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• epidemiology/population health research

• Medicine
• Surgery
• Public Health

• Gastroenterology
• Oncology
• Pharmacology

The Cancer Epidemiology Research group within the Centre for Public Health, QUB, undertakes three broad areas of research

1. Studies of progression from premalignant disease to cancer. This stream of research utilises unique population-based registers of premalignant disease within Northern Ireland including registers of Barrett's oesophagus, Colorectal Polyps, Endometrial Hyperplasia and Monoclonal Gammopathy of Underdetermined Significance. Linkage to the Northern Ireland Cancer Registry and other datasets provides data on cancer incidence within these registers, enabling accurate estimates of cancer incidence to be determined and potential modifiers of cancer risk to be explored. Retrieval of premalignant and cancer tissue through NIBIOBANK is possible and enable biomarkers of progression to cancer to be identified.

2. Molecular (Pathology) Epidemiology studies of cancer progression. Unique population based tissue and data resources (including TMAs, DNA etc.) constructed within the NIBIOBANK, e.g. in colorectal cancer, enable novel markers of cancer progression to explored.

3. Pharmacoepidemiology studies of cancer risk and progression. The group has substantial experience in using large scale primary care databases to explore the associations between commonly used medications and cancer risk and progression

Updating the Northern Ireland Barrett?s Oesophagus (BO) Register (NIBR) to address important clinical questions.

The NIBR recorded all patients diagnosed with BO (columnar lined oesophagus (CLO) with or without specialised intestinal metaplasia (SIM)) in NI between 1993 and 2010. 13,294 cases were registered, with 197 incident oesophageal adenocarcinoma (OAC) and 37 high grade dysplasia (HGD) cases diagnosed ?12 months after first BO diagnosis. During the PhD, the NIBR will be updated to 2018 to provide approximately 5,000 new BO registrations and 300/50 incident OAC/HGD cases. Several important clinical questions can be answered with the updated register

1. WHAT IS THE RISK OF OAC/HGD IN PATIENTS WITH CLO BUT WITHOUT SIM?
There remains uncertainty over whether CLO without SIM carries a risk of OAC. Recent clinical practice involves standardised BO sampling making it possible to examine cancer risk in CLO cases where SIM can be confidently excluded. Confirmation of the true cancer risk in such cases could substantially affect clinical practice and avoid unnecessary expenditure in surveillance/follow-up of such patients.

2. WHAT IS THE LONG TERM OAC/HGD RISK IN BO PATIENTS?
We have shown that OAC/HGD risk in BO remains constant up to 12 years of follow-up but conflicting evidence exists. Extending the NIBR will allow this important question (which would help determine the period of surveillance required in BO patients) to be robustly addressed.

3. WHAT ARE THE TRENDS IN DIAGNOSIS OF BO?
The large increase in BO diagnosis rates in the last 40 years is well recognised but very few studies have examined recent trends. Within NIBR we showed a substantial increase in BO detection rates between 1993 and 2005 but also a possible peak in 2003/4. Current population-based trends in BO diagnosis, which determine future resources required to manage BO, can be determined with the updated NIBR