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Golestan Cohort Study

Lead Contacts and/or Principal Investigators (PIs):

• Paolo Boffetta, M.D.
  Mount Sinai School of Medicine and
  International Prevention Research Institute (IPRI), Lyon, France
• Reza Malekzadeh, M.D.
  Digestive Disease Research Center (DDRC), Tehran University of Medical Sciences
• Christian Abnet, Ph.D.
  Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI)
• Paul Brennan, Ph.D.
  International Agency for Research on Cancer (IARC), Lyon, France

Funded Since: 2004
Funding Source: Digestive Disease Research Center, Tehran University of Medical Sciences; NCI Intramural Program (DCEG); Cancer Research UK
Year(s) of Enrollment: 2004-2008
Study Website: http://www.ddri.ir/en/modules/fmcontent/content.php?topic=gastro-intestinal-and-liver-cancers&id=249&page=golestan-cohort-study-of-esophageal-cancer

The earliest reports of high incidence of esophageal cancer in the northern parts of Iran date back to the early 1970s. A population-based cancer registry established in 1969 confirmed the high incidence of the cancer in the eastern portion of the Caspian Sea littoral, in the area which is now known as Golestan Province. The highest incidence rates were reported from the semi-desert plain settled mainly by people of Turkmen ethnicity in Gonbad and Kalaleh counties. A series of studies was conducted in the region in the 1970s, but was not conclusive in explaining the very high rates.

Etiological hypotheses related to diet and lifestyle can be best addressed in prospective cohort studies, in which measurement error can be reduced and recall bias is minimal. From 2002 to 2003, a pilot study of 1,057 subjects was conducted by the Digestive Disease Research Center (DDRC), Tehran University of Medical Sciences, in collaboration with the Mount Sinai School of Medicine, National Cancer Institute (NCI), International Prevention Research Institute (IPRI), and International Agency for Research on Cancer (IARC), to evaluate the logistical aspects of establishing a prospective study in Golestan. Subsequently, the Golestan Cohort Study (GCS) was launched in January 2004. The study protocol and the informed consent used for this study were approved by the relevant ethical review committees. In June 2008, the accrual goal of 50,000 subjects was reached and enrollment was closed. Yearly follow-up is ongoing; a repeated exposure assessment is planned for ten percent of the cohort in 2010.

The primary aims of the GCS are to:

• Identify risk factors for esophageal cancer by a comprehensive assessment of ethnicity; occupational history; socioeconomic status; past medical history; family history of cancers; gastrointestinal symptoms and signs; tobacco, opium and alcohol use; oral health; anthropometric characteristics; physical activity; and tea drinking habits, including tea temperature.
• Establish biospecimen banks for blood, urine, hair, and nail samples to be used in molecular and genetic studies of cross-sectional or nested case-control design.
• Investigate prospectively risk factors of cancers other than esophageal cancer and other chronic diseases prevalent in this population.
• Provide a model for population-based studies in a country in economic and social transition based on collaboration between local health workers, local health authorities, national research centers, the national government, and international research institutions.