Breast Cancer in MarinBreast Cancer in MarinBreast Cancer in MarinBreast Cancer in MarinThe Power of The Power of

Community EngagementCommunity Engagement

Marin Community ForumMarin Community ForumOctober 15, 2009October 15, 2009

Janice BarlowExecutive Director, Zero Breast Cancer

Once upon a time…Once upon a time…

Photo by Dennis Anderson

Community-Based, Participatory ResearchCommunity-Based, Participatory Research

Community-based participatory research is a “collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities.” WK Kellogg Foundation Community Health Scholars Program

The Adolescent Risk Factor Study and the DevelopmentThe Adolescent Risk Factor Study and the Development of Breast Cancer in Marin County of Breast Cancer in Marin County (1997-2002)(1997-2002)

The Adolescent Risk Factors Study and the Development of Breast Cancer in Marin County (ARFS) was a community-based, participatory research study funded by the California Breast Cancer Research Program (1997-2001).

It was a collaboration between Zero Breast Cancer, formerly Marin Breast Cancer Watch, and University of California, San Francisco. Researchers from the Northern California Cancer Center, Lawrence Berkeley National Laboratory and Kaiser also participated in the study.

The study was designed to understand if adolescent and pre-adolescent exposures and experiences differ between women with and without breast cancer living in Marin County.

Interviews were conducted with approximately 300 Marin County women diagnosed between July 1, 1998 and June 30, 1999 with breast cancer (cases), and 300 Marin County women without breast cancer (controls), matched for age and ethnicity.

Adolescent Risk Factors StudyAdolescent Risk Factors Study

• Physical development and changes • Adolescent stress, family and social connections • Detailed adolescent and contemporary socioeconomic factors • Passive and active smoking • Alcohol use• Residency and migration • Standard breast cancer risk factors

Factors used for comparison between cases and controls included:

Factors that were not found to be significantly different between controls and cases:

• Having a first degree relative with breast cancer (20 % of controls and 18 % of cases) • History of a non-cancerous breast biopsy • Current socioeconomic status • Age at first birth or pregnancy (mean of 25.1 for controls and 25.3 for cases) • Use of hormone replacement therapy • Height • Health insurance status • Frequency of pelvic exams and pap tests• Lifetime number of years lived in Marin was 24.2 years for both groups• The mean age first lived in Marin was 28.8 for controls and 29.6 for cases

Adolescent Risk Factors StudyAdolescent Risk Factors Study

Resulting DifferencesCases were more likely than controls to report:

• A high socioeconomic status before the age of 21 • Four or more mammograms in 1990-1994 • Giving birth without breastfeeding • Being premenopausal • Never having used birth control pills • Having a lower highest body mass index • Beginning drinking after age 21 • Drinking on average two or more drinks per day • Being raised in an organized religion

Adolescent Risk Factors StudyAdolescent Risk Factors Study

Results suggest that both groups are at a high risk for breast cancer. Specific findings, in combination with the results of other recent prospective studies, suggest that decreased alcohol consumption and increased breastfeeding after childbirth - modifiable risk factors in adults - might help to reduce breast cancer risk.

Adolescent Risk Factors StudyAdolescent Risk Factors Study

Spawned additional studies and peer reviewed publications using the ARF’s data:• Recent changes in breast cancer incidence and risk factor prevalence in San Francisco Bay

Area and California women: 1988-2004 (Clarke, et al)• Risk Factors for Estrogen Receptor Positive Breast Cancer (Hwang, et al)• Geographic Excess of Estrogen Receptor-Positive Breast Cancer: 2003 (Benz, et al)• Risk factors for breast cancer in a population with high incidence rates (Adolescent Risk

Factor Study): (Wrench, et al)• Breast Cancer and Psychological Factors: Early Stressful Life Events, Social Support and Well-

Being (Spiegel, et al)• Validation of OncoVue in a Population of Women in Marin County: 2009 (Dalessandri et al)

Laid the foundation for bringing in funding for and community participation in additional research: • Personal Environmental Risk Factor Pilot

• Marin Environmental Data Study

• The Marin Women’s Study

• Cancer Clustering for Residential Histories• Bay Area Breast Cancer and the Environment Research Center

• Pathways: Prospective Study on Breast Cancer Survivorship

Building Research and Community CapacityBuilding Research and Community Capacity

Targeted Dissemination of Research Targeted Dissemination of Research Adolescent Prevention Risk Reduction and Education Program

“I did learn the environment can have

a large effect on breast cancer” “It’s really important to convey

this information on risk factors so we can make better choices,

like how to take care of your body and how healthier choices

can benefit you”

Incidence Rates: Invasive Breast Cancer Marin County Incidence Rates: Invasive Breast Cancer Marin County Influence of revised estimates on previous observations from 1990’s

Newspaper Headlines in 2002Newspaper Headlines in 2002Marin’s Breast Cancer rate jumps 20%

Unseen killer stalks MarinThe new breast cancer hot zoneWhat’s killing the women of Marin County?Study: Is Marin County carcinogenic?

Cancer clusterIs there a link between the environment and breast cancer?

California’s breast cancer blightMarin’s breast cancer

mystery?

The Bay Area Breast CancerThe Bay Area Breast Cancer and the Environmental Research Center and the Environmental Research Center

Windows of SusceptibilityWindows of Susceptibility

Breast Development

In utero

PubertyPregnancy Menopause

Lactation

Community Outreach &

Translational Cores

Janice BarlowZero Breast Cancer

Bay Area Breast Cancer and the Environment Bay Area Breast Cancer and the Environment Research CenterResearch Center

Project Two“Environmental and

Genetic Determinants of Puberty”

Dr. Larry Kushi, PIKaiser Permenante DOR

Administrative CoreRobert Hiat, MD, Ph.D

Project One“Environmental Effects On The Molecular Architecture

And Function Of The Mammary Gland Across

The Life Span”

Dr. Zena Werb, IPUSSF School of Anatomy

Epidemiology Research QuestionsEpidemiology Research Questions

• Is the onset of puberty occurring in girls today earlier than it did in past generations?

• What environmental factors influence when puberty occurs?

• Do exposures to chemical compounds that influence female hormones affect the age at onset of puberty?

Community Outreach Translation CoreCommunity Outreach Translation Core

Incidence Rates: Invasive Breast Cancer Incidence Rates: Invasive Breast Cancer All Races/EthnicitiesAll Races/Ethnicities 2000-2007 2000-2007

Incidence Rates: Invasive Breast CancerIncidence Rates: Invasive Breast CancerBay Area Counties 2003-2007Bay Area Counties 2003-2007

All Races/EthnicitiesAll Races/Ethnicities

If you want to go quicklyIf you want to go quicklygo alone;go alone;

If you want to go farIf you want to go fargo together.go together.

- African Proverb- African Proverb