The NSW Cancer, Lifestyle and Evaluation of Risk Study (CLEAR)

A resource for cancer research

MethodsPopulation: NSW residents aged > 18 years.Cases: People with any incident cancer.Controls: Partners of cases, who are cancer free. Study requirement: Consent to participate, completion of questionnaire and an optional contribution of a blood specimen.

Study procedure • Potential participants were approached using two methods:

i. In a targeted approach all people with a recent cancer diagnosis were identified using a medical database, from the South Eastern Sydney and Illawarra Shoalhaven Local Health District Clinical Cancer Registry (SESAHS), Hospitals Contribution Fund of Australia (HCF), South Western Sydney and Sydney Local Health District Clinical Cancer Registry (SSWAHS), and Melanoma Institute Australia (MIA).

ii. In non-targeted approaches potential participants opt to participate in the study after hearing of CLEAR through community based events.

•Blood specimens were processed at CCNSW Biobank Facility.

BackgroundThe NSW CLEAR case-control study commenced in 2006. It collects lifestyle and demographic information as well as biospecimens from people with all types of cancer and controls, which are available as an open resource for researchers.

Sitas F1,2,3, Nair-Shalliker V1, Revius M1, Christou C1, Yap S1, Armstrong K1, Salagame U1,2, Christian K1, Cottrill A4, Delaney G5, Kaadan N5, Thompson J6, Haydu L6, Sara T7, Banks E8, Barton M9, Canfell K1,3, O’Connell D1,2,3,10.1. Cancer Research Division, Cancer Council NSW. 2. University of Sydney. 3. University of NSW. 4. Hospitals Contribution Fund of Australia Ltd. 5. South Western Sydney and Sydney Local Health District Clinical Cancer Registry. 6. Melanoma Institute Australia. 7. Southeastern Sydney and Illawarra Shoalhaven Local Health District Clinical Cancer Registry. 8. National Centre for Epidemiology and Population Health, Australian National University. 9. Ingham Institute for Applied Medical Research, Liverpool Hospital. 10. University of Newcastle

Record linkage•Annual linkage with the NSW Central Cancer Registry (NSWCCR) is

undertaken to validate self reported cancer status, and to obtain stage of disease.

•Other potential linkages include hospital admissions and Medicare claims.

Results•CLEAR has recruited 9433 participants (7373 cases and 2060 controls)

and 72% of these participants have contributed a blood specimen. The response rate for all targeted sites is approximately 20% (Table 1).

•Approximately 80% of all CLEAR participants are recruited from sites with a targeted approach.

Table 1. Participation characteristics in each targeted recruitment site

Recruitment Site Mailouts Median age (Min, Max)

Total mailouts Response rate %1 Case Control

SESAHS 14697 25 61 (18, 80) 60 (22, 86)

SSWAHS 14606 14 60 (18, 93) 59 (22, 92)HCF 9453 19 62 (21, 90) 63 (33, 93)MIA 1873 28 60 (19, 92) 59 (28, 86)All sites COMBINED 40629 20 61 (18, 93) 61 (22, 93)

1 Response rate (%) = Number of consents received/total mail out sent for each site

Female

Female

Male

Male

Female Female

MaleMale

CASE CONTROL

AN

ALY

SIS

RE

CR

UIT

ME

NT

Figure 1. The relationship between cases and controls at the recruitment phase is unlinked during analysis, resulting in a pool of sex-matched, cancer-free controls

ConclusionsCLEAR is a valuable resource for cancer researchers interested in the causes and consequences of a cancer diagnosis. It has the potential to significantly advance our knowledge in the occurrence and outcome of various cancers.

FundingThe NSW CLEAR Study isfunded by Cancer Council NSW

•The most common cancer types in CLEAR are listed in Table 2.•Positive predictive values for self report of the top five cancers

compared to linkage with NSWCCR are > 95%.•The risk of lung cancer in current smokers in both men and women,

after adjusting for age, socioeconomic status and migrant status were similar to those from other contemporary studies in the UK and USA (Table 3).

References1. Thun M et al NEJM. 2013;doi:10.1056/NEJM

sa 12111272. Pirie et al Lancet. 2013; doi: 10.1016/S0140-

6736(12):61720-63. Stein et al British Journal of Cancer. 2008;

98:1586 – 1592

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Table 2. Most common cancer sites in CLEAR

Cancer Type n % Cancer Group n %Breast 1533 26 Urogenital 1218 21Prostate 976 16 Bowel† 807 14Colorectal* 791 13 Lymphohaematopoietic 484 8Melanoma 458 8 Skin 483 8Lung 255 4 Gynaecological 337 6Non Hodgkin Lymphoma 227 4 Respiratory 275 5Thyroid 145 2 Head and Neck 201 3Ovary 129 2 Upper GI 177 3Bladder 94 2 Thyroid / Endocrine 152 3* Colorectal cancers include C18-C20 †Bowel cancers include C18-C21

Risk factor Cancer type Study Variable OR (95% CI)Women Men

Smoking

Lung cancer CLEAR* Never 1.0 1.0Past 5.1 (3.1, 8.3) 5.8 (2.9, 11.7)Current† 20.9 (12.0, 36.3) 31.7 (14.9, 67.7)

Cancer Prevention Study1** Never 1.0 1.0Past 8.1 (7.2, 9.1) 7.1 (6.1, 8.2)Current†† 23.4 (19.6, 25.6) 25.6 (21.7, 30.3)

Million Women Study2*** Never 1.0PastCurrent 21.4 (19.7, 23.2)

Tobacco related CLEAR* Never 1.0 1.0cancers Past 1.4 (1.0, 2.1) 1.4 (1.0, 1.9)

Current† 2.2 (1.5, 3.4) 4.9 (3.5, 7.0)JCCC3**** Never 1.0 1.0

Past 1.4 (1.1, 1.8) 2.8 (2.2, 3.5)Current† 1.9 (1.6, 2.2) 4.6 (3.7, 5.7)

* adjusted for age, socioeconomic status and migrant status** adjusted for cohort, age, race and education level***adjusted for recruitment site, age, body mass index, socioeconomic status, current alcohol intake, physical activity, oral contraceptive use, menopausal status and hormone therapy use.**** adjusted for age, education, smoking status and cooking fuel† current smokers are classified as those who still smoke or those who had quit smoking within the previous five years from date of recruitment into study† † current smokers are classified as those who were still smoking at time of recruitment into study

Table 3. Odds ratios for smoking and tobacco related cancers in CLEAR and international studies