gms | German Medical Science

MAINZ//2011: 56. GMDS-Jahrestagung und 6. DGEpi-Jahrestagung

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V.
Deutsche Gesellschaft für Epidemiologie e. V.

26. - 29.09.2011 in Mainz

Experience from the Netherlands Cohort Study on cancer etiology and prognosis

Meeting Abstract

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  • Piet A. van den Brandt - Department of Epidemiology, Maastricht University Medical Center, Maastrich the Netherlands

Mainz//2011. 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi). Mainz, 26.-29.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gmds607

doi: 10.3205/11gmds607, urn:nbn:de:0183-11gmds6070

Published: September 20, 2011

© 2011 van den Brandt.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



The prospective Netherlands Cohort Study on diet and cancer (NLCS) was initiated in 1986. The study population originated from 204 municipal population registries throughout The Netherlands. At baseline (Sep 1986), a total of 58279 men and 62573 women between the ages of 55 and 69 years, completed an 11-page mailed, self-administered questionnaire on dietary habits and other risk factors for cancer, and were asked to collect toenail clippings. Information on dietary habits and other risk factors for cancer (e.g. smoking history, anthropometry, physical activity history, education, occupational history, reproductive history, medical history, and family history of cancer) was collected through the questionnaire. About 90,000 participants (75%) also provided toenail clippings at baseline. While these were originally used for measuring selenium status, we have later shown that these toenail clippings can also be used as a source of genomic DNA, with successful high-throughput genotyping. Cancer follow-up of the cohort consists of annual record linkage to the Netherlands Cancer Registry and the pathology network PALGA, a registry of histo- and cytopathology. Because the municipalities included in the NLCS were chosen on the basis of sufficient coverage by NCR/PALGA, these registries together provide a near 100% coverage. Record linkage is now underway for 20.3 years of follow-up. For efficiency reasons, a nested case-cohort approach is used: the cases are enumerated for the entire cohort, while the person years at risk are estimated from a random sample (subcohort) of 5,000 subjects sampled at baseline. This subcohort has been actively followed up for vital status since baseline. The NLCS also has access to the automated municipal population registries (GBA) for follow-up of vital status and current address of NLCS participants (follow-up >99%). For deceased subjects, the cause of death is obtained from Statistics Netherlands. Using this approach, a series of tumor-specific analyses have been conducted in subprojects. The Netherlands has the unique nationwide pathology database PALGA to which the NLCS can link to get access to pathology laboratories and tissue archives. Through collaboration with PALGA it is possible to get access to all pathology laboratories in the country and collect tumor blocks from study participants on a large scale in a standardized fashion. Together with the Dept. of Pathology of Maastricht UMC, we successfully applied the collection and molecular analysis of tumor material of colorectal and kidney cancer in the NLCS. We collected tumor blocks from 54 Dutch pathology labs using the PALGA system with yields of 80-95%. After DNA-isolation and molecular analyses, this has been used in etiological and prognostic studies with molecularly defined cancers, and various molecular markers of interest have emerged.