Uncovering Origins of Disparities in Breast Cancer Survival

Our long-term goal is to ensure that young and black women fully benefit from the many advances made in breast cancer treatment and to ultimately eliminate survival disparities. Designing effective interventions to reduce age and race-related disparities in breast cancer survival requires that we identify modifiable causes. Our overall objective of this project is to evaluate the role of pathologic complete response to neoadjuvant chemotherapy (pCR), age, and race in breast cancer survival and to investigate a potential mechanism for previously observed disparities in HR+ breast cancer, adherence and persistence with endocrine therapy.

The central hypothesis of our research is that black and young women experience worse outcomes from less aggressive tumor subtypes and this is partially due to lower adherence to, and persistence with, endocrine therapy. The rationale for the proposed research is that the knowledge gained can identify targets for intervention to eliminate disparities including interventions to improve adherence and persistence. 


Genetic and Lifestyle Predictors of Density

Women with dense tissue in 75% or more of the breast are four to six times more likely to develop breast cancer as those with little or no dense tissue.64 While breast density (BD) is a strong risk factor for breast cancer, racial/ethnic differences in BD, and its different measures, are unclear. Using data from the Boston Mammography Cohort Study (BMCS), a large, multiethnic cohort of women receiving mammograms at Brigham and Women’s Hospital, we will investigate the relationship between race/ethnicity and BD, and change in BD with age among black, Hispanic and white women.  

We will also Use a genetic risk score (GRS) to evaluate the relationship between single-nucleotide polymorphisms (SNPs) associated with breast density in studies of European ancestry populations, and BD in black and Hispanic women in BMCS. 



Breast Density Notification

On July 1, 2014 Massachusetts (MA) became the 18th state to pass legislation requiring patient notification about dense breast tissue and federal legislation is being considered. Several previous studies have demonstrated that women have trouble understanding mammography reports and abnormal mammography results, and little is known about the effect of adding breast density information to mammogram reports. Radiologists at Brigham and Women’s Hospital (BWH) report that a lack of understanding of medical terminology has led more than one woman to feel insulted, misunderstanding the term “dense” to mean “stupid”. The potential of misunderstanding coupled with potential effects on risk perception, future screening and distress needs further study. 

Using interviews among 20 women in the Boston Mammography Cohort Study (BMCS), a cohort of women receiving mammograms at the Lee Bell Center for Breast Imaging at BWH, we plan to examine the following aims: 1) Assess women’s beliefs and knowledge about breast density, comprehension of mammography reports, and their interactions with health professionals regarding breast density. 2)Evaluate the effect of breast density notification on breast cancer screening, perceived breast cancer risk, and worry. 


Body Size Across the Lifespan and Lung Cancer Risk

Several studies have shown inverse associations between obesity and lung cancer risk.  It remains unclear whether these associations are causal or whether they reflect residual confounding by smoking and/or reverse causation.  We will explore different measures of body size at different times in the lifecourse to further explore the relationship.   


Body Size and Cancer Risk

We have several projects which explore the role of body size at different points in life and risk of cancer (e.g. lung, lethal breast, kidney).

We are also exploring how childhood adversity impacts development of obesity in youth and adulthood, and how it affects obesity associated inflammatory biomarkers.


In the decades since cancer screening tests such as mammography and prostate specific antigen (PSA) were introduced, the number of breast and prostate cancer diagnoses have risen dramatically.  Some researchers argue that many of these screen-detected tumors would not cause advanced disease if left untreated.  It is well accepted in the prostate cancer community that PSA testing can lead to overdiagnosis, and a growing number of reports suggest that the same is true of mammography for breast cancer.  In the setting of these controversies, we examine how this has affected people's beliefs about cancer screening.  We also examine people's awareness of new screening tests like CT screening for lung cancer, as well as knowledge of new screening guidelines for diseases like cervical cancer.