The leaders of the Cancer Population Science Program at Norris Cotton Cancer Cener are James Sargent, MD, Brock Christenson, PhD, and Tracy Onega, PhD, MS, MA. This research program, located at Dartmouth-Hitchcock Medical Center in Lebanon, NH, is one of four foundational research programs at Norris Cotton Cancer Center.
This active research program has monthly meetings to discuss members’ research findings, grant ideas, and potential collaborations, and to host outside speakers on Cancer Population Sciences themes. Annually, the members of Cancer Population Sciences Program gather for a retreat to discuss ongoing research, to strategize about larger multidisciplinary projects and to identify new areas for collaborative work.
Academic life at Dartmouth includes a multitude of opportunities to discuss common scientific interests with others. For example, the Integrative Biology Symposium has recently focused on epigenetics, obesity, global health, the microbiome and big data in the life sciences. Similarly, a number of Dartmouth seminar series are enriched by participation of Cancer Epidemiology members, including Genomics Grand Rounds, the Biostatistics Seminar Series, the Molecular and Systems Biology Seminar Series, the Children’s Environmental Health and Disease Prevention Seminar Series, and the Biological Sciences Department Seminars, among others.
The program fosters development of new funding opportunities such as the COBRE Center for Molecular Epidemiology, the Children’s Environmental Health and Disease Prevention Research Center, and collaborative R01/U01 applications. Recent recruitment to increase the program’s strength includes Anne Hoen, Saeed Hassanpour, Michael Passarelli, Megan Romano, and Erika Moen. All of these investigators have been or are currently funded through the COBRE grant.
CPS members have teaching, mentoring and leadership roles in graduate training programs at the Geisel School of Medicine, including the program in Quantitative Biomedical Sciences (QBS), and The Dartmouth Institute’s (TDI) graduate programs. Their courses include:
- Brock Christensen – PEMM: Biostatistics and Cancer Biology Journal Club
- Diane Gilbert-Diamond – QBS: Foundations of Epidemiology I
- Ivan Gorlov - QBS: Methods in Statistical Genetics and Genomics
- Jiang Gui – QBS: Methods of Statistical Learning for Big Data, Biostatistics Journal club, PEMM: Biostatistics
- Saeed Hassanpour – QBS: Machine Learning and Natural Language Processing, Bioinformatics Journal Club
- Anne Hoen – QBS: Applied Epidemiological Methods I & II
- Margaret Karagas –Global Health, Epidemiology
- Michael Passarelli – QBS: Clinical Epidemiology
- Tracy Onega and Erika Moen – TDI: Advanced Health Services Research
- Megan Romano – QBS: Foundations of Epidemiology II
- Judy Rees – Epidemiology/Biostatistics for medical students, QBS: Topics in Epidemiology
- James Sargent – PSYC 52.04 Adolescent Risk Behaviors: Corporate and Environmental Influences
- Anna Tosteson – TDI: Decision and Cost-effectiveness Analysis
- Steven Woloshin and Anna Adachi-Mejia – TDI: Survey Research
Community and regional impact
CPS members’ research findings are translated into sustainable policy, program and health system enhancements to reduce the impact of cancer in our region and to benefit individual and community health. Some of the major areas in which CPS research has had the greatest impact are:
- Cancer screening and prevention
- Smoking and tobacco-related products
- Obesity, nutrition, and physical activity
- Region-specific environmental exposures
Selected scientific accomplishments
Influence of new technologies—E-cigarettes, adolescent smoking, and population health
CPS members’ tobacco regulatory research aims to provide the scientific basis for effective FDA regulation of tobacco products. This involves understanding how new, potentially lower-harm tobacco products are being used and assessing how their use affects use of other products and disease outcomes. CPS members approach these questions through observational and interventional strategies to develop and test smoking cessation and reduced harm approaches in children and persons with severe mental illness. For example, in a meta-analysis of >17,000 youths from nine studies, e-cigarette use was associated with a 3 to 4-fold greater risk for subsequent cigarette smoking Altmetric 1,143 [ranked #48 of 134,034 outputs from PLOS One).6
Using brain imaging technology to probe the movie/marketing exposure—behavior relation
Early onset of smoking, alcohol use and unhealthy eating predicts increased cancer risk through tobacco and alcohol addiction, and obesity. Interdisciplinary teams of media researchers and behavioral epidemiologists and clinician-researchers employ multi-method approaches to understand how media and marketing influence the adoption and maintenance of cancer-causing behaviors, aiming to develop evidence to support causal statements about the association between media or marketing and behavior. An important scientific breakthrough during this period allowed an assessment of whether media exposure engages fMRI brain patterns consistent with a behavioral effect and determine whether genes modify the media—behavior relationship, allowing us to address biological plausibility. New Hampshire and Maine both rank 15th of 51 states in obesity among 2-4 year old children, increasingly an important target group for our media and eating studies, given their high exposure to food advertising.
Arsenic exposure and life course cancer risk
Exposure to arsenic through drinking water and food products is of special interest to our catchment area, where high levels of naturally occurring ground water arsenic result from our climate and geology, and are prevalent in residential wells. Arsenic exposure can occur early in the life course and throughout life and is a risk factor for bladder cancer, which has an approximately 20% higher incidence in NH than elsewhere in the US. The work of our members has had a major policy impact through its contribution to the US EPA 2001 reduction in the drinking water standard for arsenic from 50 to 10 ppb, and is also being cited locally as NH legislators consider a further reduction to 5 ppb.
Cancer screening and early detection
The challenge of moving towards precision breast cancer screening at a population level was addressed by A. Tosteson and colleagues from the BCSC and CISNET in a collaborative modeling study that informed the sometimes-controversial national guidelines, such as those of the US Preventive Services Task Force (USPSTF). They were the first to include breast density—a known independent risk factor for breast cancer, and a focus of notification legislation in over 35 states—in quantitative models of screening benefits and harms by age, density, and screening interval. They reported (Annals Int Med; IF: 19; altmetric 380) that women with average-risk/low-breast density undergoing triennial screening and those with higher-risk/high-breast density receiving annual screening have similar, or better outcomes than average-risk women undergoing biennial screening.