The NSW Cancer, Lifestyle and Evaluation of Risk Study (CLEAR)
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The NSW Cancer, Lifestyle and Evaluation of Risk Study (CLEAR)

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The NSW CLEAR case-control study commenced in 2006. ...

The NSW CLEAR case-control study commenced in 2006.
It collects lifestyle and demographic information as well as
biospecimens from people with all types of cancer and controls, which are available as an open resource for researchers.

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    The NSW Cancer, Lifestyle and Evaluation of Risk Study (CLEAR) The NSW Cancer, Lifestyle and Evaluation of Risk Study (CLEAR) Document Transcript

    • The NSW Cancer, Lifestyle and Evaluation of Risk Study (CLEAR) A resource for cancer research Sitas F1,2,3, Nair-Shalliker V1, Revius M1, Christou C1, Yap S1, Armstrong K1, Salagame U1,2, Christian K1, Cottrill A4, Delaney G5, Kaadan N5, Thompson J6, Haydu L6, Sara T7, Banks E8, Barton M9, Canfell K1,3, O’Connell D1,2,3,10. 1. Cancer Research Division, Cancer Council NSW. 2. University of Sydney. 3. University of NSW. 4. Hospitals Contribution Fund of Australia Ltd. 5. South Western Sydney and Sydney Local Health District Clinical Cancer Registry. 6. Melanoma Institute Australia. 7. Southeastern Sydney and Illawarra Shoalhaven Local Health District Clinical Cancer Registry. 8. National Centre for Epidemiology and Population Health, Australian National University. 9. Ingham Institute for Applied Medical Research, Liverpool Hospital. 10. University of Newcastle Background The NSW CLEAR case-control study commenced in 2006. It collects lifestyle and demographic information as well as biospecimens from people with all types of cancer and controls, which are available as an open resource for researchers. Methods Population: NSW residents aged > 18 years. Cases: People with any incident cancer. Controls: Partners of cases, who are cancer free. Study requirement: Consent to participate, completion of questionnaire and an optional contribution of a blood specimen. Study procedure • Potential participants were approached using two methods: i. In a targeted approach all people with a recent cancer diagnosis were identified using a medical database, from the South Eastern Sydney and Illawarra Shoalhaven Local Health District Clinical Cancer Registry (SESAHS), Hospitals Contribution Fund of Australia (HCF), South Western Sydney and Sydney Local Health District Clinical Cancer Registry (SSWAHS), and Melanoma Institute Australia (MIA). ii. In non-targeted approaches potential participants opt to participate in the study after hearing of CLEAR through community based events. • Blood specimens were processed at CCNSW Biobank Facility. Figure 1. The relationship between cases and controls at the recruitment phase is unlinked during analysis, resulting in a pool of sex-matched, cancer-free controls ANALYSIS RECRUITMENT CASE CONTROL Female Male Male Female Female Female Male Male Table 2. Most common cancer sites in CLEAR Cancer Type Breast Prostate Colorectal* Melanoma Lung Non Hodgkin Lymphoma Thyroid Ovary Bladder * Colorectal cancers include C18-C20 Risk factor Cancer type Lung cancer Results • CLEAR has recruited 9433 participants (7373 cases and 2060 controls) and 72% of these participants have contributed a blood specimen. The response rate for all targeted sites is approximately 20% (Table 1). Table 1. Participation characteristics in each targeted recruitment site Median age (Min, Max) Total mailouts SESAHS SSWAHS HCF MIA All sites COMBINED Cancer Group Urogenital Bowel† Lymphohaematopoietic Skin Gynaecological Respiratory Head and Neck Upper GI Thyroid / Endocrine n 1218 807 484 483 337 275 201 177 152 % 21 14 8 8 6 5 3 3 3 †Bowel cancers include C18-C21 Table 3. Odds ratios for smoking and tobacco related cancers in CLEAR and international studies Smoking Mailouts % 26 16 13 8 4 4 2 2 2 • The most common cancer types in CLEAR are listed in Table 2. • Positive predictive values for self report of the top five cancers compared to linkage with NSWCCR are > 95%. • The risk of lung cancer in current smokers in both men and women, after adjusting for age, socioeconomic status and migrant status were similar to those from other contemporary studies in the UK and USA (Table 3). Record linkage • Annual linkage with the NSW Central Cancer Registry (NSWCCR) is undertaken to validate self reported cancer status, and to obtain stage of disease. • Other potential linkages include hospital admissions and Medicare claims. Recruitment Site n 1533 976 791 458 255 227 145 129 94 Response rate %1 Case Control 14697 14606 9453 1873 25 14 19 28 61 (18, 80) 60 (18, 93) 62 (21, 90) 60 (19, 92) 60 (22, 86) 59 (22, 92) 63 (33, 93) 59 (28, 86) 40629 20 61 (18, 93) Tobacco related cancers Study Variable CLEAR* Never Past Current† Cancer Prevention Study1** Never Past Current†† Million Women Study2*** Never Past Current CLEAR* Never Past Current† JCCC3**** Never Past Current† OR (95% CI) 1.0 5.1 20.9 1.0 8.1 23.4 1.0 21.4 1.0 1.4 2.2 1.0 1.4 1.9 Women (3.1, 8.3) (12.0, 36.3) (7.2, 9.1) (19.6, 25.6) (19.7, 23.2) (1.0, 2.1) (1.5, 3.4) (1.1, 1.8) (1.6, 2.2) 1.0 5.8 31.7 1.0 7.1 25.6 1.0 1.4 4.9 1.0 2.8 4.6 • Approximately 80% of all CLEAR participants are recruited from sites with a targeted approach. (2.9, 11.7) (14.9, 67.7) (6.1, 8.2) (21.7, 30.3) (1.0, 1.9) (3.5, 7.0) (2.2, 3.5) (3.7, 5.7) * adjusted for age, socioeconomic status and migrant status ** adjusted for cohort, age, race and education level ***adjusted for recruitment site, age, body mass index, socioeconomic status, current alcohol intake, physical activity, oral contraceptive use, menopausal status and hormone therapy use. **** adjusted for age, education, smoking status and cooking fuel † current smokers are classified as those who still smoke or those who had quit smoking within the previous five years from date of recruitment into study † † current smokers are classified as those who were still smoking at time of recruitment into study 61 (22, 93) 1 Response rate (%) = Number of consents received/total mail out sent for each site Men Conclusions CLEAR is a valuable resource for cancer researchers interested in the causes and consequences of a cancer diagnosis. It has the potential to significantly advance our knowledge in the occurrence and outcome of various cancers. References 1. Thun M et al NEJM. 2013;doi:10.1056/NEJM sa 1211127 2. Pirie et al Lancet. 2013; doi: 10.1016/S01406736(12):61720-6 3. Stein et al British Journal of Cancer. 2008; 98:1586 – 1592 Funding The NSW CLEAR Study is funded by Cancer Council NSW To find out more about The NSW CLEAR Study scan the QR code