Clinical Epidemiology Unit

The Clinical Epidemiology Unit (CEU) conducts etiologic research with potential clinical and public health applications and leads studies evaluating population-based early detection and cancer prevention strategies.

Mission

Study the natural history of cancer and its precursors to develop biomarkers and new approaches for risk assessment, screening, and prevention.

Research Approach

Study shows incidence rates of aggressive subtypes of uterine cancer rising

New study shows that U.S. incidence rates for aggressive subtypes of uterine cancer rose rapidly among women age 30 to 79 from 2000 to 2015.

CEU conducts research on etiology, natural history, multi-step carcinogenesis, and molecular characterization of cancers and precancers. Investigators focus on the discovery of risk markers and assay development and evaluation, with the goal of guiding promising markers into clinical and public health use. Risk markers may include genetics, epidemiologic factors, molecular biomarkers, imaging, or any routine clinical test.

Methods

development and evaluation of screening tools
development and validation of risk prediction models
risk-based screening and clinical management guidelines.

Investigators employ novel methods and technologies, such as artificial intelligence, methylation, and somatic mutation testing, in the context of rigorous population-based studies. We conduct comprehensive molecular characterization of cancer precursors, and we evaluate biomarkers in lesion-directed biospecimens.

Translation

Risk-Based Oral Cancer Screening: Lower Cost, High Sensitivity

Improved efficiency of screening programs will benefit low-resource settings.

The risk estimates derived from CEU studies inform the development of clinical interventions and risk-based guidelines, such as the Enduring Consensus Cervical Cancer Screening and Management Guidelines. CEU strives to develop applications that are close to implementation, but we typically do not conduct implementation studies.

CEU Research Areas

Rapid, Low-cost, Risk-based HPV Genotyping Test

Redesigned HPV test for low-resource settings was validated in initial study.

Investigators and trainees in the CEU utilize multidisciplinary approaches to the following malignancies: HPV-related anogenital, endometrial, ovarian, oropharyngeal, oral cavity, and lung. Methods to explore the etiology and potential for risk prediction, and screening and early detection of these cancers include molecular epidemiology and multistage carcinogenesis, novel sampling approaches, natural history studies, biomarker discovery and validation, and investigations of the role of chronic inflammation in carcinogenesis and progression.

Clinical Epidemiology Methods

In addition to investigator-initiated research studies, the Unit also develops novel assays and other methods as needed.

Biomarker Tools

Web-based tools to estimate risk stratification and provide strategies to advance biomarkers or other risk measures to clinical or public health applications.

Approaches to studying multi-step carcinogenesis and estimating transition probabilities
Standardized approaches and analytic methods to evaluate biomarkers and risk prediction
Approaches to working with large integrated healthcare systems and electronic medical records (EMR), from natural language processing to generating precise risk estimates from heavily interval- and left-censored EMR data.