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IJE Advance Access published online on March 23, 2006
International Journal of Epidemiology, doi:10.1093/ije/dyl044
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2006; all rights reserved.
Accepted February 22, 2006

Original paper

A design for cancer case-control studies using only incident cases: experience with the GEM study of melanoma

Colin B Begg 1 *, Amanda J Hummer 1, Urvi Mujumdar 1, Bruce K Armstrong 2, Anne Kricker 2, Loraine D Marrett 3, Robert C Millikan 4, Stephen B Gruber 5, Hoda Anton Culver 6, Roberto Zanetti 7, Richard P Gallagher 8, Terrence Dwyer 9, Timothy R Rebbeck 10, Klaus Busam 1, Lynn From 3, Marianne Berwick 11, and for the GEM Study Group

1 Memorial Sloan-Kettering Cancer Center, New York, NY
2 The University of Sydney and Cancer Council New South Wales, Sydney, Australia
3 Cancer Care Ontario, Toronto, Canada
4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
5 University of Michigan, Ann Arbor, MI, USA
6 University of California at Irvine, Irvine, CA, USA
7 Centro per la Prevenzione Oncologia Torino, Torino, Piemonte, Italy
8 British Columbia Cancer Agency, Vancouver, Canada
9 Murdoch Childrens Research Institute, Melbourne, Victoria 3052, Australia
10 University of Pennsylvania, Philadelphia, PA, USA
11 University of New Mexico, Albuquerque, NM

* To whom correspondence should be addressed.
Colin B Begg, E-mail: beggc{at}mskcc.org


  Abstract

Background The population-based case-control study is not suited to the evaluation of rare genetic (or environmental) factors. The use of a novel case-control design in which cases have second primaries and controls are cancer survivors has been proposed for this purpose.

Methods We report results from an international study of melanoma that involved population-based ascertainment of incident cases of second or subsequent primary melanoma as the ‘case’ group and incident cases of first primary melanoma as the ‘control’ group. We evaluate the validity of the study design by comparing the results obtained for phenotypic factors that have been shown consistently to be associated with melanoma in previous conventional studies with the results from a conventional case-control study conducted in Connecticut and from literature reviews.

Results All but one of the known risk factors for melanoma were shown to be significantly associated with melanoma in our study, though the individual odds ratios appear to be somewhat attenuated relative to the magnitudes typically observed in the literature.

Conclusions Patients with a second or subsequent primary cancer of a single type represent a potentially valuable and under-utilized resource for the study of cancer aetiology.

Keywords: Case-control study; case-only study; melanoma.
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