Cancer Epidemiology, Prevention & Control Program Leaders Howard Strickler, MD Program Leader, Cancer Epidemiology, Prevention and Control Program Bruce Rapkin, PhD Co-Program Leader, Cancer Epidemiology, Prevention and Control Program Selected Achievements Members The Cancer Epidemiology, Prevention and Control program plays a central role in the scientific, clinical and public health mission of AECC, and is the focal point for the translation of laboratory-based research into studies at the population level. The broad aims of the CEPaC are to conduct studies in human populations to determine the behavioral, environmental and molecular etiologic risk factors that underlie cancer development and outcomes, especially actionable targets for screening, prevention, and treatment, and further, to implement interventions and test their effectiveness in the community. The CEPaC is organized into four major themes: (i) Infectious Risk Factors, including oncogenic HPV, HIV, HCV, and the human microbiome; (ii) Hormonal, Obesity, and Inflammation Related Risk Factors; (iii) Genetic/Epigenetic Risk Factors; and (iv) Cancer Prevention, Control, and Implementation Science, encompassing prevention, health care delivery, health disparities, and survivorship/outcomes, especially in the Bronx catchment area. CEPaC research has had an ongoing impact on clinical practice and guidelines. Recent examples of advancements include: (i) Results of a series of studies characterizing HPV sub-lineages and patterns of HPV DNA methylation have shown sufficiently strong associations with risk of cervical cancer/precancer that they may have the potential to help improve the positive predictive value (PPV) of recently FDA-approved “primary HPV screening” as well as to elucidate novel aspects of HPV-related tumorigenesis; (ii) Several CEPaC studies have implicated the high prevalence of hyperinsulinemia in obese individuals in the obesity-cancer relationship. In one recent study, compared to metabolically healthy / normal weight women, healthy obese women did not have an increased risk of breast cancer, whereas metabolically unhealthy women had a nearly two-fold increased breast cancer risk irrespective of whether the individual was obese or normal weight. The combination of insulin and biomarkers of systemic inflammation fully explained the relation of BMI with breast cancer – results that demonstrate the importance of etiologic biomarkers in risk stratification (e.g., versus obesity), characterizing possible carcinogenic pathways, and as targets for chemoprevention; (iii) A novel signature of metastatic risk (called TMEM for Tumor Microenvironment of Metastasis), based on laboratory and animal model studies, was strongly associated with metastasis of ER+/HER2- tumors in postmenopausal women and may have a role in guiding treatment decisions. (iv) Firefighter first-responders who worked at the 9/11 WTC disaster site were found to be at increased risk of developing MUGUS, a precursor of multiple myeloma, as well as several other cancer types informing monitoring practices in this group. (v) Cancer prevention and control initiatives in the Bronx have identified the detrimental impact of noncompliance to radiation protocols and predictors of non-compliance on cancer mortality. These studies further suggested that an often unperceived decrease in patient activity (objectively detected using accelerometer) may be predictive of re-hospitalization and poor outcome, with potential implications to telemonotoring of outpatients.