The Epidemiology and Control of Chronic Disease research programme has come about as a result of the recognition that risk and prognosis factors relating to the most prevalent diseases and other chronic health issues are more often than not shared among patients. Some of these common determinants are life habits, factors extracted from the physical, chemical and psychosocial environment, pathogenic mechanisms such as inflammation and oxidation, and also a number of genetic factors. The prognosis of these diseases can also be affected by the same factors and by quality healthcare. Finally, control of these health issues may require legal measures, screening, health recommendations, and immuno- and chemoprophylaxis, which are also shared among diseases of this type.
1. Multi-centre study of population-based cancer cases and controls (MCC-Spain)
In 2008, with the funds received from the Cross-sectional Action in Cancer (Ministerio de Sanidad and Instituto de Salud Carlos III), CIBERESP started up a multi-centre study of population-based cases and controls to investigate the role of environmental factors and their interaction with genetic factors in the genesis of high-incidence tumours (breast cancer, prostate cancer, colorectal cancer and gastroesophageal cancer), the MCC-Spain study. The list of tumours was later augmented to include chronic lymphocytic leukaemia (CLL).
The general objective of the study was to evaluate the environmental and genetic factors associated with colorectal cancer, breast cancer, stomach/oesophageal cancer and prostate cancer, adding chronic lymphocytic leukaemia (CLL) to these cancers in a second phase.
The MCC-Spain has recruited 10193 subjects in 23 hospitals in 12 Spanish provinces, comprising 1115 cases of prostate cancer, 1750 cases of breast cancer, 2171 cases of colorectal cancer, 492 cases of gastroesophageal cancer, 564 cases of chronic lymphocytic leukaemia (CLL) and 4101 population-based controls paired by age, sex and region of residence. MCC-Spain participates in several international consortiums and in European projects.
GenRisk started in 2016 with the goal of compiling and analyzing genetic biomarkers as disease risk factors to define personalized preventive actions. The progressive availability of affordable genotyping and sequencing technologies make possible the assessment of genetic biomarkers in a variety of chronic diseases such as cancer, diabetes, cardiovascular and respiratory diseases,… The objective of the GenRisk subprogram is to coordinate actions in this field, share the knowledge about methodologies of analysis and use of genetic data, organize coordinated or multicenter studies, evaluate actions, and study the society impact.
For cancer studies, the subprogram has received funding from the Asociación Española contra el Cáncer.
3. Cancer Epidemiological Surveillance Subprogram (VICA):
Advances in the epidemiological surveillance of cancer: from incidence to the study of health inequalities
The VICA subprogram is included in the P1 program of “Epidemiology and control of chronic diseases” of the CIBER of Epidemiology and Public Health (CIBERESP).
The main objective of the subprogram is to further develop the analysis of the main epidemiological cancer indicators, introducing the perspective of health inequalities, with the ultimate goal of improving cancer outcomes in the population. Population-Based Cancer Registries (PBCRs) are crucial for the development of this subprogram, because they provide exhaustive and high-quality data on the incidence of cancer in their respective geographical areas. The general aim of the subprogram is broken down into the following specific objectives:
- To consolidate a geographic information system in the PBCRs that allows the geolocation of registered incident cancer cases.
- To obtain epidemiological cancer indicators (mortality, incidence, and survival) according to socioeconomic strata of the population, assigned through a deprivation index.
- To identify geographic variations of these epidemiological indicators.
- To expand the knowledge of how socioeconomic status influences cancer outcomes and interacts with other prognostic factors.
In addition, the VICA subprogram has developed since its inception in 2018 a series of training workshops for research groups belonging to CIBERESP and the PBCRs integrated into the Spanish Network of Cancer Registries (REDECAN). These workshops are helping to improve the technical capacity of professionals for the calculation, analysis, and interpretation of epidemiological indicators in the geographical context.
4. Mammographic density and breast cancer
Mammographic density (MD) is one of the most important risk determinants of breast cancer, the risk being more than 30% for a tumour in which classic risk factors do not account for 50% of the cases. The suggestion to use MD as an intermediate phenotype in epidemiological, clinical and genetic studies on breast cancer was put forth in 2005. Some Regions of Spain are considering the inclusion of MD in breast cancer screening programmes.
Objectives of the subprogramme:
5. Nutrition and cardiovascular risk study in Spain (ENRICA)
The ENRICA study assesses the frequency and distribution of the primary components of the natural history of cardiovascular disease in Spain, including food intake and other behavioural risk factors, biological risk factors, early damage in target organs, and diagnosed morbidity. To attain these objectives, a cross-sectional study was conducted in 2008 in 11991 people representing the non-institutionalised population of 18 years and older in Spain, which became a cohort, and the study comprised a median follow-up of 6 years. This cohort has enabled accessing two ongoing European projects, i.e., FRAILOMIC (7th Framework Programme) and ATHLOS (H2020). FRAILOMIC seeks to identify the ohmic determinants of frailty syndrome in the elderly, and the purpose of ATHLOS is to learn more about healthy aging and its determinants.
6. DARIOS Study
This study includes 28,887 participants, and started in 2009. Six papers have already been published in high impact factor journals. Furthermore, a web page (http://darios.imim.es) has been set up which allows the prevalence of different combinations of cardiovascular risk factors in Spain to be estimated using different cut-off points.
7. FRESCO Study
This is a collaborative study based on the grouping of 12 population-based cohorts of 7 regions of Spain including about 55000 individuals whose ages are comprised between 35 and 79 years old. It started in 2009.
8. EPIC (European Prospective Research into Cancer and Nutrition)
This is a multi-centre cohort study including over 500,000 people that is being conducted in 23 centres from 10 different European countries (Denmark, France, Germany, Greece, Italy, Netherlands, Norway, Spain, Sweden and the United Kingdom). In Spain the project is being conducted in Asturias, Gipuzkoa, Granada, Murcia and Navarre. Its international relevance can be assessed by simply writing EPIC in PubMed.
9. InterAct Study
European cohort-case study (case-cohort) designed to investigate the risk of type 2 diabetes mellitus (DM2) and the interaction between genes and modifiable lifestyle and behavioural factors, especially diet and physical activity. Eight of the 10 countries from the EPIC project are participating in InterAct. The study is primarily funded by the 6th EU Framework Programme, the Medical Research Council (MRC) of the United Kingdom and the participating Spanish Regions.
10. EPIC-CVD Study
The EPIC-CVD (previously EPIC-Heart) study is the cardiovascular component of the EPIC project. The purpose of this study is to provide further understanding of the separate and combined influence of lifestyles (primarily diet), environment and metabolic and genetic factors on heart disease and cerebrovascular disease.
11. Neuro-Epic Study
The Neuro-Epic study is the neurodegenerative disease component of the EPIC Study. The main objective is to identify the environmental and genetic factors affecting the onset of neurodegenerative diseases and to quantify their effect both separately and together. Three neurodegenerative diseases have been selected: Alzheimer’s disease, Parkinson’s disease and Amyotrophic Lateral Sclerosis.
12. Population Cancer Registry Platform
This platform has reinforced the good relations between registries with the creation of the Red de Registros de Cáncer (REDECAN) (Cancer Registry Network) in Spain for the purpose of generating scientific knowledge that is directly relevant for the control of cancer.
13. POIBC Study
The POIBC Study (FIS PI11/01900) is an intervention study to evaluate the long-term effects of implementing community-based intervention in relation to the prevention of childhood obesity, conducted on 2140 children comprised between the ages of 8 and 10 years old and their families, from four different municipalities in Catalonia.
See spanish website for furher information about research groups participating in this program.