When a woman is diagnosed with breast cancer, she is often interested in pursuing actions that may improve prognosis and survival. Of concern are not only making appropriate treatment choices, but also whether there are steps that she can take – such as
changing one’s diet – that may be beneficial. Despite this, there are surprisingly few studies that have addressed whether lifestyle factors may influence outcomes after a cancer diagnosis. The Pathways Study, a prospective cohort study of women diagnosed
with breast cancer, was designed to address these gaps in knowledge, and ultimately to develop information to survivors, family members and caregivers, and health care providers.
The Pathways Study is based in the integrated health care system of Kaiser Permanente Northern California, which provides key benefits in the design and conduct of studies of cancer prognosis. Currently covering about four million members in the San Francisco
Bay Area and Central Valley of California, availability of clinical electronic databases that document most aspects of care provides more detail on treatment, toxicities, comorbid conditions, and other factors that may influence prognosis in people with cancer.
From 2006 to 2013, we enrolled 4,505 women soon after diagnosis with breast cancer, including approximately 360 African Americans, 560 Hispanics, and 560 Asians. We are following them actively through periodic surveys, and passively through linkage with electronic
health records and mortality databases. Data collection includes information on food intake, physical activity, dietary supplements, complementary and alternative therapies, and psychosocial factors. We have also linked addresses at diagnosis to examine
geospatial characteristics, including measures of neighborhood social and built environment characteristics. Resources also include blood samples collected on about 90 percent of the cohort, saliva on 95 percent, and a source of DNA on over 98 percent. Under
current cancer epidemiology cohort infrastructure funding, we are creating a biobank with tumor specimens and tissue microarrays, conducting genome-wide assays with a custom version of the Illumina Multi-Ethnic Global Array, and augmenting neighborhood variables
by carrying out neighborhood audits using Google Street View. With a dozen ancillary studies that have been funded, the Pathways Study is becoming an outstanding, multi-level resource for studies of breast cancer prognosis and outcomes.
Brief bio: Lawrence Kushi is Director of Scientific Policy, Division of Research, Kaiser Permanente Northern California. His research focuses on nutritional epidemiology and cancer prognosis. In addition to the Pathways Study, he is multiple
PI of a prospective cohort study of dietary factors in recurrence of bladder cancer based in Kaiser Permanente. He also leads the Cancer Research Network, an infrastructure grant that supports cancer research across a consortium of a dozen integrated health
care systems across the US. He has been the Principal Investigator on NIH grants with budgets totaling over $50 million. A graduate of Amherst College and the Harvard School of Public Health, he has held research and faculty positions at the Fred Hutchinson
Cancer Research Center, the University of Minnesota, and Columbia University.