Clinical Cancer Epidemiology
Principal investigator: Lars Holmberg
The Clinical Cancer Epidemiology Group is organised under the Department of Surgical Sciences and located at the Regional Cancer Centre for the Uppsala Örebro Health Care Region. The Regional Cancer Centre hosts the regional cancer registry and over 20 data bases for clinical audit and research for virtually every cancer diagnosis. The Regional Biobank Centre is closely connected to the Regional Cancer Centre. The Regional Biobank Centre and Regional Cancer Centre together support a network for services for clinical researchers.
The Clinical Cancer Epidemiology Group collaborates with many other research groups, foremost at King’s College London, the Karolinska Institutet and Harvard School of Public Health and Dana Farber Cancer Institute at Harvard School of Medicine. The principal investigator, Lars Holmberg, has a part time association as Professor of Cancer Epidemiology at the Division of Cancer Studies, King’s College London Medical School.
The group has a broad range of activities in epidemiological and clinical studies of prostate cancer. We are currently conducting and developing studies around:
- Translational studies of fat metabolism and cancer progression together with the Dana Farber Cancer Institute and King’s College London.
- Epidemiological studies of the association between components of the metabolic syndrome and risk of prostate cancer and progression of prostate cancer.
- We are currently setting up a large multicenter, randomised trial to study the safety and effectiveness of active surveillance for early, localised prostate cancer.
- We conduct detailed studies of the long-term consequences and side-effects of androgen deprivation therapy for advanced prostate cancer.
The research group develops projects based on high quality clinical registers at Guy’s Hospital London, in Swedish clinical data bases for breast cancer audit and research, and on information extracted from Swedish biobanks. Examples of studies are:
- We have previously detected intriguing patterns of risk of death from breast cancer in relation to the occurrence of a contralateral breast cancer. These concepts are now developed to study local breast recurrences.
- Translational studies of the relation between tumour and patient characteristics and metastatic pathways.
- Studies of the disease burden of metastatic breast cancer disease.
- Long-term consequences and side-effects of radiotherapy for breast cancer.
- Tumour biology in breast cancers occurring early in life
The combination of the Swedish Prescribed Drug Registry with data in the clinical cancer data bases creates rich opportunities for research. The Clinical Cancer Epidemiology Group is currently expanding its research within cancer pharmaco-epidemiology with the following projects:
- Members of the group have developed methods to increase the signal/noise ratio in detecting clinically important side-effects in the pharma registries. These methods will now be applied to a number cancer medicine.
- The group is searching for and validating previous findings of unintended positive effects on cancer of medications on other indications. Examples are the association between the use of statins and anti-hypertensive medications and cancer risk.
Biomarkers in cancer research
The group is collaborating closely with researchers at the Karolinska Institutet holding a large data base with information from health checkups and then subsequent disease burden including cancer. A broad range of studies has already been undertaken in the data base (AMORIS) for prostate and breast cancer, but the studies are also expanded to other forms of cancer. The studies include:
- Studies of markers of chronic inflammation and risk of cancer.
- Markers of perturbed lipid metabolism and components of the metabolic syndrome and cancer risk.
Development of new methods
The Clinical Cancer Epidemiology Group has a strong interest in method’s development and collaborates with colleagues within mathematics, theoretical epidemiology and systems theory to develop new analytical methods. Examples of such projects are:
- There is a need to develop methods to study causal inference in observational studies given the great need to better utilize rapidly growing information in clinical data bases.
- We are developing new analytical tools to study survival in terms of causal inference. This has become increasingly important given that many cancer patients will be long-term survivors and old statistical methods are not suited to compensate well for competing risks.
- Our currently very rich information on clinical data and complex information from tumour biology (sometimes many thousands of data point for each individual) calls for new methods and many of the current challenges within modern bioinformatics are far from solved. We are working on projects to reduce the risk of false positive leads.
Members of the group during 2015
Lars Holmberg, Professor
Mats Lambe, Professor
Mieke Van Hemelrijck, PhD
Danielle Crawley, MD
Wahyu Wulaningsih, MSc
Greger Nilsson, MD
Sonja Eaker, PhD
Irma Fredriksson, MD, PhD
Hanna Fredholm, MD
Anna Bill-Axelson, MD, PhD
Hans Garmo, PhD
Fredrik Sandin, MSc