Using the BCSC Research Infrastructure as a Junior Investigator BCSC Meeting: Celebrating 15 Years of Accomplishment Bethesda, MD April 27, 2010 E. Shelley Hwang MD, MPH Chief, Division of Breast Surgery UCSF Helen Diller Family Comprehensive Cancer Center

Personal Background  Training: Surgical oncology Joined UCSF faculty at UCSF after completing fellowship Little prior background in epidemiology/research methods  Research interest: DCIS and preinvasive breast cancer Obtained training grant 2004 Interested in working with large datasets as part of master’s thesis for MPH

BCSC and me  Advantages to a junior investigator Limited funding Large existing datasets Research mentorship Statistical support High likelihood of a completing a successful product  Junior researcher responsibilities: Define research question Identify time, resources Bring energy, enthusiasm, focus to project

BCSC and me  Introduction to BCSC Research infrastructure: UCSF Women’s Health Research Center (PI: Grady) BCSC primary mentor (Kerlikowske): Identify opportunities; bring together junior researchers and data Navigate process of data request, analysis, interpretation BCSC senior staff (Miglioretti, Ballard-Barbash): Guide the analysis and presentation of data Facilitate access to data dictionary, dataset Establish team of BCSC researchers with like interests Create opportunities to present research

BCSC AB71: Association Between Breast Density and Recurrence Following Treatment for DCIS  Breast density strongly correlated with breast cancer risk (RR 4-6)  Heritable component (twin studies): 60%  Responsive to changes in exogenous and endogenous hormones  HRT  Luteal phase of menstrual cycle  Menopause  Lifestyle/modifiable component:  Late age at first birth  Nulliparity  HRT  Is increased breast density associated with a higher risk of invasive recurrence in women following lumpectomy for DCIS?

Study Design 4431 women undergoing screening mammography at a BCSC site diagnosed with DCIS, women excluded for diagnosis of ipsilateral invasive cancer within 60 days of DCIS 899 women excluded for mastectomy

Effect of radiation: Association of breast density and risk of subsequent breast events* *all HR adjusted for age

Conclusions  Women with higher breast density are not more likely to develop invasive cancer in the ipsilateral breast following treatment for DCIS  High breast density is associated with a 3-fold higher risk of contralateral invasive cancer compared to women with low density  Women undergoing treatment for DCIS with increased breast density may benefit most from strategies aimed towards contralateral risk reduction

I had such a great experience that I’m working with the BCSC again!  AB81: The Association of Breast Density and Contralateral Breast Events in Women Undergoing Lumpectomy and Radiation  --Do women undergoing radiation as part of treatment for index cancer have increased risk of CBC compared to women who did not receive radiation?  --Are young age or breast density associated with this risk?

AB81: The Association of Breast Density and Contralateral Breast Events in Women Undergoing Lumpectomy and Radiation Ipsilateral Events Contralateral Events *Adjusted for age, race, menopausal status, HT use

BCSC Publications

Recent High Impact BCSC publications by Junior Investigators (success is not the exception!)  Are there racial/ethnic disparities among women younger than 40 undergoing mammography? Kapp JM, Walker R, Haneuse S, Buist DS, Yankaskas BC. Breast Cancer Res Treat Mar 4. [Epub ahead of print] Are there racial/ethnic disparities among women younger than 40 undergoing mammography?  Rates of atypical ductal hyperplasia have declined with less use of postmenopausal hormone treatment: findings from the Breast Cancer Surveillance Consortium. Menes TS, Kerlikowske K, Jaffer S, Seger D, Miglioretti DL. Cancer Epidemiol Biomarkers Prev Nov;18(11): Rates of atypical ductal hyperplasia have declined with less use of postmenopausal hormone treatment: findings from the Breast Cancer Surveillance Consortium.  Using clinical factors and mammographic breast density to estimate breast cancer risk: development and validation of a new predictive model. Tice JA, Cummings SR, Smith- Bindman R, Ichikawa L, Barlow WE, Kerlikowske K. Ann Intern Med Mar 4;148(5): Using clinical factors and mammographic breast density to estimate breast cancer risk: development and validation of a new predictive model.  Influence of computer-aided detection on performance of screening mammography. Fenton JJ, Taplin SH, Carney PA, Abraham L, Sickles EA, D'Orsi C, Berns EA, Cutter G, Hendrick RE, Barlow WE, Elmore JG. N Engl J Med Apr 5;356(14): Influence of computer-aided detection on performance of screening mammography.

Working with the BCSC  Outstanding resource for investigators, particularly junior researchers  Access to BCSC mentoring, large datasets, analytical support (Statistical Coordinating Center); ease of application process for data requests  Important to have clear research question, clear definitions and parameters for variables (years of diagnosis, definition of “recurrence”)  Potential resource to gather preliminary data for grant submissions Specific Data Requests Risk Estimation Data Set Cancer Incidence Data

Summary  BCSC has made key contributions in breast screening and breast cancer outcomes research; this is expected to continue well into the future as new questions emerge cost-effectiveness resource allocation quality metrics  Excellent ROI as many projects attain funding apart from BCSC; BCSC essential to providing the resources and data to secure such funding  The resource and infrastructure have made important contributions to academic training and career advancement; this resource is vital in institutions with strong BCSC mentorship  Need to continue outreach efforts to non-BCSC investigators

Acknowledgements  Karla Kerlikowske  Diana Miglioretti  Rachel Ballard-Barbash  Donald Weaver  Ed Sickles  Steve Taplin  Staff and Researchers of the Statistical Coordinating Center  Sebastian Haneuse  Ina Gylys-Colwell  Patients who continue to contribute their valuable time and data to support the BCSC

Thank you!