Cancer Epidemiology
- Epidemiology, Public Health, Prevention and Survivorship
Dr. Renée Turzanski Fortner
Head of Division
The overarching goal of the Division’s research is to provide insights on the etiology of cancer, strategies for prevention and earlier detection, and predictors of survival, with the goal of reducing the morbidity and mortality associated with a cancer diagnosis.
Our Research
On the basis of established, genetic and non-genetic risk factors, we build quantitative risk models for the identification of individuals who have an increased risk of developing cancer compared to others, and who may gain increased benefit from targeted prevention measures such as regular cancer screening.
A further focus is exploring new routes for prevention and early diagnosis of cancer, as well as quality control of introduced measures. Due to their population-related approach, statistical methods and their further development are of particularly high relevance in epidemiology.
A major part of our research takes place within the setting of large-scale prospective cohort studies, such as the European Prospective Investigation into Cancer and Nutrition (EPIC) and the Scandinavian Consortium of Maternity Cohorts. Besides these prospective studies in the general population, our division conducts studies within large cohorts of cancer patients.
FUTURE OUTLOOK
Studies within our various prospective cohorts are increasingly making use of modern, high-throughput “omics” technologies (metabolomics, genomics, epigenomics, next-generation sequencing) for the identification of risk factors and predictors for cancer and markers for early detection.
For future studies, our division has a central role in the development and set-up of the “NAKO” – a new, large-scale prospective cohort study in Germany.
NAKO Study Center Mannheim
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Yuliya Ertel
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Altan Adanali
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Farah Alam
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Mailin Anna Theresia Antl
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Annika Baert
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Özlem Bedir
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Nimet Demir
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Patrycja Hamryszak
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Silke Kahmann
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Torben Loßmann
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Anna-Constanze Mast
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Ute Metzger
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Ute Muskatewitz
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Colin Ofenloch
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Louisa Sautner
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Maria Antonia Scafiti
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Rita Schanzenbach-Bauer
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Christine Schestak
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Leni Schwarzwälder
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Jasmin Tabakhtory-Fard
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Nicoleta-Sanda Veredas Caballero
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Luisa Wagner
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Gülsüm Yurtseven
Our Projects
A key focus of our research is the prevention and early detection of lung cancer. Through various national and international projects, we are investigating how lung cancer risks can be identified early, how to reach appropriate individuals for early detection programs, and how screening services can be implemented effectively and equitably.
Among other things, we focus on evaluating lung cancer screening using low-dose computed tomography (LDCT), participation in screening programs, social and regional disparities in uptake, as well as issues related to health literacy, risk communication, and smoking cessation. Our work is based on data from epidemiological studies, screening projects, and healthcare systems.
Our research aims to contribute to further developing the evidence for effective, target-group-appropriate, and equitable lung cancer screening and to support its translation into clinical practice.
LUSI
The German Lung Cancer Screening Intervention Study (LUSI) investigates the benefits of lung cancer screening using low-dose computed tomography (LDCT) in individuals at increased risk for lung cancer.
4-IN-THE-LUNG-RUN
4-IN-THE-LUNG-RUN (4ITLR) is a European research project aimed at further developing risk-based strategies for lung cancer screening and implementing them in various European healthcare systems.
SOLACE
The European SOLACE project is investigating how to improve access to early lung cancer screening and, in particular, how to better reach hard-to-reach and underserved populations.
The MARIE study is a population-based case-control study on breast cancer with more than 11,000 women. In the years 2001-2005, histologically confirmed patients with breast cancer or carcinoma in situ (age range 50-74 years) and, as controls, women without breast cancer were included. The study took place in the two regions of Hamburg and Rhine-Neckar-Karlsruhe. There were three follow-up studies.
The EPIC study (European Prospective Investigation into Cancer and Nutrition) is a long-term, large-scale collaborative project designed to investigate the links between diet, lifestyle, and environmental factors and the incidence of cancer and other chronic diseases. It is one of the largest cohort studies in the world, with more than half a million participants across 10 Western European countries. EPIC was launched in the 1990s and has been ongoing for more than 30 years.
Ovarian Cancer: Risk, Earlier Detection and Survival
Ovarian cancer has relatively few established risk factors, and due to a lack of reliable early detection methods, most women with ovarian cancer are diagnosed at an advanced stage when treatment is less effective. Worldwide, it is the 6th leading cause of cancer-related mortality in females, and in Europe it is the most lethal gynecological malignancy. Ovarian cancer is a very heterogeneous disease, with different risk factors, treatment, and prognosis by disease subtype. A major focus of our work has been to improve characterization of risk, early detection, and survival by disease subtype and in the context of contemporary exposures and treatments. Our studies are conducted in leading prospective cohorts (e.g., European Prospective Investigation into Cancer and Nutrition ), international consortia (e.g., Ovarian Cancer Cohort Consortium), and registry-based studies.
Publications
Stawiski K, Fortner RT, Pestarino L, Umu SU, Kaaks R, Rounge TB, Elias KM, Fendler W, Langseth H. Validation of miRNA signatures for ovarian cancer earlier detection in the pre-diagnosis setting using machine learning approaches. Front Oncol. 2024 Jun 25;14:1389066. doi: 10.3389/fonc.2024.1389066. PMID: 38983926
Fortner RT, Trewin-Nybråten CB, Paulsen T, Langseth H. Characterization of ovarian cancer survival by histotype and stage: A nationwide study in Norway. Int J Cancer. 2023 Sep 1;153(5):969-978. doi: 10.1002/ijc.34576. Epub 2023 May 25. PMID: 37226635
Skarga E, Surcel HM, Kaaks R, Waterboer T, Fortner RT. Sexually Transmitted Infections and Risk of Epithelial Ovarian Cancer: Results From the Finnish Maternity Cohort. J Infect Dis. 2023 Nov 28;228(11):1621-1629. doi: 10.1093/infdis/jiad171. PMID: 37196097
Mukama T, Fortner RT, Katzke V, Hynes LC, Petrera A, Hauck SM, Johnson T, Schulze M, Schiborn C, Rostgaard-Hansen AL, Tjønneland A, Overvad K, Pérez MJS, Crous-Bou M, Chirlaque MD, Amiano P, Ardanaz E, Watts EL, Travis RC, Sacerdote C, Grioni S, Masala G, Signoriello S, Tumino R, Gram IT, Sandanger TM, Sartor H, Lundin E, Idahl A, Heath AK, Dossus L, Weiderpass E, Kaaks R. Prospective evaluation of 92 serum protein biomarkers for early detection of ovarian cancer. Br J Cancer. 2022 May;126(9):1301-1309. doi: 10.1038/s41416-021-01697-z. Epub 2022 Jan 14. PMID: 35031764
The German National Cohort (“NAKO Gesundheitsstudie”) is an interdisciplinary, population-based cohort study that will follow the long-term medical histories of 200,000 participants over 25-30 years. As Germany’s largest health study, the overarching aim of the National Cohort is to inform more effective disease prevention strategies, with a focus on seven major disease groups: cancer, diabetes, and cardiovascular, neurologic and psychiatric, infectious, respiratory and musculoskeletal diseases. It will provide a major, central resource for population-based epidemiology in Germany, and will help to identify new and tailored strategies for early detection, prediction, and primary prevention of major diseases.
The main objectives of the study are:
- to identify etiologic pathways linking lifestyle and environmental risk factors to chronic diseases and functional impairments;
- to study the causes of regional and socio-economic disparities in health status and disease risk in Germany; and
- to develop risk prediction models for the identification of individuals at increased risk of major chronic diseases; and (iv) to identify and validate markers for early detection of disease and pre-disease phenotypes.
The study participants are recruited through a network of 18 local recruitment centres, in 8 regional clusters throughout Germany, which cover both urban, strongly industrialized and rural regions (Figure V.1). Each centre recruits a minimum of 10,000 cohort participants, men and women aged 20-69 who are randomly selected from municipal population registers. At baseline, the participants are invited to visit their local study centre, where they have a face-to-face interview, fill out computer-aided questionnaires, provide biological samples, and take part in an extensive series of medical examinations.
The Division of Cancer Epidemiology is responsible for one of the 18 recruitment centres of the German National Cohort, which is located in Mannheim (PI: Dr. Renée Turzanski Fortner, together with Co-PIs from the University of Heidelberg) In addition, the MRI centre in Mannheim conducts 6,000 MRIs for study participants from the study centres Mannheim, Saarbrücken and Freiburg under the joint responsibility of the DKFZ and the University Hospital Heidelberg.
As part of the Competence Network Secondary and Registry Data, the division also has responsibility for the administrative and scientific organization of record linkages to epidemiological and clinical cancer registries throughout Germany.
In environmental epidemiology, we investigate how environmental exposures and pollutants influence cancer risk and which individual factors may modify these effects.
Persistent Organic Pollutants (POPs)
A major research focus at the division is the study of persistent organic pollutants (POPs). The work examines how exposure to and circulating concentrations of these long-lasting environmental chemicals are associated with the risk of hormone-related cancers, particularly breast and endometrial cancer.
Selected Publications
Löfling LL, Støer NC, Botteri E, Fortner RT.
Le Cornet C, Jung AY, Behrens S, Middha P, Truong T, Jernström H, Bolla MK, Wang Q, Southey MC, Beane Freeman LE, Koutros S, Stone J, Rennert G, Shulman K, Aronson KJ, Murphy RA, Guénel P, Patel AV, Bodelon C, Teras LR, Shahi S, Lacey JV, Dossus L, Kaaks R, Holleczek B, Brenner H, Brauch H, Hoppe R, Czene K, Hall PFL, Mannermaa A, Wu AH, Obi N, Michailidou K, Panayiotidis MI, McLean C, Haiman CA, Augustinsson A, Zheng W, Shu XO, Perou CM, Troester MA, Van Alsten S, Eliassen AH, Abubakar M, Kraft P, Ahearn TU, Evans DG, Wolk A, Milne RL, Easton DF, Pharoah PDP, Schmidt MK, García-Closas M, Vachon CM, Fortner RT, Chang-Claude J.
Trewin-Nybråten CB, Leithe S, Paulsen T, Langseth H, Fortner RT.
Kaaks R, Cooley V, Mukama T, Teras LR, Patel AV, Masala G, Crous-Bou M, Harris HR, Langseth H, Surcel HM, Wentzensen N, Terry K, Sasamoto N, Tworoger S, Fortner RT.
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