genomics Research Laboratory, National Cancer Institute, Division of Cancer Epidemiology and Genetics, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Bin Zhu
- Division of Cancer Epidemiology and Genetics
| | | | | | - Jinping Jia
- Division of Cancer Epidemiology and Genetics
| | - Charles C Chung
- Division of Cancer Epidemiology and Genetics, Cancer Genomics Research Laboratory, National Cancer Institute, Division of Cancer Epidemiology and Genetics, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | | | - Amy Hutchinson
- Division of Cancer Epidemiology and Genetics, Cancer Genomics Research Laboratory, National Cancer Institute, Division of Cancer Epidemiology and Genetics, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Laurie Burdette
- Division of Cancer Epidemiology and Genetics, Cancer Genomics Research Laboratory, National Cancer Institute, Division of Cancer Epidemiology and Genetics, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | - Christopher Hautman
- Division of Cancer Epidemiology and Genetics, Cancer Genomics Research Laboratory, National Cancer Institute, Division of Cancer Epidemiology and Genetics, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | | | - Andrew A Adjei
- Korle Bu Teaching Hospital, PO BOX 77, Accra, Ghana, University of Ghana Medical School, PO Box 4236, Accra, Ghana
| | - Anders Ahlbom
- Unit of Epidemiology, Institute of Environmental Medicine
| | | | - Naomi E Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Melinda Aldrich
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Pilar Amiano
- Public Health Division of Gipuzkoa, Basque Regional Health Department, San Sebastian, Spain, CIBERESP, CIBER Epidemiologia y Salud Publica, Madrid, Spain
| | | | | | - Gerald Andriole
- Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Irene L Andrulis
- Litwin Centre for Cancer Genetics, Samuel Lunenfeld Research Institute, Mt Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Cecilia Arici
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - Alan A Arslan
- Department of Obstetrics and Gynecology and Department of Population Health, New York University School of Medicine, New York, NY, USA, New York University Cancer Institute, New York, NY, USA
| | - Melissa A Austin
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Dalsu Baris
- Division of Cancer Epidemiology and Genetics
| | - Donald A Barkauskas
- Department of Preventive Medicine, Biostatistics Division, Keck School of Medicine and
| | - Bryan A Bassig
- Division of Cancer Epidemiology and Genetics, Division of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | | | | | | | - Pier Alberto Bertazzi
- Department of Clinical Sciences and Community Health, University of Milan, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda Policlinico Hospital, Milan, Italy
| | - Richard B Biritwum
- Korle Bu Teaching Hospital, PO BOX 77, Accra, Ghana, University of Ghana Medical School, PO Box 4236, Accra, Ghana
| | | | - William Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA, International Epidemiology Institute, Rockville, MD, USA
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
| | - Paolo Boffetta
- Institute for Translational Epidemiology, Hematology and Medical Oncology, Mount Sinai Hospital School of Medicine, New York, NY, USA
| | - Kelly Bolton
- Division of Cancer Epidemiology and Genetics, Department of Oncology, University of Cambridge, Cambridge CB2 2RE, UK
| | | | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Paul Brennan
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | | | | | - H Bas Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands, Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Julie E Buring
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary Ann Butler
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Guangwen Cao
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | | | - Alfredo Carrato
- Medical Oncology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Tania Carreon
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Angela Carta
- Litwin Centre for Cancer Genetics, Samuel Lunenfeld Research Institute, Mt Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Gee-Chen Chang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Jenny Chang-Claude
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Xu Che
- Department of Abdominal Surgery and
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chih-Yi Chen
- Cancer Center, China Medical University Hospital, Taipei, Taiwan
| | | | | | - Kuan-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine and Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | | | - Lisa W Chu
- Cancer Prevention Institute of California, Fremont, CA, USA
| | | | | | | | - David Conti
- Department of Preventive Medicine, Biostatistics Division, Keck School of Medicine and
| | | | - Victoria K Cortessis
- Department of Preventive Medicine, Biostatistics Division, Keck School of Medicine and
| | | | - Olivier Cussenot
- CeRePP, Paris, France, AP-HP, Department of Urology, Tenon Hospital, GHU-Est, Paris, France, UPMC Univ Paris 06, GRC n°5, ONCOTYPE-URO, Paris, France
| | - Faith G Davis
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB, Canada T6G 2R3
| | - Immaculata De Vivo
- Program in Molecular and Genetic Epidemiology, Department of Medicine, Channing Division of Network Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Xiang Deng
- Division of Cancer Epidemiology and Genetics, Cancer Genomics Research Laboratory, National Cancer Institute, Division of Cancer Epidemiology and Genetics, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Ti Ding
- Shanxi Cancer Hospital, Taiyuan, Shanxi, People's Republic of China
| | | | - Anna Luisa Di Stefano
- Service de Neurologie Mazarin, GH Pitie-Salpetriere, APHP, and UMR 975 INSERM-UPMC, CRICM, Paris, France
| | - W Ryan Diver
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Eric J Duell
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Joanne W Elena
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, Bethesda, MD, USA
| | - Jin-Hu Fan
- Shanghai Cancer Institute, Shanghai, People's Republic of China
| | | | | | | | - Adrienne M Flanagan
- UCL Cancer Institute, Huntley Street, London WC1E 6BT, UK, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex HA7 4LP, UK
| | | | | | - Brooke L Fridley
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Charles S Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA, Channing Laboratory, Department of Medicine
| | - Manuela Gago-Dominguez
- Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | | | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotaong University School of Medicine, Shanghai, China
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK
| | - Reina Garcia-Closas
- Unidad de Investigación, Hospital Universitario de Canarias, La Laguna, Spain
| | - Julie M Gastier-Foster
- Nationwide Children's Hospital, and The Ohio State University Department of Pathology and Pediatrics, Columbus, OH, USA
| | - J Michael Gaziano
- Division of Preventive Medicine, Department of Medicine and Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, Massachusetts Veteran's Epidemiology, Research and Information Center, Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Daniela S Gerhard
- Office of Cancer Genomics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Carol A Giffen
- Information Management Services Inc., Calverton, MD, USA
| | - Graham G Giles
- Cancer Epidemiology Centre, The Cancer Council Victoria & Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Victoria, Australia
| | | | | | - Michael Goggins
- Department of Oncology, Department of Pathology and Department of Medicine, The Sol Goldman Pancreatic Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nalan Gokgoz
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Carlos Gonzalez
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - Richard Gorlick
- Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY, USA
| | | | - Myron Gross
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Robert Grubb
- Department of Urology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Peng Guan
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Goran Hallmans
- Department of Public Health and Clinical Medicine/Nutritional Research
| | | | - Curtis C Harris
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | | | - Claudia Hattinger
- Laboratory of Experimental Oncology, Orthopaedic Rizzoli Institute, Bologna, Italy
| | - Richard B Hayes
- Division of Cancer Epidemiology and Genetics, Department of Population Health, New York University Langone Medical Center and Department of Environmental Medicine, New York University Langone Medical Center, New York University Cancer Institute, New York, NY, USA
| | - Qincheng He
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | | | - Brian E Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | - Chancellor Hohensee
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Elizabeth A Holly
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Yun-Chul Hong
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea, Department of Preventive Medicine and
| | | | - H Dean Hosgood
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Chin-Fu Hsiao
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences and Taiwan Lung Cancer Tissue/Specimen Information Resource Center, National Health Research Institutes, Zhunan, Taiwan
| | - Ann W Hsing
- Cancer Prevention Institute of California, Fremont, CA, USA, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Chao Agnes Hsiung
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences and
| | - Nan Hu
- Division of Cancer Epidemiology and Genetics
| | - Wei Hu
- Division of Cancer Epidemiology and Genetics
| | - Zhibin Hu
- Department of Epidemiology and Biostatistics, Cancer Center, Nanjing Medical University, Nanjing, China
| | - Ming-Shyan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - David J Hunter
- Program in Molecular and Genetic Epidemiology, Department of Medicine, Channing Division of Network Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | | | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Eric J Jacobs
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Kevin B Jacobs
- Cancer Genomics Research Laboratory, National Cancer Institute, Division of Cancer Epidemiology and Genetics, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA, Cancer Genomics Research Laboratory, National Cancer Institute, Division of Cancer Epidemiology and Genetics, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA, Bioinformed, LLC, Gaithersburg, MD, USA
| | - Mazda Jenab
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Bu-Tian Ji
- Division of Cancer Epidemiology and Genetics
| | - Christoffer Johansen
- Department of Oncology, Finsen Center, Rigshospitalet, Copenhagen, Denmark, Unit of Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mattias Johansson
- International Agency for Research on Cancer (IARC-WHO), Lyon, France, Department of Public Health and Clinical Medicine
| | | | - Rudolf Kaaks
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | | | | | - Kay-Tee Khaw
- School of Clinical Medicine, University of Cambridge, UK
| | | | - In-Sam Kim
- Department of Biochemistry and Department of Cell Biology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jin Hee Kim
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Yeul Hong Kim
- Genomic Research Center for Lung and Breast/Ovarian Cancers, Korea University Anam Hospital, Seoul, Republic of Korea, Department of Internal Medicine and Division of Brain and Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Chul Kim
- Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun-eup, Republic of Korea
| | - Young Tae Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Hyun Kang
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoo Jin Jung
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Alison P Klein
- Department of Oncology, Department of Pathology and Department of Medicine, The Sol Goldman Pancreatic Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain, National School of Public Health, Athens, Greece
| | - Woon-Puay Koh
- Duke-NUS Graduate Medical School, Singapore, Singapore, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Takashi Kohno
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Laurence N Kolonel
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Vittorio Krogh
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Hideo Kunitoh
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan, Department of Respiratory Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - Nilgun Kurucu
- Department of Pediatric Oncology, A.Y. Ankara Oncology Training and Research Hospital, Yenimahalle- Ankara, Turkey
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics
| | - Mark Lathrop
- Centre National de Genotypage, IG/CEA, Evry Cedex, France, Centre d'Étude du Polymorphism Humain (CEPH), Paris, France
| | - Ching C Lau
- Texas Children's Cancer and Hematology Centers
| | - Fernando Lecanda
- Department of Pediatrics, University Clinic of Navarra, Universidad de Navarra, Pamplona, Spain
| | - Kyoung-Mu Lee
- Department of Preventive Medicine and Department of Environmental Health, Korea National Open University, Seoul, Republic of Korea
| | | | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | | | - Donghui Li
- Department of Gastrointestinal Medical Oncology
| | | | - Wei-Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Dongxin Lin
- State Key Laboratory of Molecular Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, Maria Sklodowska-Curie Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Jianjun Liu
- Human Genetics Division, Genome Institute of Singapore, Singapore, School of Life Sciences, Anhui Medical University, Hefei, China
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology and
| | - Josep Lloreta
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Daru Lu
- Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China, State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
| | - Jing Ma
- Department of Medicine, Channing Division of Network Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nuria Malats
- Centro Nacional de Investigaciones Oncologicas, Melchor Fernández Almagro, 3, Madrid E-28029, Spain
| | - Satu Mannisto
- National Institute for Health and Welfare, Helsinki, Finland
| | - Neyssa Marina
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Giuseppe Mastrangelo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Keitaro Matsuo
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan, Department of Preventive Medicine, Kyushu University Faculty of Medical Scicence, Fukuoka, Japan
| | | | | | - Lorna H McNeill
- Department of Health Disparities Research, Division of OVP, Cancer Prevention and Population Sciences, and Center for Community-Engaged Translational Research, Duncan Family Institute and
| | | | | | | | - James E Mensah
- Korle Bu Teaching Hospital, PO BOX 77, Accra, Ghana, University of Ghana Medical School, PO Box 4236, Accra, Ghana
| | - Xiaoping Miao
- Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, China
| | - Dominique S Michaud
- Department of Epidemiology, Division of Biology and Medicine, Brown University, Providence, RI, USA
| | | | - Lee E Moore
- Division of Cancer Epidemiology and Genetics
| | - Kenneth Muir
- Health Sciences Research Institute, University of Warwick, Coventry, UK
| | | | - Sara H Olson
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nick Orr
- Complex Traits Genetics Team and
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Jae Yong Park
- Department of Biochemistry and Department of Cell Biology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea, Lung Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Alpa V Patel
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Ana Patino-Garcia
- Department of Pediatrics, University Clinic of Navarra, Universidad de Navarra, Pamplona, Spain
| | - Sofia Pavanello
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Utrecht, The Netherlands, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | | | - Ulrike Peters
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Gloria M Petersen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Piero Picci
- Laboratory of Experimental Oncology, Orthopaedic Rizzoli Institute, Bologna, Italy
| | - Malcolm C Pike
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Stefano Porru
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - Jennifer Prescott
- Program in Molecular and Genetic Epidemiology, Department of Medicine, Channing Division of Network Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Xia Pu
- Department of Epidemiology
| | | | - You-Lin Qiao
- Department of Epidemiology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | | | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | | | - Rebecca J Rodabough
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Avima M Ruder
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Jeong-Seon Ryu
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Marc Sanson
- Service de Neurologie Mazarin, GH Pitie-Salpetriere, APHP, and UMR 975 INSERM-UPMC, CRICM, Paris, France
| | - Alan Schned
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Fredrick R Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ann G Schwartz
- Karmanos Cancer Institute and Department of Oncology and
| | - Kendra L Schwartz
- Karmanos Cancer Institute and Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Katia Scotlandi
- Laboratory of Experimental Oncology, Orthopaedic Rizzoli Institute, Bologna, Italy
| | - Adeline Seow
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Consol Serra
- Centre for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain, CIBER of Epidemiology and Public Health (CIBERESP)
| | - Massimo Serra
- Laboratory of Experimental Oncology, Orthopaedic Rizzoli Institute, Bologna, Italy
| | - Howard D Sesso
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Gianluca Severi
- Cancer Epidemiology Centre, The Cancer Council Victoria & Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Victoria, Australia
| | - Hongbing Shen
- Department of Epidemiology and Biostatistics, Cancer Center, Nanjing Medical University, Nanjing, China
| | - Min Shen
- Division of Cancer Epidemiology and Genetics
| | - Sanjay Shete
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Afshan Siddiq
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, London, UK
| | - Luis Sierrasesumaga
- Department of Pediatrics, University Clinic of Navarra, Universidad de Navarra, Pamplona, Spain
| | - Sabina Sierri
- Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alan Dart Loon Sihoe
- Department of Surgery, Division of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
| | | | - Matthias Simon
- Department of Neurosurgery, University of Bonn Medical Center, Bonn, Germany
| | - Melissa C Southey
- Department of Pathology, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Margaret Spitz
- Dan L. Duncan Center, Baylor College of Medicine, Houston, TX, USA
| | - Meir Stampfer
- Department of Medicine, Channing Division of Network Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Par Stattin
- Department of Surgical and Perioperative Sciences, Urology and Andrology and
| | - Mariana C Stern
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Victoria L Stevens
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | | | - Daniel O Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sara S Strom
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wu-Chou Su
- Department of Internal Medicine, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Malin Sund
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - Sook Whan Sung
- Department of Thoracic and Cardiovascular Surgery, Seoul St Mary's Hospital, Seoul, South Korea
| | - Anthony Swerdlow
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, UK, Division of Breast Cancer Research, Institute of Cancer Research, London, UK
| | - Wen Tan
- State Key Laboratory of Molecular Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hideo Tanaka
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Wei Tang
- Division of Cancer Epidemiology and Genetics
| | - Ze-Zhang Tang
- Shanxi Cancer Hospital, Taiyuan, Shanxi, People's Republic of China
| | - Adonina Tardon
- Instituto Universitario de Oncología, Universidad de Oviedo, Oviedo, Spain
| | - Evelyn Tay
- Korle Bu Teaching Hospital, PO BOX 77, Accra, Ghana, University of Ghana Medical School, PO Box 4236, Accra, Ghana
| | | | - Yao Tettey
- Korle Bu Teaching Hospital, PO BOX 77, Accra, Ghana, University of Ghana Medical School, PO Box 4236, Accra, Ghana
| | - David M Thomas
- Sir Peter MacCallum Department of Oncology, University of Melbourne, St Andrew's Place, East Melbourne, VIC, Australia
| | - Roberto Tirabosco
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex HA7 4LP, UK
| | | | | | | | - Ruth C Travis
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | | | | | | | - Ying-Huang Tsai
- Department of Pulmonary Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | | | - Rosario Tumino
- Cancer Registry Associazione Iblea Ricerca Epidemiologica, Onlus and Asp Ragusa, Ragusa Italy
| | - David Van Den Berg
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Roel Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Paolo Vineis
- Imperial College, London, UK, Human Genetics Foundation (HuGeF), Torino Italy
| | - Kala Visvanathan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ulla Vogel
- National Research Centre for the Working Environment, Copenhagen, Denmark, National Food Institute, Technical University of Denmark, Soborg, Denmark
| | - Chaoyu Wang
- Division of Cancer Epidemiology and Genetics
| | | | - Junwen Wang
- Division of Cancer Epidemiology and Genetics, Cancer Genomics Research Laboratory, National Cancer Institute, Division of Cancer Epidemiology and Genetics, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA, Department of Biochemistry and Centre for Genomic Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sophia S Wang
- Division of Cancer Etiology, Department of Population Sciences, City of Hope and the Beckman Research Institute, Duarte, CA, USA
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway, Department of Research, Cancer Registry of Norway, Oslo, Norway, Department of Medical Epidemiology and Biostatistics and Samfundet Folkhälsan, Helsinki, Finland
| | | | | | | | - Emily White
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - John K Wiencke
- University of California San Francisco, San Francisco, CA, USA
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Brian M Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA, Channing Laboratory, Department of Medicine
| | | | | | - Chen Wu
- State Key Laboratory of Molecular Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tangchun Wu
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | | | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Medical Research Center and Cancer Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jay S Wunder
- Division of Urologic Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Yong-Bing Xiang
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotaong University School of Medicine, Shanghai, China
| | - Jun Xu
- School of Public Health, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Pan-Chyr Yang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital and
| | | | - Edward D Yeboah
- Korle Bu Teaching Hospital, PO BOX 77, Accra, Ghana, University of Ghana Medical School, PO Box 4236, Accra, Ghana
| | - Zhihua Yin
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Chen Ying
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chong-Jen Yu
- Department of Internal Medicine, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Kai Yu
- Division of Cancer Epidemiology and Genetics
| | - Jian-Min Yuan
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA and
| | - Krista A Zanetti
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, Bethesda, MD, USA
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health, New York University School of Medicine, New York, NY, USA, New York University Cancer Institute, New York, NY, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Baosen Zhou
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | | | | | - Peter Kraft
- Program in Molecular and Genetic Epidemiology, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, Cancer Genomics Research Laboratory, National Cancer Institute, Division of Cancer Epidemiology and Genetics, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Meredith Yeager
- Division of Cancer Epidemiology and Genetics, Cancer Genomics Research Laboratory, National Cancer Institute, Division of Cancer Epidemiology and Genetics, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | - Jianxin Shi
- Division of Cancer Epidemiology and Genetics
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Tammemägi MC, Church TR, Hocking WG, Silvestri GA, Kvale PA, Riley TL, Commins J, Berg CD. Evaluation of the lung cancer risks at which to screen ever- and never-smokers: screening rules applied to the PLCO and NLST cohorts. PLoS Med 2014; 11:e1001764. [PMID: 25460915 PMCID: PMC4251899 DOI: 10.1371/journal.pmed.1001764] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/21/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lung cancer risks at which individuals should be screened with computed tomography (CT) for lung cancer are undecided. This study's objectives are to identify a risk threshold for selecting individuals for screening, to compare its efficiency with the U.S. Preventive Services Task Force (USPSTF) criteria for identifying screenees, and to determine whether never-smokers should be screened. Lung cancer risks are compared between smokers aged 55-64 and ≥ 65-80 y. METHODS AND FINDINGS Applying the PLCO(m2012) model, a model based on 6-y lung cancer incidence, we identified the risk threshold above which National Lung Screening Trial (NLST, n = 53,452) CT arm lung cancer mortality rates were consistently lower than rates in the chest X-ray (CXR) arm. We evaluated the USPSTF and PLCO(m2012) risk criteria in intervention arm (CXR) smokers (n = 37,327) of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). The numbers of smokers selected for screening, and the sensitivities, specificities, and positive predictive values (PPVs) for identifying lung cancers were assessed. A modified model (PLCOall2014) evaluated risks in never-smokers. At PLCO(m2012) risk ≥ 0.0151, the 65th percentile of risk, the NLST CT arm mortality rates are consistently below the CXR arm's rates. The number needed to screen to prevent one lung cancer death in the 65th to 100th percentile risk group is 255 (95% CI 143 to 1,184), and in the 30th to <65th percentile risk group is 963 (95% CI 291 to -754); the number needed to screen could not be estimated in the <30th percentile risk group because of absence of lung cancer deaths. When applied to PLCO intervention arm smokers, compared to the USPSTF criteria, the PLCO(m2012) risk ≥ 0.0151 threshold selected 8.8% fewer individuals for screening (p<0.001) but identified 12.4% more lung cancers (sensitivity 80.1% [95% CI 76.8%-83.0%] versus 71.2% [95% CI 67.6%-74.6%], p<0.001), had fewer false-positives (specificity 66.2% [95% CI 65.7%-66.7%] versus 62.7% [95% CI 62.2%-63.1%], p<0.001), and had higher PPV (4.2% [95% CI 3.9%-4.6%] versus 3.4% [95% CI 3.1%-3.7%], p<0.001). In total, 26% of individuals selected for screening based on USPSTF criteria had risks below the threshold PLCO(m2012) risk ≥ 0.0151. Of PLCO former smokers with quit time >15 y, 8.5% had PLCO(m2012) risk ≥ 0.0151. None of 65,711 PLCO never-smokers had PLCO(m2012) risk ≥ 0.0151. Risks and lung cancers were significantly greater in PLCO smokers aged ≥ 65-80 y than in those aged 55-64 y. This study omitted cost-effectiveness analysis. CONCLUSIONS The USPSTF criteria for CT screening include some low-risk individuals and exclude some high-risk individuals. Use of the PLCO(m2012) risk ≥ 0.0151 criterion can improve screening efficiency. Currently, never-smokers should not be screened. Smokers aged ≥ 65-80 y are a high-risk group who may benefit from screening. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Martin C. Tammemägi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
- * E-mail:
| | - Timothy R. Church
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | | | - Gerard A. Silvestri
- Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Paul A. Kvale
- Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, Michigan, United States of America
| | - Thomas L. Riley
- Information Management Systems, Rockville, Maryland, United States of America
| | - John Commins
- Information Management Systems, Rockville, Maryland, United States of America
| | - Christine D. Berg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, Maryland, United States of America
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