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November/December 2008 Cover

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The Time and Place of Cancer

Photo by Kathy Rice

The Time and Place of Cancer
A spatiotemporal database of risk factors will explore connections between the environment and the disease

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Radon and Cancer

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(Editor's note: Full-length version of story.)

Better understanding of the interaction between cancer genes and the environment is the goal of a research project launched by the Maine Institute for Human Genetics and Health and two of the leading research institutions in the state - the University of Maine and Jackson Laboratory. At the heart of the initiative is what researchers hope is a new cancer-fighting tool, the Biobank of Maine, to explore the relationship between the disease and its geographic, demographic, health and environmental variables.

"We will ask questions such as why breast cancer rates are low in Aroostook County while all rates of cancers are highest in Washington County," says Janet Hock, director of the Maine Institute for Human Genetics and Health, headquartered in Brewer. "It's not simply that you live in an area with high radon or lead in the water. It's far more complex. It's the interplay between genes and the environment. We're going beyond asking whether variations of the genes make people more susceptible, to asking what is their interaction with the environment."

In 2007, the Maine Institute for Human Genetics and Health launched the Biobank of Maine with a $1.8 million award from the Department of Defense. The goal is to investigate the effects of rural environments on human genetics and health to find solutions to reducing the high rates of cancer in Maine.

In Maine, lung, breast, prostate and colorectal cancers predominate, and melanoma rates are rising.

The biobank has two core components - a cancer tissue repository managed by the Maine Institute for Human Genetics and Health, and a complex geographic information system (GIS) database developed by the University of Maine and Jackson Laboratory.

Both adhere to the strictest of confidentiality guidelines as set by the National Cancer Institute and the International Society for Biological and Environmental Repositories.

Nov. 1, the first of the tissue samples will be deposited in the biobank. Patients consenting to have their postsurgical blood and tissue samples archived in the repository will complete a confidential geospatial questionnaire. On it they will be asked to provide information about their behavioral, occupational, residential and healthcare histories.

The demographic information will be entered in the secure database known as the Maine Cancer Geographic Information System or MeCancerGIS. The database will integrate four basic types of data: geographic, demographic, health and environmental. Publicly available databases on geography, environment and occupational exposures will be included, as will geospatial and temporal information on environmental exposures in Maine, such as radon and arsenic in water and bedrock, and herbicide and pesticide applications.

The goal is to provide a spatiotemporal perspective on the state's incidence of cancer. Such detection and monitoring of cancer incidence and mortality in space and time in Maine could help identify regions where there are higher-than-expected cancer rates and could aid investigations of the connections between specific environmental variables and cancer.

The spatiotemporal database of risk factors for cancer also has the potential to be a model for mapping patterns in other diseases.

"Maine Cancer GIS will map incidences of cancer and provide tools to investigate interactions with environmental, socioeconomic and demographic factors," says University of Maine Professor of Spatial Information Science and Engineering Kate Beard-Tisdale, who is collaborating with Jackson Laboratory bioinformatics scientist Carol Bult to develop the database. "Through representation of the data, we can generate many different ways to look at patterns and subsets. Does where people live or have lived make any difference? Are there spatial structures that can help diagnose how disease evolves?"

This summer, Beard-Tisdale and Bult focused on the intricate protocols for the database. Graduate student Paul Smitherman, a research assistant in the Department of Spatial Information Science and Engineering, focused on the hardware configurations.

"There's a huge set of parameters to plug in to the statistical engine in order to take a lot of inputs to output specific results," says Smitherman, whose 2006-07 study of radon in more than 1,000 wells in the Augusta area will be included in thedatabase. "The creation of the logical model of how to store data spatially and temporally is a huge challenge. That actual, logical
structure of the database will be a groundbreaking research area."

The incorporation of GIS as an analytical tool for the Biobank of Maine is "a unique marriage," says Hock. Other biobanks across the country record some geocode information like the patient's last known address, but Maine will be the first to comprehensively compile the gene-environment interactions that change the risk of cancer.

The research initiative is being watched closely by other states. Already, Hock is discussing partnerships to share resources with other biobanks, including one in New Brunswick, the province with the highest cancer rate in Canada.

The hope is to find out how the environment influences the genes, ultimately informing the development of treatments to target the risk
factors. Physicians could one day treat cancer patients by looking at both their medical and environmental histories. Clinics could be established in areas with populations at higher risk, helping overcome socioeconomic boundaries in rural states like Maine.

Such a multifactor inquiry could shed light on questions like why some breast cancer patients go into remission and others do not, or why the incidence of lung cancer in nonsmoking women is rising.

"There's potential richness in combining genetics with socio-economic, environmental and geographic factors," says Beard-Tisdale, who directs the National Center for Geographic Information and Analysis at UMaine. "This data gives us the possibility of isolating which factors pose greatest risk."

"The hope is that by building a baseline that is perpetuated, we can create a model to tease apart the complexity of the different potential risk factors to make a diagnosis about cancers. We hope the database helps us address some of the questions we have about whether risk factors are working in isolation or in combinations of ways we don't yet understand."

by Margaret Nagle
November-December, 2008

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