Medical-based Geographical Information System (mGIS)
Diagnosis versus Healing
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Case Study: Breast Cancer
GIS
Health
Environment
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Study objectives
• To determine the association (if any) between selected spatial environmental factors and breast cancer rates in the US. • To investigate the possible (if any) cause(s) contributed by those factors. • To define new, modular prototype Geographic Information System
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Facts/Spatial-based patterns
• Estimated 211,300 new cases of invasive breast cancer expected to occur in US • All locations are not equal for breast cancer risk; geography plays a role • High mortality rates in the northeastern US, while in the far East (China & Japan) it is very much rare
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F e m a le B re a s t C a n c e r M o rta lity (1 9 9 4 -9 8 ) R a te b y S ta te
M o rtality R ate 0 - 20.9 20.9 - 22.9 22.9 - 23.9 23.9 - 25.1 25.1 - 27.2
N W
1000 0 1000 2000 M ile s
E S
Fig 1
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Methods & analysis
Regression analysis revealed that two environmental factors; mainly average temperature & mean elevation accounted for 48.6 % of the variance in the mortality rates (F=21.71; p=0.000)
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Stepwise regression analysis
All the relevant finding related to the explanatory power of the independent variables, in the goodness of fit of all possible models can be enhanced by looking at the best-fit models with the significant (at the 5% level, p 0.05) explanatory underlying variables, for each of the mortality/incidence pattern groups according to the spatial environmental factors
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Effect of average temperature on breast cancer
Melatonin rhythm
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Temperature vs Melatonin vs breast cancer
• Temperature cause a variety of physiological changes, e.g. of blood composition, blood pressure and circadian rhythms • Melatonin exert potent inhibition on cancer growth (anti-angiogenic molecule) • Temperature is a major regulator of melatonin rhythms
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Latitude vs Altitude vs Temperature
• The principle controls of temperature variation are latitude and altitude (elevation) • latitude for a given point on the earth has an effect on temperature, the farther from the Equator a point is the cooler average temperature that point is likely to have
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• The existence of negative relationship between latitude and mortality rates • Variation in latitude lead to variations in temperature and sunlight intensity and hence disturbance of melatonin rhythms • Positive relationships between mortality data and longitude as we move toward East: mortality rates are approx. 25% higher for women in the northeastern US than for women in the South or West.
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Jet Lag and Circadian Rhythm
• “Jet Lag” is caused from air travel through changing time zones. Usually going East is worse than going West • It caused due to disturbance of melatonin rhythms
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Hypothesis
The exposure to some spatial environmental factors seems likely to have a major impact on the overall trends in breast cancer rates. The possibility to develop cancer is existing naturally through the environment factors. Unbalanced in these nature factors and/or other existing risk factors, e.g. socioeconomic conditions will increase the chance for cancer development.
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Geographic Information System
• “Is a computer-based tool for mapping and analyzing things that exist and events that happen on earth. GIS technology integrates common database operations such as query and statistical analysis with the unique visualization and geographic analysis benefits offered by maps” ESRI • “Is an integrated system of computer hardware, software, and trained personnel linking topographic, demographic, utility, facility, image and other resource data that is 16 geographically referenced.” NASA
GIS vs Health
• As far as the time of Hippocrates (c. 3rd century BC), physician have observed that certain diseases seems to occur in some places and not others
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Geographical mapping of disease events date back to the first maps used by Dr. John Snow in 1859 to trace the origin of cholera outbreak in London, England
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Examples: GIS in Health
• 1970s, National Cancer Institute (NCI) mapped cancer data • The Long Island Breast Cancer Study Project • GIS-H (AverStar, Inc., of Vienna, Virginia) • Epi Map 2000 to public health (CDC, Centers of Disease Control & Prevention) • Late-Stage Breast Cancer Program (Baystate Medical Center in Springfield, Massachusetts) 20 • The WHO Health Mapper
Uses of GIS in public health
• Determining geographic distribution of diseases • Analyzing spatial and temporal trends • Mapping populations at risk • Stratifying risk factors • Assessing resource allocation • Planning and targeting interventions • Monitoring diseases and interventions over time
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Why not apply GIS technology for prevention and healing
The role of ecology
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Proposed mGIS for breast cancer
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Conclusion
• Spatial factors can induce changes in melatonin rhythms, which can lead to increase in breast cancer rates • Environmental temperatures can modulate cancer via changes induced in melatonin rhythms. • Map-based exploration of georeferenced health statistics will lead to a better understanding of health/environment interaction.
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1 Kulldorff M, Feuer EJ, Miller BA, Freedman LS. Breast cancer clusters in the northeast United States: a geographic analysis. Am J Epidemiol 1997; 146(2):161-70. 2 Laden F, Spiegelman D, Neas LM, Colditz GA, Hankinson SE, Byrne C, Rosner BA, Speizer FE, Hunter DJ. Geographic variation in breast cancer incidence rates in a cohort of US women. J Natl Cancer Instit 1997; 89(18):1373-8. 3 American Cancer Society. Breast cancer facts & figures 2003. Available: http://seer.cancer.gov. 4 Roche LM, Koltz J, Abe T, Koher BA. Breast cancer in New Jersey: 1979-1995. New Jersey Dept of Health and Senior Services. Available: http://www.state.nj.us/health.
Refrences
11 Kliukiene J, Tynes T, Andersen A. Risk of breast cancer among Norwegian women with visual impairment. British J Cancer 2001; 84(3): 397-9. 12 Coleman MP. Reiter RJ. Breast cancer, blindness and melatonin. Eur J Cancer 1992; 28(2-3): 501-3. 13 Reiter RJ, Richardson BA. Magnetic field effects on pineal indolemine metabolism and possible biological consequences. FASEB J 1992; 6: 2283-7. 14 Indira N, Granger M. Part I: Biological effects, concern focuses on cancer and endocrine and nervous system disorders. IEEE Spectrum 1990: 23-27. 15 Lissoni P, Rovelli F, Malugani F, Bucovec R, Conti A, Maestroni GJ. Anti-angiogenic activity of melatonin in advanced cancer patients. Neuroendocrinol Lett 2001; 22(1): 45-7.
23 Wang RJ. Lethal effect of daylight fluorescent light on human cells in tissue culture medium. Photochem Photobiol 1975; B(21): 373-5. 24 James SG, Jean LF, Jonathan DM, Daniel HF, Ann BN. Geographic variations in breast cancer survival among older women. J Gerontol Series A: Biol Sci Med Sci 2002; 57: M401M406. 25 Goodwin JS, Freeman JL, Freeman D, Nattinger AB. Geographic variations in breast cancer mortality: do higher rates imply elevated incidence or poorer survival?. Am J Public Health 1998; 88(3): 458-60. 26 Samel A, Wegmann HM. Bright light: a countermeasure for Jet Lag. Chronobiol Int 1997; 14: 173-83. 27 Delagrange P, Guardiola-Lemaitre B. Melatonin its receptors and relationships with biological rhythm disorders. Clin Neuropharm 1997; 20: 482-510.
Akram
Nanna
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