Hawaii cancer center
mounts massive study

A $14 million grant will help
in funding the world's largest
population sampling

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By Helen Altonn
haltonn@starbulletin.com

The world's largest population study is being conducted by the Cancer Research Center of Hawaii to learn why some people get cancer and others do not.

The center recently received $14 million from the National Cancer Institute for the massive study, which began with about 215,000 people in Hawaii and California.

"It is unique in the world," said Dr. Laurence Kolonel, project director. "There is no other multiethnic cohort like this. We're starting to get kind of prominent."

Actually, two NCI-funded studies at the Hawaii center are being linked.

The new grant is for the fourth five-year cycle of a project, now in its 17th year, in which many individual studies were done of particular cancers.

Thousands of people were interviewed over the years as the researchers identified different cancer cases through the hospitals and compared them with cancer-free people in the community.

They tried to understand, for example, why Filipino women in Hawaii have such high rates of thyroid cancer, Kolonel said.

They tested different theories about cancer, generally related to diet, looking at a whole range of cancers. Each involved thousands of people.

One study alone had 1,100 people with colorectal cancer, plus residents without cancer in a control group, Kolonel said.

An "incredible data base" was developed, he said.

In the next study cycle, he said, the $14 million grant is being tied to another NCI grant of about $8 million over five years. It is in its second five-year cycle and will be proposed for renewal in about a year.

A huge multiethnic study group, or cohort, was organized under that grant to get basic data over a long period of time to see who gets cancer and what distinguishes them from people who do not.

A 26-page questionnaire, with 17 pages just on diet, was mailed randomly to adults in Hawaii and California, Kolonel said.

The study was limited here to Japanese, Caucasians and native Hawaiians. Hawaii researchers worked with a colleague at the University of Southern California to include African Americans and Hispanics.

Up to three mailings were done, and the study ended up with 215,000 participants, Kolonel said.

Information was collected on their diets, physical activity, reproductive history, medications and past illnesses.

The researchers wanted at the outset to get biological specimens from the people, but "it was enough to get them in the cohort to fill out a questionnaire," Kolonel said.

Blood and urine specimens now will be collected in a follow-up phase to look at different biochemical markers of diet and other exposures, he said.

"We can also get DNA from white blood cells to look at different genetic susceptibilities that might characterize who gets cancer and who doesn't, or how they interact with diet, smoking and other environmental exposures."

With the long-term study ready for renewal, it was decided to ask NCI to fund a biorepository of about 80,000 basically healthy cohort members -- divided between Hawaii and California, Kolonel said.

Brian Henderson, a professor in the USC Department of Preventative Medicine, renewed a separate grant for more than $20 million to collect biological specimens on African Americans and Hispanics in the Los Angeles study group.

He has a more difficult task because his team has to go to every participant's home to collect samples, Kolonel said. "It adds tremendously to the costs."

In Hawaii, participants will be asked to go to nearby Diagnostic Laboratory Services labs for free blood and urine tests. Kolonel estimates about 90 percent will go to the labs and that home visits will be needed for the other 10 percent.

The samples will not be analyzed immediately but will be stored in liquid nitrogen freezers until participants get various cancers, Kolonel said. Those cases then will be analyzed and compared with those who do not have the cancer to see if there are differences.

"Until people become cases, the blood and urine stays in the repository. The same thing goes on in California. We exchange samples so we will include the entire cohort when we do analyses."

When the study began, participants ranged from 44 to 75 years old, Now some are in their 80s, Kolonel said.

Answers on why some get certain cancers will not be coming right away. It will take four to five years to collect all the specimens, Kolonel said.

But he said: "We have really good data we can look at, and still have all the dietary data. We are just starting to analyze that. We're just at the point now where we've got enough cases. We have thousands already of breast cancers and prostate cancers in the basic cohort."

Diet and reproductive histories also have been collected for those involved in the biorepository project, although they do not have cancer.

Researchers working with Kolonel in Hawaii are Drs. Abraham Nomura, Loic Le Marchand, Marc Goodman, Lynne Wilkens, Terrilea Burnett and Adrian Franke. Daniel Stram, a USC statistician, also works with the Hawaii group.