GERA: A Collaboration of Genetics, the Environment and Cancer

The Genetic Epidemiology and Risk Assessment (GERA) Program uses observational studies with large numbers of patients and the community at large to study cancer patterns, risk factors and genes that predispose people to develop cancer. GERA investigators are examining molecular and other biomarkers and lifestyle reports to discern patients' habits and exposures to various elements and their relation to the onset of cancer. The resulting data is used to understand the causes of cancer and to look for ways to detect cancer earlier, enhance treatment, and to prevent cancer altogether.

GERA researchers are also researching ways to forestall cancer in people who are genetically predisposed to it, for example, counseling them to be especially vigilant about smoking cessation or weight control. Other avenues of research include investigating how genetic, lifestyle, and behavioral factors influence outcomes after a cancer diagnosis, ranging from whether genetic background influences the response to treatment to the long-term psychosocial impacts of cancer.

Since 2003, GERA has generated 301 publications, 27 percent of which reflect intra-programmatic collaborations and 40 percent of which reflect inter-programmatic collaborations. Notable contributions have been made in the epidemiology of prostate, breast, colon, ovarian, pancreatic and lung cancer, non-Hodgkin lymphoma, and mammographic breast density, as well as to the statistical genetics and medical informatics literature. Read about some of GERA’s research advances.

The Program membership consists of a team of 22 multidisciplinary investigators from across the institution. These researchers make extensive use of Mayo Clinic Cancer Center’s Shared Resources, especially Survey Research, Clinical Research Office, Biospecimens Accessioning and Processing, TACMA, Genotyping, Bioinformatics, and Biostatistics. Over the next few years, the researchers will be continuing their work in cancer etiology with a focus on genomics, as well as expanding to work in genetic and molecular epidemiology of cancer prognosis, host-tumor interaction, and survivorship. They also plan to broaden their work in epigenetics and proteomics. With many new collaborators such as those in medical informatics and bioinformatics, many opportunities exist to develop new methods for the design and analysis of epidemiologic studies.

GERA Program Goals
The goals of the Genetic Epidemiology and Risk Assessment Program are to:

• Utilize the tremendous advances in genetics and molecular biology in order to understand genetic, environmental, and gene-environment interactions in the etiology of cancer in human populations
• Utilize these same advances in order to understand the genetic and molecular epidemiology of cancer prognosis
• Develop and apply novel statistical and informatics methods for the design and analysis of genetic and molecular epidemiology studies

Genetic and molecular epidemiologic approaches have proven to be highly productive research strategies in cancer research. GERA seeks to apply genetic and molecular epidemiology methods to study critical questions in the etiology and prognosis of cancer in human populations. Cancer etiology studies focus on the genetic epidemiology of cancer, pre-malignant conditions, and risk markers; genome-wide association and genetic variability in candidate genes/pathways; biomarkers of risk; and evaluation of non-genetic risk factors and gene-environment interactions. The goal of these studies is to identify risk and prognostic factors, improve risk stratification, and provide an evidence base for primary, secondary and tertiary prevention strategies.

Moving to a 'Big Science' Model
The nature of genetic epidemiology and risk assessment science demands increasingly large groups of investigators and centers working together. Mayo Clinic Cancer Center is a nationally recognized leader in large-scale population science and has many advantages over other institutions in this respect. In addition to outstanding scientists working in the population sciences arena, Mayo Clinic has:

• Some of the largest numbers and the widest variety of cancer patients of any institution. More than 19,500 new cancer patients come to Mayo's three campuses - Scottsdale/Phoenix, Ariz., Jacksonville, Fla., and Rochester, Minn. - every year, providing large numbers and diverse patient populations for study.
• A leadership role in working with other cancer centers to create even greater pools of patients across the globe. The GERA program leads multi-center consortia to find genes for pancreatic cancer and chronic lymphocytic leukemia, and has a major role in several other international consortia involving lymphoma and lung, esophageal, colon, brain and prostate cancer.
• A large bank of blood and tissue samples linked to extensive medical records that is unmatched by other institutions.
• A culture of collaboration spanning research, education, clinical activities and geographic locations that allows researchers ready and rapid access to patients for research activities.
• One of the most comprehensive and complex information systems ever developed for clinical investigation. To utilize all of its data, Mayo Clinic has an informatics collaboration with IBM to enhance access to Mayo's medical records, ensure patient confidentiality, and mine the knowledge contained there to improve health.