When Brian Henderson, professor of preventive medicine, first arrived at USC School of Medicine in 1969 he had one eye on the past and the other on a vision of the future.
In his immediate past, Henderson had studied the spread of yellow fever in Africa. The future held a different challenge — how to set up an epidemiology program to track and study a wholly different kind of disease — cancer — in urban Los Angeles.
Henderson set about the project with the same approach he had used in his studies of infectious disease — an approach that seemed novel at the time.
“First you find out who gets the disease within a certain population. When you identify a pattern of who gets it, then you have a clue about why people are getting it,” he said.
Henderson, joined by USC preventive medicine faculty Thomas Mack, Malcolm Pike, Susan Preston-Martin, and John Hisserich, formally established the Los Angeles Cancer Surveillance Program (CSP) at USC in 1972.
By studying the cancer patients, and comparing them with healthy controls from the same area, USC researchers have been teasing out new ideas about cancer causes, risk factors and what may prevent the disease ever since.
Last month, the CSP celebrated its 25th anniversary with a symposium that brought together scientists, CSP staff and hospital-based cancer registrars. CSP Director Ronald Ross moderated the meeting.
Speakers at the day-long event discussed just a few of the some 350 research studies that have been culled from CSP data. They honored long-time staff and faculty members who have made the registry one of the world’s best.
“We began these annual symposia as a way of acknowledging the tremendous contributions of the cancer registrars who work at each of the hospitals and at the CSP,” said Leslie Bernstein, professor of preventive medicine and scientific director of the CSP.
“Without their careful documentation of information about cancer patients in Los Angeles County, we would not have had the resource to develop our world-class cancer epidemiology program,” she said.
The CSP has evolved from a voluntary agreement with hospital, clinic and laboratory pathologists to send USC researchers notice of all diagnosed cancer cases in the area to an official depository of cancer information for regional, state and national cancer registries.
The CSP computerized database now exceeds 1 million records, with more than 37,000 newly diagnosed cancer cases added each year.
Recently, CSP was awarded the gold standard of excellence by the North American Association of Central Cancer Registries, said CSP Executive Director Dennis Deapen.
CSP has also provided epidemiologists with a unique research resource. Scientists can use the records to identify and contact eligible cancer patients soon after diagnosis. Over the years, some 25,000 cancer patients have taken part in CSP studies.
The sheer diversity of Los Angeles also makes the CSP a much-sought after resource for cancer scientists. Users can explore differences in cancer rates among racial/ethnic groups like Asian-Americans and Latinos that have historically been left out of major studies.
In addition, access to the CSP resource attracts millions in federal NIH grants to USC investigators, Deapen said. “Scientists use the data every single day.”
Research was always part of the program’s aim, Henderson said.
“From the beginning, we set up a system that would identify the people who were getting cancer but also allow us to follow up on why these people were getting disease. We never meant it to be a passive archive of data. Instead, we pictured it — as it’s turned out to be — an active surveillance system that scientists would use,” he said.
Only a population-based cancer registry like the CSP can give health researchers an idea about how cancer incidence changes from year to year or whether one neighborhood has a much higher incidence than another.
“We get calls from doctors or the lay public who say, ‘There seems to be a lot of cancer in my neighborhood.’ Because we have a population-based approach, we can actually calculate the rate in that specific area.”
Most often, the fears are unfounded, he said.
“The cancer registry data really makes it clear that most cancers don’t have to do with exactly where you live, but with influences from race and ethnicity, smoking, diet and other lifestyle and genetic factors,” Deapen said.
For example, despite what much of the public believes, lung cancer is no more common in smoggy Los Angeles than in wind-swept San Francisco.
“The only way we know that is because of the CSP,” he said. “Henderson showed true foresight when he founded the program.”
Brian Henderson, Thomas Mack, Ronald Ross, Leslie Bernstein and Susan Preston-Martin are professors of preventive medicine. John Hisserich serves as associate vice president for health affairs. Dennis Deapen is an associate professor preventive medicine. Malcolm Pike is professor and chair of the Department of Preventive Medicine.