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Biostatistics and Epidemiology Unit

Biostatistics Unit

The Biostatistics and Epidemiology Unit primarily provides statistical and epidemiological support for clinical trials and other studies conducted at the National Cancer Centre Singapore. This is in the form of consultations, collaborations as well as teaching. We also initiate and engage in relevant areas of applied biostatistics and epidemiology research.

​Head:​A/Prof Daniel TAN

Principal Biostatistician:

Senior Biostatisticians:


Sze Huey TAN

Whee Sze ONG          
Cindy LIM

Siqin ZHOU

The conduct of good biomedical research requires the appropriate disease expertise and rigorous research methodology combined with strong quantitative analyses. The added value of statistical techniques to biomedical research is well recognised. In biomedical studies the correct design, analysis and interpretation of the study all require the development and application of good statistical methods. While many such techniques have already been developed, only a relatively small number of these are routinely used in practice. A key reason for this is that many of these methods have not made the transition from the ‘statistical lab’ to the clinic. However, these methods may potentially help improve all aspects of the biomedical research process, ultimately resulting in more accurate conclusions being drawn e.g. regarding the usefulness of new treatments. This has important ethical implications as patients consent to have their data used for biomedical research with the expectation that the information that they provide will be used in the most optimal way to provide benefits for future patients and potentially themselves as well. Research thus needs to be carried out to test and bring better biostatistical and clinical research methodologies into clinical practice.

Moreover, there are many problems in biomedical research for which better (albeit less well known) statistical methods could be employed, to allow for a better analysis and interpretation of the data. This can be achieved through the conduct of applied biostatistics research and teaching.
Some of the projects currently engaged include prognostic modeling, clinical trial methodology, applications of Bayesian statistics in medicine and applications of statistics in genetics. The Biostatistics Unit also provides expert biostatistics support for all clinical trials and related studies conducted at the National Cancer Centre Singapore.

Selected publications:

1. Chong ST, Tan KM, Kok CYL, Guan SP, Lai SH, Lim C, Hu J, Sturgis C, Eng C, Lam PYP, Ngeow J. IL13RA2 Is Differentially Regulated in Papillary Thyroid Carcinoma vs Follicular Thyroid Carcinoma. J Clin Endocrinol Metab. 2019;104(11):5573-5584.

2. Lee SH, Nguyen TK, Ong WS, Haaland B, Tay GC, Tan NC, Tan HK, Ng JCF, Iyer NG. Comparing the Utility and Surgical Outcomes of Harmonic Focus Ultrasonic Scalpel with Ligasure Small Jaw Bipolar Device in Thyroidectomies: A Prospective Randomized Controlled Trial. Ann Surg Oncol. 2019;26(13):4414-4422.

3. Lai GGY, Lim TH, Lim JHC, Liew PJR, Kwang XL, Nahar R, Aung ZW, Takano A, Lee YY, Lau DPX, Tan GS, Tan SH, Tan WL, Ang MK, Toh CK, Tan BS, Devanand A, Too CW, Gogna A, Ong BH, Koh TPT, Kanesvaran R, Ng QS, Jain A, Rajasekaran T, Yuan J, Lim TKH, Lim AST, Hillmer AM, Lim WT, Iyer NG, Tam WL, Zhai W , Tan EH, Tan DSW. Clonal cMET amplification as a determinant of tyrosine kinase inhibitor resistance in Epidermal Growth Factor Receptor mutant non-small cell lung cancer. J Clin Oncol. 2019; 37(11):876-884.

4. Tan WL, Ng QS, Lim C, Tan EH, Toh CK, Ang MK, Kanesvaran R, Jain A, Tan DSW, Lim DWT. Influence of afatinib dose on outcomes of advanced EGFR-mutant NSCLC patients with brain metastases. BMC Cancer. 2018; 18(1): 1198.

5. Wong TH, Lau ZY, Ong WS, Tan KB, Wong YJ, Farid M, Teo MCC, Yee ACP, Nguyen HV, Ong MEH, Iyer NG. Cancer patients as frequent attenders in emergency departments: A national cohort study. Cancer Med. 2018; 7(9):4434-4446.

6. Machin D, Campbell MJ, Tan SB, Tan SH. (2018). Sample Sizes for Clinical, Laboratory and Epidemiology Studies, 4th Edition. Wiley-Blackwell, Chichester.

7. Li YQ, Tian YM, Tan SH, Liu MZ, Kusumawidjaja G, Ong EHW, Zhao C, Tan TWK, Fong KW, Sommat K, Soong YL, Wee JTS, Han F, Chua MLK. Prognostic Model for Stratification of Radioresistant Nasopharynx Carcinoma to Curative Salvage Radiotherapy. J Clin Oncol. 2018;36(9):891-9.

8. Yap YS, Kwok L, Syn N, Chay WY, Chia JWK, Tham CK, Wong NS, Lo SK, Dent RA, Tan S, Mok ZY, Koh KX, Toh HC, Koo WH, Loh M, Ng RCH, Choo SP, Soong RCT. Predictors of Hand-Foot Syndrome and Pyridoxine for Prevention of Capecitabine–Induced Hand-Foot Syndrome: A Randomized Clinical Trial. JAMA Oncol. 2017;3(11):1538–1545.

Epidemiology Unit

The primary objective of the Epidemiology Unit is to conduct clinical translational research to investigate the risk factors for cancer and the patterns of disease in the wider population at large. This provides a platform for the development of studies to investigate possible interventions to increase survival and reduce the incidence of cancer or the stage at which the disease is diagnosed. As new technology becomes available, such as the ability to detect molecular biomarkers, better treatment outcomes for patients will also become available. The design and conduct of scientifically sound epidemiological studies is important in ensuring quality results for the future benefit of all patients. The conduct and provision of epidemiological research is able to provide direct clinical applications for patient care.

Almost all aspects of medical research require the use of statistical and epidemiological techniques at some point of the research process. Inefficient or erroneous methodology could have severe consequences on the interpretations of the research findings. This could eventually result in patients having less than optimal or worse still, inappropriate treatment.

The unit applies principles of evidence-based medicine when designing studies to ensure that the most feasible study has been conducted. A variety of studies are currently being investigated including studies in genetic epidemiology, screening and cancer risk factors. With collaborations both locally and internationally, the unit aims to investigate population risk factors for cancer.

Selected publications:

1. Yong SK, Ha TC, Yeo MC, Gaborieau V, McKay JD, Wee J. Associations of lifestyle and diet with the risk of nasopharyngeal carcinoma in Singapore: a case-control study. Chin J Cancer. 2017 Jan 7;36(1):3. doi: 10.1186/s40880-016-0174-3.

2. Ha TC, Yong SK, Yeoh KW, Kamberakis K, Yeo RM, Koh GC. The effect of test kit provision, and individual and family education on the uptake rates of fecal occult blood test in an Asian population: a randomized controlled trial. Cancer Causes Control. 2014 Nov;25(11):1473-88.

3. Li H, Ha TC, Tai BC XRCC1 Gene Polymorphisms and Breast Cancer Risk in Different Populations: A Meta-Analysis. The Breast (2009) 18(3):183-91.

4. Gao F, Ng GY, Cheung YB, Thumboo J, Pang G, Koo WH, Sethi VK, Wee J, Goh C The Singaporean English and Chinese versions of the EQ-5D achieve measurement equivalence in cancer patients. J. Clin. Epidemiol. (2009) 62(2):206-213.

5. Ha TC, Li H Meta-analysis of Clodronate and Breast Cancer Survival. British Journal of Cancer (2007) 96(12):1796-1801.