Ambitious new study is a powerful tool in the fight against cancer and chronic disease

Ambitious new study is a powerful tool in the fight against cancer and chronic disease (Originally Published on National Post) A new and powerful resource is now available in Canada to help researchers in the fight against cancer and other chronic diseases. The Canadian Partnership for Tomorrow Project (CPTP) is the first national database designed to both document and follow the health of hundreds of thousands of Canadians for decades to come. CPTP seeks to better understand the complex pathways of disease, and is aimed at improving health outcomes for the next generations. CPTP is the largest research database ever built in Canada, comprising harmonized information from five regional population health studies. Participants were recruited from British Columbia, Alberta, Ontario, Quebec and the Atlantic provinces. Dr. Catherine Boileau is the Director of Epidemiology at CARTaGENE, CPTP’s Quebec partner. She says the database offers researchers an opportunity to focus on analyzing data rather than starting from scratch to set up studies and recruit participants. Researchers have access to a wealth of biological and health data through a simple online request process. “Collecting information, collecting biological material and physical measurements costs a lot of money,” Dr. Boileau notes. “Gaining access to this resource saves money and time. Instead of having to collect data, recruit people and process biological material, researchers can now access the high-quality biological material they need [through CPTP].” Study participants are between the ages of 30 and 74, and have volunteered to provide updated health information over the course of their lives. They come from varying socio-economic backgrounds, and live in both large urban centres and remote rural towns. All have volunteered to fill out a baseline survey that includes detailed questions on their medical history, diet and lifestyle. They have also agreed to link their questionnaires and any bio-specimens with information from electronic health records. Nearly half of CPTP participants have provided blood samples that can be used for biochemical research. There are also 100,000 urine samples, as well as 45,000 blood spots and saliva samples that are additional sources of DNA. CPTP bio-samples also include more than 30,000 toenail clippings that can be tested for environmental exposure to toxins. “Researchers now have at their fingertips a valuable resource they can use,” says Dr. Trevor Dummer, co-leader of the West Coast’s regional population study, the BC Generations Project.  He notes the national sample size represents about one in 50 Canadians within the CPTP’s age group. “We have gathered a lot of information on a large proportion of Canadians. Now that the infrastructure has been created, it is going to accelerate the speed at which we can do research studies.” Accelerated research into the risk factors for cancer is of particular urgency. Despite important advances made in recent decades, cancer remains a formidable adversary for those looking for new prevention strategies and treatments. The disease is complex, unpredictable, and the leading cause of death in this country. As Canada’s population ages, cancers are expected to become even more prevalent, and are forecast to rise by about 40 per cent by the year 2030. CPTP offers a unique window into the genetic make-up and health of people from across the country. It has significant statistical power to explore how genetic predispositions and environment can influence cancer risks. The database gives researchers a new opportunity to scale up their work to include more data from Canadians from diverse geographic regions. “You can test out whether a particular hypothesis in one province may hold true in other populations,” Dr. Dummer says. He points to a research project he and his colleagues are pursuing in B.C., on how urban development can impact people’s health in Metropolitan Vancouver. With CPTP, there is potential to expand the study to include people from other regions of the country. “You can see whether health outcomes in British Columbia hold true for the Prairies. It effectively enables us to do a number of cutting-edge projects.” CPTP is still considered a young population health research study. Its greatest value, according to Dr. Boileau and other researchers, may well be found in the years and decades to come. As the regional population health studies return to their participants for updates, the new information gathered might help shed light on why some people develop cancer and other chronic diseases while others don’t. “We are just beginning. We plan to follow participants for many years, and the study will become more valuable with time,” says Dr. Boileau. “We will be able to compare people who were exposed to different risk factors, and at what rate they develop these diseases.” Dr. Boileau adds that as researchers return the findings of their studies to the cohorts, they will enhance the quality of the data. The more researchers use the database, the more questions CPTP might be able to help answer. The door is now open for independent investigators to use this new national resource – one that holds great potential for scientific discovery.

National database offers new tool in fight against chronic disease

National database offers new tool in fight against chronic disease (Originally Published on National Post) A new and powerful resource is now available in Canada to help researchers in the fight against cancer and other chronic diseases. The Canadian Partnership for Tomorrow Project (CPTP) is the first national database designed to both document and follow the health of hundreds of thousands of Canadians for decades to come. CPTP seeks to better understand the complex pathways of disease, and is aimed at improving health outcomes for the next generations. CPTP is the largest research database ever built in Canada, comprising harmonized information from five regional population health studies. Participants were recruited from British Columbia, Alberta, Ontario, Quebec and the Atlantic provinces. Dr. Catherine Boileau is the Director of Epidemiology at CARTaGENE, CPTP’s Quebec partner. She says the database offers researchers an opportunity to focus on analyzing data rather than starting from scratch to set up studies and recruit participants. Researchers have access to a wealth of biological and health data through a simple online request process. “Collecting information, collecting biological material and physical measurements costs a lot of money,” Dr. Boileau notes. “Gaining access to this resource saves money and time. Instead of having to collect data, recruit people and process biological material, researchers can now access the high-quality biological material they need [through CPTP].” Study participants are between the ages of 30 and 74, and have volunteered to provide updated health information over the course of their lives. They come from varying socio-economic backgrounds, and live in both large urban centres and remote rural towns. All have volunteered to fill out a baseline survey that includes detailed questions on their medical history, diet and lifestyle. They have also agreed to link their questionnaires and any bio-specimens with information from electronic health records. Nearly half of CPTP participants have provided blood samples that can be used for biochemical research. There are also 100,000 urine samples, as well as 45,000 blood spots and saliva samples that are additional sources of DNA. CPTP bio-samples also include more than 30,000 toenail clippings that can be tested for environmental exposure to toxins. “Researchers now have at their fingertips a valuable resource they can use,” says Dr. Trevor Dummer, co-leader of the West Coast’s regional population study, the BC Generations Project.  He notes the national sample size represents about one in 50 Canadians within the CPTP’s age group. “We have gathered a lot of information on a large proportion of Canadians. Now that the infrastructure has been created, it is going to accelerate the speed at which we can do research studies.” Accelerated research into the risk factors for cancer is of particular urgency. Despite important advances made in recent decades, cancer remains a formidable adversary for those looking for new prevention strategies and treatments. The disease is complex, unpredictable, and the leading cause of death in this country. As Canada’s population ages, cancers are expected to become even more prevalent, and are forecast to rise by about 40 per cent by the year 2030. CPTP offers a unique window into the genetic make-up and health of people from across the country. It has significant statistical power to explore how genetic predispositions and environment can influence cancer risks. The database gives researchers a new opportunity to scale up their work to include more data from Canadians from diverse geographic regions. “You can test out whether a particular hypothesis in one province may hold true in other populations,” Dr. Dummer says. He points to a research project he and his colleagues are pursuing in B.C., on how urban development can impact people’s health in Metropolitan Vancouver. With CPTP, there is potential to expand the study to include people from other regions of the country. “You can see whether health outcomes in British Columbia hold true for the Prairies. It effectively enables us to do a number of cutting-edge projects.” CPTP is still considered a young population health research study. Its greatest value, according to Dr. Boileau and other researchers, may well be found in the years and decades to come. As the regional population health studies return to their participants for updates, the new information gathered might help shed light on why some people develop cancer and other chronic diseases while others don’t. “We are just beginning. We plan to follow participants for many years, and the study will become more valuable with time,” says Dr. Boileau. “We will be able to compare people who were exposed to different risk factors, and at what rate they develop these diseases.” Dr. Boileau adds that as researchers return the findings of their studies to the cohorts, they will enhance the quality of the data. The more researchers use the database, the more questions CPTP might be able to help answer. The door is now open for independent investigators to use this new national resource – one that holds great potential for scientific discovery.

Canadian volunteers in national study do their part in fight against cancer and chronic diseases

Canadian volunteers in national study do their part in fight against cancer and chronic diseases (Originally Published on National Post) A new population health study has garnered the unprecedented support of Canadians from coast to coast. The Canadian Partnership for Tomorrow Project (CPTP) has recruited more than 300,000 volunteers to be part of a promising national research platform. Participants have agreed to have their health followed in the coming decades to help in the fight against cancer and other chronic diseases. The volunteers for the study are between the ages of 30 and 74, and include Canadians from many different walks of life. They have offered to provide information about their health, medical history and lifestyle for the CPTP health database. More than half of the volunteers have also offered blood samples for analysis. For some participants, the battle against cancer is deeply personal. Wayne Matthews, a retired electrician living in Fort McMurray, Alta., joined the study in 2012. Cancer has struck many of his family members, including his mother, wife and eldest son. “I just felt it was important to me,” he says. “I don’t want to see other people lose family members. There is so much research going on, and I am hoping this project can dovetail with some of the cancer treatments to make them more effective.” The year 2010 was particularly difficult for the Matthews family. Wayne’s son, Nathan, had a passion for skateboarding and was a talented graphic artist. When he was diagnosed with testicular cancer in 2009 at the age of 28, it came as a shock to family and friends. Nathan, who had proposed to his girlfriend from his Vancouver hospital bed, died in February of 2010. “He was always helping out,” his father remembers. “He had badgered the city council in Williams Lake, B.C., to get a skate park built when he was a teenager. They ended up renaming the skate park in his memory.” Just months later, in July 2010, Wayne’s wife of more than 30 years also passed away. Kathy Matthews was undergoing treatments for multiple myeloma, a form of bone marrow cancer.  Kathy and her son were among an estimated 75,000 Canadians who lost their lives to cancer in 2010 alone. Today, cancer continues to be the leading cause of death in this country, taking the life of one in four Canadians. In an effort to learn more about this and other complex diseases, beginning in the 1990s several provinces launched regional population health studies that followed participants over an extended period of time. CPTP was initiated in 2008 as a collaboration between five of these regional studies in an effort build a large collection of data that are consistent and comparable across the country. Now that the recruitment of volunteers is complete, researchers can delve deeper to address key questions around why cancer takes hold in some people and bypasses others. Most participants in the study were recruited when they were cancer-free and have agreed to provide regular health updates for decades to come. Most have also consented to allow CPTP to access relevant information from their health records through the regional studies. Bringing together information from participants with data from their health records gives researchers a powerful tool to observe possible connections between environmental exposures, lifestyle and the development of disease. “One of the things about these studies is they have to be very large,” says Dr. Heather Bryant, vice-president of cancer control with the Canadian Partnership Against Cancer, noting that CPTP’s participants comprise about one in 50 Canadians in the target age group. “You have to have a big enough study group that you can compare, for example, people who develop colorectal cancer with people who don’t.” Crystal Ormond of Calgary joined CPTP along with her husband in 2014. The 39-year-old emergency nurse has seen cancer take the lives of relatives. She has also witnessed friends and co-workers fight back and beat the disease. “It seemed like a really interesting study to be part of,” she says. “I think it is important, as everyone is touched at some point by cancer. It is a diagnosis where everything just stops.” Ormond was approached to volunteer for the project at a public flu clinic and decided to sign up. She plans to stick with CPTP and fill out new questionnaires over time as they are mailed to her. As the mother of two young boys, she hopes CPTP can help shed light on the triggers for cancer and find ways to better prevent and treat the disease in the future. “It seems like more and more people are getting cancer,” she observes. “Are there things we are doing in our environment, or things we can change to reduce the risk? I think that would be great to figure out, why some people get cancer and others remain healthy throughout their lives.” Wayne Matthews also sees reason for hope in this initiative and other medical breakthroughs. He has lost so much, and looks forward to a day when cancer does not leave such a devastating imprint on families and communities. “I see articles out there about new treatments, gene therapies and targeted treatments,” he says. “I look at the progress that has been made even in the short time since 2010 and I think, yeah, we are headed in the right direction. We just need to take it all the way.”

Unlocking the mysteries of cancer and other chronic diseases

Unlocking the mysteries of cancer and other chronic diseases (Originally Published on National Post) Why do people who live in British Columbia have lower cancer rates than those who live in the Atlantic provinces? How can we detect cancer earlier, and reduce the risk of developing the disease? These are just some of the questions at the heart of an ambitious national project that aims to better understand the causes of cancer and other chronic illnesses. In a national collaboration known as the Canadian Partnership for Tomorrow Project (CPTP), research teams across Canada have recruited volunteers from a wide cross-section of society to participate in a long-term population health study. CPTP is the largest data collection of its kind in Canadian history. More than 300,000 people between the ages of 30 and 74, living everywhere from urban centres in British Columbia to remote villages in Newfoundland, have signed on to have their health followed over the course of their adult lives. “This is not your typical clinical research. Participants are acting as citizens, as representatives of the Canadian population, and creating a resource of data and samples to be used by more disease-specific researchers over time,” notes Prof. Bartha Maria Knoppers, director of the Centre of Genomics and Policy at McGill University and one of the socio-ethical and legal architects of CPTP. “There is no direct personal benefit, but they are proud to be contributing to the health of future generations.” CPTP volunteers have provided researchers with personal health information in a range of areas. They were asked about their education and ethnic background, as well as their medical history, level of physical activity, and alcohol and tobacco use. Nearly half of the participants have also provided blood samples, and all have agreed to be contacted in the future to provide regular updates on their health. This long-term, observational data helps medical investigators establish links between risk factors and health outcomes.

Adiposity Measures and Plasma Adipokines in Females with Rheumatoid and Osteoarthritis

Authors: DeClercq, V., Cui, Y., Forbes, C., Grandy, S., Keats, M., Parker, L., Sweeney, E., Yu, Z.M., Dummer, T.J.B. (2017) Journal: Mediators of Inflammation, 2017. doi: https://doi.org/10.1155/2017/4302412 Abstract: The objective of this study was to examine the relationship between adipokines and adiposity in individuals with rheumatoid and osteoarthritis in the Atlantic PATH cohort. Using a nested case-control analysis, participants in the Atlantic PATH cohort with rheumatoid or osteoarthritis were matched for measures of adiposity with participants without a history of arthritis. Both measured and self-reported data were used to examine disease status, adiposity, and lifestyle factors. Immunoassays were used to measure plasma markers. BMI was positively correlated with percentage body fat, fat mass index (FMI), and a change in BMI from 18 years of age in all 3 groups. There were no statistical differences between levels of plasma adipokines; adiponectin levels were 6.6, 7.9, and 8.2 μg/ml, leptin levels were 10.3, 13.7, and 11.5 ng/ml, and resistin levels were 10.0, 12.1, and 10.8 ng/ml in participants without arthritis, with rheumatoid arthritis, and with osteoarthritis, respectively. Those with higher levels of adiponectin were more likely to have osteoarthritis (but not rheumatoid arthritis). No association was found between arthritis types and leptin or resistin. This study demonstrates differences in measures of adiposity and adipokines in specific types of arthritis and highlights the need for more research targeting specific adipokines during arthritic disease progression. Link: https://www.hindawi.com/journals/mi/2017/4302412/

Multimorbidity in Atlantic Canada and association with low levels of physical activity.

Authors: Keats, M., Cui, Y., DeClercq, V., Dummer, T.J.B., Forbes, C., Grandy, S., Hicks, J., Sweeney, E., Yu, Z.M., Parker, L. (2017). Journal: Preventive Medicine, 105. Abstract: Owing to an aging population and medical advances, the anticipated growth and prevalence of multimorbidity has been recognized as a significant challenge and priority in health care settings. Although physical activity has been shown to play a vital role in the primary and secondary prevention of chronic disease, much less is known about the relationship between physical activity and multimorbidity. The objective of the present study was to examine the relationship between physical activity levels and multimorbidity in male and female adults after adjusting for key demographic, geographical, and lifestyle factors. The study drew data from a prospective cohort in Atlantic Canada (2009-2015). The sample included 18,709 participants between the ages of 35-69. Eighteen chronic diseases were identified. Physical activity levels were estimated based on the long form of the International Physical Activity Questionnaire. Using logistic regression analysis, we found that multimorbid individuals were significantly more likely to be physically inactive (OR=1.26; 95% CI 1.10, 1.44) after adjusting for key sociodemographic and lifestyle characteristics. Additional stratified analyses suggest that the magnitude of the effect between multimorbidity and physical activity was stronger for men (OR=1.41; 95% CI 1.12, 1.79) than women (OR=1.18; CI 1.00, 1.39) and those living in rural (OR=1.43; CI 1.10, 1.85) versus urban (OR=1.20; CI 1.02, 141) areas. Given the generally low levels of physical activity across populations and a growing prevalence of multimorbidity, there is a need for a prospective study to explore causal associations between physical activity, multimorbidity, and health outcomes. Link: doi: https://doi.org/10.1016/j.ypmed.2017.10.013

Cohort Profile: The Atlantic Partnership for Tomorrow’s Health (Atlantic PATH) Study.

Cohort Profile: The Atlantic Partnership for Tomorrow’s Health (Atlantic PATH) Study. Authors : Sweeney, E., Cui, Y., DeClercq, V., Devichand, P., Forbes, C., Grandy, S., Hicks, J., Keats, M., Parker, L., Thompson, D., Volodarsky, M., Yu, Z.M., and Dummer, T. (2017). Journal: International Journal of Epidemiology, dyx124. doi: https://doi.org/10.1093/ije/dyx124. Abstract: Cohort purpose: The Atlantic Partnership for Tomorrow’s Health (Atlantic PATH) study is a regional cohort of a federated prospective cohort study, the Canadian Partnership for Tomorrow Project (CPTP). The Atlantic PATH study was established in 2009 to recruit participants from the general population across Atlantic Canada (Nova Scotia, New Brunswick, Prince Edward Island, and Newfoundland and Labrador). The study collected health measures and biological samples in order to examine the genetic, environmental and lifestyle factors that interact to influence the development of cancer and chronic diseases. Link: https://academic.oup.com/ije/article/doi/10.1093/ije/dyx124/4093155/Cohort-Profile-The-Atlantic-Partnership-for?guestAccessKey=e2e3e4e4-785f-479f-87e1-1f45ca4ae39a

Associations of Coffee, Diet Drinks, and Non-Nutritive Sweetener Use with Depression among Populations in Eastern Canada

Associations of Coffee, Diet Drinks, and Non-Nutritive Sweetener Use with Depression among Populations in Eastern Canada Authors: Yu, Z.M., Parker, L., and Dummer, T. (2017). Journal:  Scientific Reports, 7. doi:10.1038/s41598-017-06529-w. Abstract: Consumption of coffee and diet drinks and the use of non-nutritive sweeteners is commonplace worldwide. We conducted a cross-sectional analysis to investigate the associations between coffee consumption and non-nutritive sweetener use and depression among populations in Atlantic Canada. During 2009 to 2013, we recruited 18838 participants aged 35–69 years (5854 men and 12984 women) for the baseline survey of the Atlantic Partnership for Tomorrow’s Health cohort study. Coffee consumption, sweetener use, and major depression were assessed using a set of standardized questionnaires. We utilized multiple logistic regression models to assess the associations of coffee drinking and non-nutritive sweetener use with major depression. Compared with non-coffee drinkers, female participants who drank coffee ≥4 cups/day had an odds ratio of 1.38 (95% confidence interval, 1.15–1.64) for major depression with adjustment for sociodemographic and behavioral factors, chronic disease status, and body mass index. We found a significant association between depression and consumption of sweeteners and diet drinks, which was more apparent among women than men. We conclude that heavy coffee drinking and non-nutritive sweetener use were associated with depression among populations in Atlantic Canada. Further studies are warranted to investigate the underlying biological mechanisms. Link: https://www.nature.com/articles/s41598-017-06529-w

Atopic dermatitis and risk of hypertension, type-2 diabetes, myocardial infarction and stroke in a cross-sectional analysis from the Canadian Partnership for Tomorrow Project.

Atopic dermatitis and risk of hypertension, type-2 diabetes, myocardial infarction and stroke in a cross-sectional analysis from the Canadian Partnership for Tomorrow Project. Authors: Drucker, A.M., Qureshi, A.A., Dummer, T.J.B., Parker, L., Li, W.Q. (2017). Journal:  British Journal of Dermatology. Doi: 10.1111/bjd.15727. Abstract: Atopic dermatitis (AD) has been associated with cardiovascular risk factors and diseases, but epidemiologic studies to date have found conflicting results. Objectives: We aimed to determine the associations of AD with hypertension, type-2 diabetes (T2D), myocardial infarction (MI) and stroke. Methods: We conducted a cross-sectional analysis of baseline data from the Canadian Partnership for Tomorrow Project which includes Canadian residents aged 30-74 living in British Columbia, Alberta, Ontario, Quebec and the Atlantic Provinces. We excluded participants with incomplete data on AD, hypertension, T2D, MI or stroke, who had type-1 or gestational diabetes or who developed any of the outcomes at an age prior to a diagnosis of AD, leaving 259,119 participants in our analysis. We used logistic regression to calculate age and sex- and multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CI) between AD and subsequent hypertension, T2D, MI and stroke. Results: AD was reported by 21,379 (8.4%) participants. A total of 52,787 cases of hypertension, 12,739 cases of T2D, 4,390 cases of MI and 2,235 cases of stroke were reported by participants at enrollment. In the multivariable-adjusted model, AD was associated with decreased odds (OR, 95% CI) of hypertension (0.87, 0.83-0.90), T2D (0.78, 0.71-0.84), MI (0.87, 0.75-1.00) and stroke (0.79, 0.66-0.95). Conclusions: We did not find evidence of a positive association between AD and subsequent hypertension, T2D, MI or stroke; AD was inversely associated with these outcomes in our study. Given our findings and the conflicting literature, AD is likely not a major risk factor for cardiovascular disease.  

Lead in Drinking Water: A Response from the Atlantic PATH Study

Lead in Drinking Water: A Response from the Atlantic PATH Study Authors: Sweeney, E., Yu, Z.M., Dummer, T., Parker, L. (2017). Journal: Environmental Health Review, 60(1). doi:  https://doi.org/10.5864/d2017-002. Abstract: Exposure to lead through drinking water is an issue of increasing concern, particularly with recent high-profile cases of lead-contaminated water. The maximum acceptable concentration level for drinking water in Canada is 10 µg/L, whereas the current blood intervention level is 10 µg/dL. The health effects related to lead exposure are well established and there is evidence that blood lead levels as low as <5 µg/dL are associated with adverse health effects in both children and adults. We analyzed water and toenail samples for lead concentrations from the Atlantic Partnership for Tomorrow’s Health (Atlantic PATH) project, a cohort of the general population in Nova Scotia. Approximately 46% of Nova Scotia residents use well water as their primary source of drinking water. Water from dug wells had higher lead concentrations compared to drilled wells, and the lowest lead levels were found in water from municipal supplies. Although the majority of the lead levels in the drinking water provided by Atlantic PATH participants were below the Canadian maximum acceptable concentration level, there were outliers, particularly among unregulated private well water sources. Given the health effects that are linked to low-level exposures, any exposure to lead in primary water sources remains a concern. Link: http://pubs.ciphi.ca/doi/abs/10.5864/d2017-002