Download Cancer Epidemiology: The need for Global Information sharing in

Cancer Epidemiology: The need for
Global Information sharing in obesity
and cancer?
Edinburgh, August 2011
Faina Linkov, PhD
Research Assistant Professor
University of Pittsburgh
What is cancer?
Cancer is a term used for diseases in
which abnormal cells divide without
control and are able to invade other
tissues.
Only 5–10% of all cancer cases can be
attributed to genetic defects, whereas
the remaining 90–95% have their
roots in the environment and lifestyle.
Cancer is not just one disease but many
diseases. There are more than 100
different types of cancer.
While many diseases (such as heart
failure) may have a worse prognosis
than most cases of cancer, it is the
subject of widespread fear and
taboos.
Increase in uterine cancer mortality
might be associated with increase in
obesity epidemic
Why is it important to prevent cancer?
• Treatment options are not available for several
forms of cancer
• Existing cancer treatments do not target specific
cancer cells
• Existing cancer treatments have many
undesirable side effects and are not always 100%
effective
• One of the main causes of failure in the
treatment of cancer is the development of drug
resistance by the cancer cells.
Obesity and Cancer: Mechanisms
Adipose tissue is an active endocrine organ
Mechanisms by which adipose tissue may influence
cancer risk
- Production of sex steroid hormones (e.g., estrogen, androgen)
- Effects on insulin sensitivity and production of insulin-like growth
factors
- Actions on other hormones in adipose tissue (e.g., leptin,
adiponectin)
- Increases in oxidative stress and chronic low-grade inflammation
that affect the body’s immune response
Obesity as a common phenomenon
In 2009, no state met the Healthy People 2010 obesity target of 15%, and the self-reported
overall prevalence of obesity among U.S. adults had increased 1.1 percentage points from 2007.
What is media saying about
obesity and cancer?
1998
2003
2005
http://www.usatoday.com/news/health/2005-05-25-obesity_x.htm
007
What is the awareness of
obesity as a risk factor for
cancer?
Data from American Institute for Cancer Research
(AICR)
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% of Americans who Believe it to be a Cause of Cancer
2009 Cancer Risk Awareness
100
94
87
80
70
60
51
46
40
38
30
20
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How much excess weight is
too much???
Obesity and Mortality from Cancer
NEJM April 2003
NEJM 348:1625(April 2003)
Mortality from Cancer According to BMI for
U.S. Men in the
Cancer Prevention Study II
My research interests:
Endometrial cancer risk reduction
in the context of weight loss
through bariatric surgery
Why bariatric surgery?
Traditional diet and exercise
weight loss programs do not
result in sustainable weight
loss. Up to 90% of dieters
regain weight. Bariatric surgery
potentially offers means to
lose weight and keep it off
Unadjusted cumulative mortality for subjects who
underwent bariatric surgery vs. controls
From Sjöström et al. August 23, 2007
Endometrial Cancer:
Incidence and Prevalence
•
•
•
•
Most common gynecologic cancer
4th most common in women (US)
5th most common in women (worldwide)
approximately 39,080 new cases of
endometrial cancer are diagnosed yearly
in the US
• about 7400 women will die from the
disease this year
• While we do not have specific markers
for endometrial cancer, we know that
various inflammatory markers,
adipokines, and cancer antigens have
been associated with the disease
What kind of studies can we propose?
It is particularly interesting to
explore weight loss in
relation to endometrial
cancer risk because limited
evidence suggests that
premalignant changes in the
endometrium can
potentially be reversed with
achieving more optimal
weight.
Why is bariatric surgery patients ideal
group for this research?
• Rapid weight loss within short period of time
• High risk for endometrial cancer and other
malignancies
• Many routine care appointments (can overlap
with research appointments)
• Relatively healthy, potential for long term
follow up
Information that is being collected
• Blood
• Urine
• Health forms (including
General Health form,
reproductive health form, SF36, CES-D, MAQ, Sleep scale)
• Endometrial biopsy (only for a
pilot study supported by Scaife
foundation)
1938
The era of
cancer
treatment
2011
The era of cancer
prevention
Baruch Blumberg and
prevention of liver cancer
(July 28, 1925 – April 5, 2011)
Discovery of hepatitis vaccine prevented large number of primary liver cancers,
especially in the developed world
Cancer Supercourse Status
• Over 200 lectures
• Over 500 faculty members with interest in
cancer
• Translation in up to 5 languages for selected
sets of lectures
Raj Bhopal: Concepts of Epidemiology
course in the Supercourse
Future directions
• The long-term goal is to investigate mechanisms
by which obesity promotes endometrial cancer
development and weight loss reduces the risk of
endometrial cancer development.
• Targeting studies where patients lost weight
through means other than bariatric surgery is one
of the things that we are currently working on
• Sharing information about cancer prevention
with scientists around the world using the
Supercourse
At the end of our fight against
cancer, there can be only one…
That one is prevention
Contact Faina Linkov at
[email protected] with any questions or
new ideas.