Cancer Epidemiology Research

 
Current projections indicate that the burden of cancer will increase from 10 million new cases globally in 2000, to 15 million in 2020. This public health burden will necessitate further research into the etiology and prevention of cancer. Epidemiology provides an important approach to elucidating the causes of cancer, improving our understanding of mechanisms, as well as developing strategies for the treatment, prevention and control of cancer.

Students in the cancer epidemiology program receive training in epidemiologic methods, biostatistics, related substantive areas, and cancer biology. Outside the classroom, students obtain an appreciation for interdisciplinary, collaborative research by working with diverse and strong faculty. The strengths and national reputation of the program and department has consistently attracted top graduate students. Program graduates have gone on to assume positions at the University of Washington, MD Anderson Cancer Center, National Cancer Institute, Centers for Disease Control and Prevention, Vanderbilt University, and other academic, federal, and private organizations.

The primary goal of the Cancer Epidemiology Program is to develop new knowledge relevant to cancer etiology, diagnosis, prognosis, and prevention using an interdisciplinary epidemiologic approach. The cancer epidemiology faculty have developed a rich research program including diverse cancers (breast, prostate, colon, head and neck, childhood, and melanoma) and exposures (lifestyle, diet, genes, occupational and environmental, health care, screening, socioeconomic factors), and areas of investigation (etiology, survivorship, access to health care). The research has an emphasis on health disparities, especially among African-Americans, and gene-environment interaction. The research base in cancer epidemiology has continued to grow, with over 7 million dollars in current cancer-related grant funding. Major studies include the following:

All program faculty are members of UNC’s Lineberger Comprehensive Cancer Center (LCCC). The LCCC program in Cancer Epidemiology is directed by Dr. Olshan. In addition, Dr. Olshan directs the LCCC Rapid Case Ascertainment Core facility and co-directs the Biospecimens Processing Facility. The LCCC provides a hub for cancer research across campus and the Department of Epidemiology’s cancer epidemiology program faculty are actively engaged in LCCC’s activities. For example, Drs. Millikan and Bensen are conducting a project within the LCCC breast cancer SPORE grant and the Carolina-Louisiana Prostate Cancer Study, a DOD-funded consortium study of risk factors for prostate cancer among African-Americans in North Carolina and Louisiana, involving Drs. Bensen. It is administered through the LCCC. Dr. Gammon is a member of the steering committee for the LCCC survivorship program. Finally, the LCCC offers cores in rapid case ascertainment, genotyping, tissue procurement, and biospecimens processing that are heavily utilized by program faculty.

 
Learning objectives

  • Understand cancer statistics and the descriptive epidemiology of cancer;
  • Understand known risk factors and gaps in knowledge for the major cancers;
  • Understand the pathobiology of cancer;
  • Apply epidemiologic methods in the design, conduct, and analysis of cancer research studies;
  • Apply critical thinking in the review of projects and publications in cancer epidemiology;
  • Appreciate the interdisciplinary aspect of cancer including the contributions of basic sciences, clinical medicine, health services research, and the social sciences to the understanding of cancer etiology and progression;
  • Appreciate methods for cancer risk assessment and screening;
  • Appreciate the role and interdisciplinary methods of cancer control and prevention.
  • Appreciate the practical aspects of conducting research in cancer epidemiology
 

Available Courses

The learning objectives are met through formal coursework, mentored research training, and individualized study.

There are three formal courses in cancer epidemiology:

  • EPID770 Cancer Epidemiology and Pathogenesis,
  • EPID771 Cancer Epidemiology Methods, and
  • EPID775 Advanced Cancer Epidemiology

Students are also encouraged to enroll in additional related courses including:

  • EPID772 Cancer Prevention and Control,
  • PATH225 Cancer Pathology,
  • EPID743 Genetic Epidemiology,
  • EPID745 Molecular Techniques for Public Health Research, and
  • EPID815 Diet and Cancer.
  • EPID 690 Use of Biospecimens in Population Research

 

 
Jeannette Bensen, MS, PhD, Research Assistant Professor, Epidemiology. Dr. Jeannette Bensen’s interests are focused on the molecular genetic epidemiology of prostate and breast cancer as well as birth defects. Within molecular genetic epidemiology focuses include: inflammation, gene structure-function, haplotype, admixture, and genome-wide association and gene-environment interaction analyses. She is the Co-Director of the North Carolina-Louisiana Prostate Cancer Study (PCaP), a DoD-funded consortium study of risk factors that may explain disparity in prostate cancer between African and European American men in North Carolina and Louisiana and PI on the PCaP follow-up grant funded by the American Cancer Society, focused on health care and quality of life. Dr. Bensen is involved in two University Cancer Research Fund (UCRF) supported studies; the Carolina Breast Cancer Study and the UNC Health Registry and Cancer Survivorship Cohort as co-investigator and leader, respectively.

Kathleen Conway-Dorsey, PhD., Research Assistant Professor, Epidemiology. Dr. Dorsey’s interests are focused on the molecular epidemiology and molecular genetics of breast cancer, melanoma and head and neck cancer. Within molecular epidemiology, the emphasis has been on the study of molecular genetic changes within human tumors and benign tissues, including mutations in the p53, estrogen receptor, BRAF and RAS genes, loss of heterozygosity, and DNA methylation profiling, and the relationships of such changes to patient risk factors and demographic factors, tumor characteristics and prognosis. Dr. Dorsey is Director of the Molecular Epidemiology Laboratory, which collaborates with epidemiologists, clinicians and researchers to perform molecular studies of cancer within the context of large population-based, case-control studies or clinical translational studies. Over the past few years, Dr. Dorsey has been involved in research studies focusing on the international Genes, Environment and Melanoma (GEM) study, the Carolina Breast Cancer Study (CBCS), the I-SPY InterSPORE Breast Cancer Neoadjuvant Chemotherapy Trial, the Mayo Clinic Benign Breast Disease study, and the Carolina Head and Neck Cancer CHANCE) Study. The Molecular Epidemiology Lab also develops and optimizes new high-throughput technologies that can be applied to archival or formalin-fixed tumor specimens, such as p53 GeneChip technologies, the Illumina Goldengate methylation array and Affymetrix molecular inversion probe array platforms. Dr. Dorsey is co-director of EPID 745, Molecular Techniques for Public Health Research.

Lawrence S. Engel, PhD, Associate Professor, Epidemiology. Dr. Engel’s research is focused primarily on environmental and occupational risk factors for cancer and the role of genetic susceptibility. Dr. Engel is a lead investigator on the GuLF STUDY, a long-term prospective cohort study being conducted by NIEHS to investigate the possible health effects of the Gulf of Mexico’s Deepwater Horizon oil spill on 55,000 cleanup workers and volunteers. Dr. Engel is principal investigator of an international study examining blood levels of organochlorines and aflatoxin adducts in relation to risk of primary liver cancer in two large, prospective, general-population cohorts. He is also collaborating with colleagues at the National Cancer Institute, the Centers for Disease Control, and the Norwegian Cancer Registry on a study of serum organochlorine levels and risk of selected cancers using prospectively collected sera. In addition, he is principal investigator of studies of breast cancer risk within a large agricultural cohort, currently focusing on pesticide exposures as well as sun exposure and genetic variation in the vitamin D pathway.

Marilie D. Gammon, PhD, Professor, Epidemiology. Dr. Gammon’s research focuses on the identification of: (1) etiologic risk factors for (a) breast cancer, including energy balance (obesity, physical activity and diet)) environmental exposures ( polycyclic aromatic hydrocarbons, and active and passive cigarette smoking), and (b) esophageal and gastric cardia adenocarcinomas, including obesity, cigarette smoking, alcohol intake and Barrett’s esophagus, the precursor lesion to these tumors; and (2) predictors of survival among patients with breast cancer and esophageal cancer. Dr. Gammon is currently principal investigator of the Long Island Breast Cancer Study Project, a multi-institutional collaboration to identify environmental risk factors for the disease. Dr. Gammon is Chair of the Pooling Working Group for the international Barretts and Esophgeal Adenocarcinoma Consortium (BEACON), a member of the external advisory board for the UNC Survivorship Cohort, Program Leader in Environmental Epidemiology for UNC’s Department of Epidemiology, and Deputy Director of UNC Center for Environmental Health and Susceptibility.

Jenny Lund, PhD, Assistant Professor, Epidemiology.

Hazel Nichols, PhD, Assistant Professor, Epidemiology.

Andrew Olshan, PhD., Professor and Chair of Epidemiology. Dr. Olshan’s cancer research involves studies of the molecular epidemiology of cancers of the head and neck and evaluation of risk factors for childhood cancer. The head and neck cancer studies focus on gene-environment interaction involving variation in genes involved in the metabolism of tobacco and alcohol and repair of DNA damage. The studies have also included investigation of alterations of tumor suppressor genes and human papillomavirus. Related projects have examined environmental, clinical, and genetic predictors of quality of life and survival among head and neck cancer patients. Dr. Olshan led the Carolina Head and Neck Cancer Study (CHANCE) with over 1,300 cases of head and neck cancer. Dr. Olshan has initiated a new national study of neuroblastoma including the investigation of polymorphisms of genes involved in vitamin metabolism. Dr. Olshan is Interim Associate Director for Population Sciences and Program Leader for Cancer Epidemiology in the Department of Epidemiology and at UNC’s Lineberger Comprehensive Cancer Center. He also directs LCCC Rapid Cancer Ascertainment Core and co-directs the Biospecimens Processing core facility. Dr. Olshan is lead instructor for EPID775, Advanced Cancer Epidemiology.

Charles Poole, MPH, ScD, Associate Professor, Epidemiology. Dr. Poole is interested in the development and dissemination of epidemiologic methods in study design, data analysis, interpretation and application. His substantive research interests include cancer epidemiology, environmental epidemiology, pharmacoepidemiology, and a wide range of other subject matter areas. A special interest is in meta-analytic methods and applications. Dr. Poole is the lead instructor for two of the Department’s core epidemiologic methods courses: Deductive and Probability Logic in Epidemiology (EPID 705) and Theory and Quantitative Methods in Epidemiologic Research (EPID 715). He also teaches a continuing seminar on meta-analytic methods and occasional seminars on other methodologic topics. He has collaborated with Drs. Gammon, Olshan, Millikan, Kaufman, and Schroeder in cancer epidemiology and with faculty in each of the Department’s other program areas.

David B. Richardson, PhD, is Associate Professor of Epidemiology in the School of Public Health at the University of North Carolina at Chapel Hill. His research focuses on the health effects of exposure to ionizing radiation. He has conducted studies of cancer among nuclear workers at several U.S. Department of Energy facilities, as well as studied cancer among the Japanese survivors of the atomic bombings of Hiroshima and Nagasaki. He has served as a visiting scientist at the World Health Organization’s International Agency for Research on Cancer in Lyon, France and at the Radiation Effects Research Foundation in Hiroshima, Japan. He is an Associate Editor of the journals Occupational and Environmental Medicine and Environmental Health Perspectives; and, he is a member of the President’s Advisory Board on Radiation and Worker Health.

Whitney Robinson, PhD, is an Assistant Professor of Epidemiology who specializes in quantitative methodology for studying health inequalities in cancer and obesity incidence. Her work has shown that childhood obesity is not a major driver of the Black-White disparity in prostate cancer incidence. She has also found that perinatal poverty and stress may predispose females, more so than males, to adult obesity, and she has used age-period-cohort analysis to predict future trends in obesity prevalence in Millennials. Dr. Robinson brings expertise in analysis of observational data, anthropometric data, and the social context of health in young Black men and women. Dr. Robinson will assist in analyzing data in Aim 2 of Project 1, focusing specifically on obesity and basal-like breast cancer. She is an NCI Career Development Award Recipient.

Robert S. Sandler, MD, MPH, Professor, Medicine and Epidemiology. Dr. Sandler is an internist/gastroenterologist with research interests in colon cancer etiology, screening and prevention, and intermediate markers of colon cancer risk. He was Principal Investigator of the North Carolina Colon Cancer Study, a population-based, case-control study exploring environmental, lifestyle and medical factors that might explain diverging black-white incidence and mortality trends for colorectal cancer. He is principal investigator for an NCI-funded investigation to study obesity, inflammation and colorectal adenomas (precursors to colon cancer). Dr. Sandler is also principal investigator of the North Carolina Colorectal Cancer Care Outcomes Research and Surveillance (CanCORS) study, an NCI initiative to investigate the impact of cancer care processes on outcomes. He directs an NIH-funded training grant in digestive disease epidemiology and the NIH-funded UNC Center for Gastrointestinal Biology and Disease.

Jennifer S. Smith, PhD, MPH, Research Associate Professor, Epidemiology. Dr. Jennifer Smith has research interests on infections and cancer. Her current research focuses on human papillomavirus (HPV) and cervical cancer worldwide. She is a principal-investigator on a NCI R01-funded study, the Effect of Male Circumcision on the Natural History of Penile HPV Infection in Kisumu, Kenya. Her current research focuses on epidemiological studies of HPV and cervical cancer worldwide (primarily in North Carolina, China, Kenya and South Africa), with a focus on prevention via screening and prophylactic vaccines. Dr. Smith has been funded to conduct an outreach research study to investigate the role of self-collection sampling for the detection of high-risk HPV infection at home among women who have not been screened in the last four years in North Carolina. Dr. Smith is the principal investigator of Cervical Cancer-Free America, a project aimed at preventing cervical cancer through vaccination against human papillomavirus (HPV) and effective screening for early signs of cervical cancer in the United States. Dr. Smith has published over 115 articles in international peer-reviewed journal on HPV and HPV-associated cancer. She is an Associate Editor of Sexually Transmitted Infections and on the editorial board of Sexually Transmitted Diseases.

Til Stürmer, MD, PhD, Professor Epidemiology, Director of the Center for Pharmacoepidemiology, and principal investigator of the U.S. Agency for Healthcare Research and Quality’s (AHRQ) DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) center at UNC. Dr. Stürmer has a dual focus in epidemiologic methods and clinical epidemiology. His research in epidemiologic methods includes the development of more efficient matching strategies; measurement error correction methods, propensity scores, instrumental variables, and external control for confounding. His clinical epidemiology research is focused on colorectal cancer including the potential chemoprevention with aspirin and nonexperimental comparative effectiveness (outcomes) research of chemotherapies based on linked SEER-Medicare data.

Melissa Troester, PhD., MPH. Assistant Professor. Dr. Troester’s research is focused on genomics of normal breast and breast cancer. Dr. Troester is conducting studies of how exposure to breast cancer risk factors alters breast gene expression using normal breast tissue. She is also examining how histologically normal breast tissue is altered during progression to disease. Complimentary to these observational studies using patient samples, she is conducting experimental work to study how cell-cell communication is altered in breast cancer and by environmental exposures. Dr. Troester’s research is funded by the National Institutes for Environmental Health Sciences and the National Cancer Institute. She is a member of the Cancer Epidemiology Program at the Lineberger Comprehensive Cancer Center, a recipient of a 2008 Specialized Program of Research Excellence in Breast Cancer Career Development Award, and is co-director of the Center for Environmental Health and Susceptibility Integrated Health Sciences Facility Core. Dr. Troester is the lead instructor of EPID770 Cancer Epidemiology and Pathogenesis.

 

 
Training Grants

Epidemiology graduate students can compete for predoctoral positions in the UNC Lineberger’s Cancer Control Education Program (CCEP) which trains pre- and postdoctoral fellows for careers as independent investigators in interdisciplinary and collaborative cancer prevention and control research.

Graduate Student Research Assistantships

Research assistantships (RAs) offer students an opportunity to gain research-related experience, develop close working relationships with faculty, and sometimes earn co-authorship on peer-reviewed publications. Information on the type of assistantships available and how to locate them is available from Student Services. A small number of RA positions are typically available in the Cancer program. Students interested in an assistantship should submit an application form (available from Student Services), and should discuss this interest with their advisors.

External funding

Students in the Cancer Epidemiology training program are sometimes able to secure funding through sources that external to the university. Below is a list of a number of the external sources from which students have received financial support.

National Institute for Environmental Health Sciences Predoctoral Fellowships
Minority Predoctoral Fellowships
National Cancer Institute Summer Program (DCEG)