Cancer Prevention Study-3 (CPS-3) Research Today for a Cancer-Free Tomorrow Alpa V Patel, PhD

1. Cancer Prevention Study-3 (CPS-3) Research Today for a Cancer-Free Tomorrow Alpa V Patel, PhD Principal Investigator, CPS-3 Meeting

2. A partnership between research and Society Volunteers

3. Cancer Prevention Studies For nearly 60 years, the American Cancer Society has conducted some of the world’s largest cohort studies to understand how cancer develops in a population, identify the causes of cancer and ultimately, learn how to prevent it. Years Participants Sex Volunteers States Cancer endpoints Research Emphases Hammond-Horn 1952-55 188,000 Men 22,000 9 Mortality Smoking CPS-I 1959-72 1,000,000 Both 68,000 25 Mortality Smoking, obesity CPS-II* 1982- 1,200,000 Both 77,000 50 Mortality & incidence Multiple CPS-3* 2006- 300,000 Both 25,000 35 Mortality & incidence Multiple *CPS-II 40K participants with blood; 110K with DNA *CPS-3 all participants with blood at enrollment

4. Tobacco Control and Mortality Cigarette consumption Lung cancerMen Lung cancerwomen CPS-I CPS-II Hammond-Horn IMPACT{ ●1964 Surgeon General’s report ● 1965-9 Public laws on advertising ● 1975 Smoke-free laws ● 2010 FDA bans labeling “light” etc. ● 2011 80% of US with smoke-free laws

5. CPS Major Contributions to Public Health • Smoking • Contributions to 21 U.S. Surgeon General Reports on Smoking & Cancer. • Confirm relationship of 2nd hand smoke with lung cancer & heart disease, helping to motivate smoke-free laws. • Ongoing role in debunking myths from tobacco industry. • Low tar/nicotine cigarettes do not reduce the risk of lung cancer.

6. CPS Major Contributions to Public Health Obesity, nutrition, and physical activity • First epidemiological study that overweight/obesity shortens longevity. • Landmark paper linking obesity to increased death rates from 10+ cancer sites. • First US epidemiologic study that sitting time shortens longevity. • Adherence to ACS Nutrition & Physical Activity Guidelines lowers risk of cancer, as well as increases CVD and overall longevity. • Major contributions to IARC Monographs, WCRF/AICR Reports Other areas • Discovery of the link between aspirin use and lower risk of colon cancer. • Air pollution (small particulates and ozone), increase death rates from heart and lung conditions; motivate the Environmental Protection Agency to propose more stringent limits on air pollution.

7. CPS-II involved in International Collaborative Research Inherited Susceptibility Genes 43 Cohorts, Over 4.0 Million Individuals Female Breast Prostate Colorectal NHL Male Breast Pancreas Endometrial Lung Smoking Bladder Kidney Glioma

8. What about the next generation of cancer control and prevention?

9. Obesity* Epidemic (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2000 1990 2010 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Sources: Behavioral Risk Factor Surveillance System, CDC

10. What does the future hold? We don’t completely understand the health effects of a LIFETIME of being obese! Newsweek Cover Image June 2000 http://www.cdc.gov/EXCITE/images/overweight_newsweek.jpg

11. Is 150 minutes of intentional physical activity weekly sufficient for optimal health if an individual is sitting the remainder of the time (the “active couch potato”)? Then Now

12. Risks & Benefits from Prophylactic Use of Aspirin & other NSAIDs in Cancer Prevention Benefit Risk

13. Knowledge gap in cancer disparities Diverse populations very underrepresented in existing studies 2011 President’s Cancer Panel concluded: “The current understanding of cancer risk, progression, and outcomes is based largely on studies of non-Hispanic white populations. The risk factors, screening guidelines, and treatment regimens identified through research are often not appropriate for individuals of non-European descent.” Without racially/ethnically diverse study populations in place, we can’t improve our understanding of why these differences exist

14. From Questionnaire and Blood Collection to Scientific Answers PRE-CARCINOGEN QUESTIONNAIRE DATA Reproductive Factors ● Infection ● Medications ●Occupation● Weight ● Diet●Alcohol● Physical activity●Built environment CARCINOGEN DNA/ PROTEIN ADDUCT ABNORMAL CELL GROWTH BLOOD MARKERS Diet● Genetics ● DNA damage ● Immune function● Hormones PRE-CANCER CANCER METASTASIS SURVIVAL

15. Individualized Risk Prediction ENVIRONMENT LIFESTYLE EPIGENETICS, METABOLOMICS GENETICS

16. CPS-3 Goals Operational Enroll a diverse group of at least300,000 men and women aged 30-65 years with no prior history of cancer, by December 2013 At least 25% racial/ethnic minority participation Geographic diversity Blood specimens at enrollment Scientific Examine a wide spectrum of lifestyle, behavioral, environmental, and genetic factors in relation cancer risk and mortality Study gene x environment interactions in cancer risk and mortality Identify and/or validate early markers of disease Improve individualized risk prediction

17. Enrollment Strategies Aggressive and coordinated nationwide implementation across a range of venues Venues pilot tested and validated include: Relay For Life, MSABC Open community venues utilizing corporate partner worksites, local Society offices, hospitals, faith-based, YMCA, etc. Various venues for targeted recruitment Each Division has set specific recruitment goals

18. Study Participation Initial enrollment In Person: Brief survey and informed consent Waist circumference measurement Small blood sample At home: Comprehensive baseline survey collecting information on reproductive, medical & family history, lifestyle and behaviors Long-term follow-up Repeat surveys every few years Annual participant newsletter

19. Importance of Establishing CPS-3 • Society’s studies important and unique because of their size and sequential coverage over 50 years • CPS-3 is essential to: • Identify new, relevant risk factors for cancer • Expand knowledge of risk factors in diverse populations • Take advantage of new laboratory and technology advancements • Improve understanding of cancer biology and risk prediction • Provide scientific basis for cancer control in 21st century • Without U.S. studies, we would have to rely on international studies to inform our public health knowledge, programs, and policies

20. Thank you to our partners! • Vidant Health System – Chowan & Bertie, NC • Sentara Leigh Hospital – Norfolk, VA • Sentara Norfolk General Hospital – Norfolk, VA • Sentara Williamsburg Regional Medical Center – Williamsburg, VA • Chesapeake Regional Medical Center – Chesapeake, VA • Sentara Virginia Beach General Hospital – Virginia Beach, VA • Sentara Princess Anne Hospital – Virginia Beach, VA • Riverside Regional Medical Center – Newport News, VA • Sentara Obici Hospital – Suffolk, VASentara Careplex – Hampton, VA • Alan B. Pearson Regional Cancer Center - Lynchburg, VA • Lewis-Gale Medical Center – Salem, VA • Carilion Clinic – Roanoke, VA • HCA Healthcare- Richmond, VA • Bon Secours Health System – Richmond, VA • Mary Washington Hospital - Fredericksburg, VA • Stafford Hospital – Stafford, VA • Spotsylvania Regional Medical Center – Fredericksburg, VA • MedStar Health – Baltimore, MD • LifeBridge Health – Baltimore, MD • Greater Baltimore Medical Center – Baltimore, MD • Univ of MD, Marlene and Stewart Greenebaum Cancer Center – Baltimore, MD • Anne Arundel Medical Center – Annapolis, MD • Western Maryland Health System – Cumberland, MD • Upper Chesapeake Medical Center – Bel Air, MD • Peninsula Regional Medical Center - Salisbury, MD • North Fulton Hospital – Alpharetta, GA • Medical Center of Central Georgia – Macon, GA • Medical College of Georgia – Augusta, GA • University Hospital – Augusta, GA • Doctors Hospital – Augusta, GA • Redmond Regional Medical Center – Rome, GA • Grady Hospital - Atlanta, GA • Piedmont Healthcare– Atlanta, GA (multiple sites) • Hamilton Hospital – Dalton, GA • Phoebe Putney Memorial Hospital – Albany, GA • Phoebe Sumter Medical Center – Americus, GA • Athens Regional Medical Center – Athens, GA • Carolinas Hospital – Florence, SC • Spartanburg Regional – Spartanburg, SC • Greenville Health System – Greenville, SC • Bon Secours St Francis Health System – Greenville, SC • Georgetown Health System – Georgetown, SC • Grand Stand Regional Medical Center – Myrtle Beach, SC • MUSC Hollings Cancer – Charleston, SC • Roper St. Francis – Charleston, SC • Trident Health System – Charleston, SC • CaroMont Health – Gastonia, NC • Mission Hospital – Asheville, NC • Margaret R. Pardee Memorial Hospital – Hendersonville, NC • New Hanover Regional Medical Center – Wilmington, NC • Frye Regional Medical Center – Hickory, NC • Catawba Valley Medical Center – Hickory, NC