Abstract
Background/Aims With over 2.5 million breast cancer survivors in the U.S. today, identification of modifiable factors associated with recurrence and survival is imperative. The Pathways Study, a prospective study of breast cancer survivors in Kaiser Permanente Northern California (KPNC) is examining the effects of lifestyle (e.g., diet, physical activity, complementary and alternative medicine [CAM]), contextual (e.g., social and built environment characteristics), medical care, and genetic and molecular factors on breast cancer prognosis.
Methods Women who are newly-diagnosed with invasive breast cancer are identified daily from KPNC electronic pathology records. Eligibility criteria include being at least 21 years old at diagnosis, no previous history of invasive cancer, and English, Spanish, or Chinese-speaking. Women are enrolled during an in-person baseline interview with collection of blood and saliva specimens, and followed periodically for lifestyle updates, treatment, and outcomes via mailed questionnaires, telephone interviews, and web surveys. Outcomes are also confirmed using KPNC electronic databases.
Results As of October 23, 2012, 4,340 women have been enrolled. The cohort is racially and ethnically diverse: 62% White, 12% Hispanic, 12% Asian, 8% Black, 3% Other. Blood and saliva have been obtained on 89% and 95% of enrollees, respectively. Recruitment is planned to end in March 2013, and follow-up will continue through June 2015 and beyond pending further funding. A total of 230 recurrences and 245 deaths have been confirmed.
Conclusions To date, 14 papers have been published on topics ranging from CAM use at diagnosis, quality of life at diagnosis, lymphedema risk factors, physical activity during treatment, employment status and quality of life, adherence to adjuvant hormonal therapy, breast cancer DNA methylation profiles, and correlates of breast cancer subtypes. The Pathways Study has provided a platform for several ancillary studies, investigating lymphedema, racial disparities in treatment, the physiology of aging, and bone health, and also has provided support for several career development awards. The research team has also included Zero Breast Cancer, a nonprofit organization dedicated to breast cancer research through community participation. The Pathways Study has become a rich resource of behavioral, genetic and molecular factors and breast cancer outcomes.
