Cancer Prevention Study-3 (CPS-3)

Research today for a cancer-free tomorrow.

Alpa Patel, PhD

Strategic Director, CPS-3

Epidemiology & Surveillance Research

2

Outline

•History of Cancer Prevention Studies

•CPS-3: Overview and the need for a new study

•Addressing disparities through CPS-3

•CPS-3 enrollment and promotion

3

Analytic Epidemiology

Mission Statement:

“To conduct and publish high-quality epidemiologic research to advance our understanding of cancer etiology and thereby contribute to the prevention of cancer and death from cancer.”

4

History of Our Follow-up Studies

Partnership

• ACS researchers and volunteers

• Began in early 1950’s

Results

• 1st to show link between smoking and lung cancer

• 1st to show impact of obesity on cancer deaths

• 1st to show link between aspirin and colon cancer

5

Annual Number of Publications

0

5

10

15

20

25

30

35

40

1990 1992 1994 1996 1998 2000 2002 2004

6

Previous Society Follow-up Studies

Participants

Sex

Volunteers

States

Years

Research Emphasis

Hammond-Horn

188,000

Men

22,000

9

1952-55

Smoking, cohort model

CPS-I

1,000,000

Both

68,000

25

1959-72

Smoking, obesity

CPS-II

1,200,000

Both

77,000

50

1982-

Multiple

7

CPS-3: Planning for the Future

8

Purpose

•Better understand the factors (lifestyle, environmental, genetic) that cause or prevent cancer

•Ultimately, to help eliminate cancer as a major health concern for future generations

9

Study Objectives

• Enroll a diverse group of 500,000 men and women

• 30-65 years of age• Never been diagnosed with cancer• Willing to make a long-term commitment to the

study (by completing questionnaires every few years)

• Recruitment goals

• At least 25% minority (racial/ethnic) participation

• Geographic diversity• Blood sample on all study participants at

enrollment

10

The need for a new study…

• Why do we need it?• CPS-II is aging (median age=77 years)• Changes in environment and lifestyles lead to

new research directives• Ex: Assessing how the rise in obesity impacts

cancer risk• New scientific technologies also lead to new

research directives

• Why is it important?• Most large studies have moved overseas• Blood specimens on 500,000 individuals will be

an entirely unique resource in the US• Brings CPS studies into the 21st century• Positions the Society to answer new and

important questions in the future

11

US Follow-up Studies with Diverse Populations

Study Name Study Size Blood collected?Southern Communities Cohort Study (SCCS)

135,000 (n=90,000 African

American)

YES (N=52,500 total)

Multiethnic Cohort (MEC) 215,000 (n=165,000 AA, Japanese, Latino,

Hawaiian)

YES (N=95,000 total)

Black Women’s Health Study

65,000 NO

AIAN Study 80,000 (only 6,000 to date)

NO

Sister’s Study 50,000 (n=20,000 AA planned)

YES

AARP Diet and Health Study

540,000 (n=42,000 non-white)

Planning (n=200,000)

•Previous long-term follow-up studies have been predominantly Caucasian populations (ex. CPS-I and CPS-II >90%)

12

CPS-3 and Cancer Risk in Diverse Populations

•Racial/ethnic differences in cancer risk not well understood

• Need comprehensive studies with lifestyle and genetic information

• Differences in incidence and mortality by race/ethnicity may be due to:

• Access to care, SES, education• Cultural differences• Risk factors• Genetic susceptibility

• Ex. prostate cancer risk

13

0

50

100

150

200

250

300

350

Men Women

White African American Asian/Pacific Islander American Indian/Alaska Native Hispanic

Cancer Death Rates, by Race and Ethnicity, 1998-2002

Rat

e p

er 1

00,0

00 p

erso

ns R

ate

per

100

,000

per

son

s

14

0

4

8

12

16

20

Men Women

White African American Asian/Pacific Islander American Indian/Alaska Native Hispanic

Liver Cancer Mortality Rates, by Race/Ethnicity, 1998-2002

15

0

10

20

30

40

50

19

75

19

78

19

81

19

84

19

87

19

90

19

93

19

96

19

99

20

02

Female Breast Cancer Death Rates, US,1975-2002

African Americans

Whites

Rate

per

100,0

00

pers

on

s

Year of Death

16

pCurrent Cigarette Use, Adults (>18 yrs)

by Race and Sex, United States, 1965-2001

Source: National Health Interview Survey, 1965-2001. National Center for Chronic Disease Prevention and Health Promotion, CDC.

0

10

20

30

40

50

60

70

Year

Pe

rce

nt

Cu

rre

nt

Sm

ok

ers

1974 1979 1985 1990 1995 2000

Black women

White men

Black men

White women

1965

17

% Obese by Race/Ethnicity, 1999-2001

Obese* % Men % Women

Race/Ethnicity

White (Non-Hispanic) 21.7 19.8

African American (Non-Hispanic)24.9 34.9

Hispanic 22.2 25.5

American Indian and Alaska Native38.6 29.7

Asian American 6.0 6.2

*BMI >30 kg/m2

Source: NHIS, 1999-2001, Vital Health Statistics, Series 10, No. 219, 2/2004

18

CPS-3: Enrolling a diverse population

19

Enrollment Venues

Main enrollment venue -- Relay For Life• Partnership with Society volunteers

• Efficient for large-scale enrollment

• Committed, diverse population

• 2006-2011

Enrollment at Celebration on the Hill 2006• Show research in action

• Engage very committed volunteers from across the country

20

21

Study Participation

• Initial enrollment at RFL• Complete a brief survey and sign informed

consent• Provide a waist measurement• Provide a small blood sample

•Within 2 months after enrollment at RFL, mailed baseline survey • To collect complete, detailed environmental

and lifestyle information

•Follow-up into the future• Repeat surveys every few years to update

exposure information

22

23

24

25

26

27

2006/2007 Pilot Work

• Spring 2006 (CA, TX, GA)-6 events total• Goal: Assess efficiency and effectiveness of enrollment protocol

(through Relay with volunteers, and Quest Diagnostics)• Results:

• Enrolled 1,374 participants• 27% men• At diverse Relays, up to 46% NHW

• Sept. 2006-Celebration on the Hill• Results: Enrolled 1,018 participants

• 2007-64 events across 7 divisions• Goal: Identify successful promotional tactics, general and

targeted

28

Targeted Promotion

• Integrated approach throughout the Society• Proof point of commitment to addressing

disparities in cancer prevention• Engage more diverse groups in Relay For

Life• Ex.: Chief Diversity Officer, Employer

Initiatives, Coaches vs. Cancer

• Partnerships in Communities• Faith-based organizations• Service/fraternal organizations • Leadership Volunteers

29

2006 2007 2008 2009 2010 2011

High Plains Pilot Pilot Rollout

South Atlantic Pilot Pilot Rollout

California Pilot Pilot Rollout

Eastern Pilot Pilot Rollout

Florida Pilot Pilot Rollout

New England Pilot Pilot Rollout

Great West Pilot Pilot Rollout

Ohio, Illinois, Great Lakes

Pilot Pilot Rollout

Pennsylvania, Mid-South, Midwest

Pilot Pilot Rollout

CPS-3 Enrollment Timeline

30

CPS-3 Enrollment States

Puerto Rico

31

“My mom is a two-time cancer survivor and I’m doing everything I can to make sure my children don’t ever have to say that…I really, really believe this is part of the answer.”

-CPS-3 participant

32

For more information…

•Website: www.cancer.org/cps3

•Toll-free number: 1-888-604-5888

•Email: cps3@cancer.org

33

Thank you