1. THE MARIN WOMEN’S STUDY

2. Why was it initiated? Why was it initiated? What is happening now? What is happening now? What will the future bring? What will the future bring?

3. Why Was it Initiated?

4. Breast Cancer Incidence Trends in Marin County* (2001-02) * White non-Hispanic women, invasive cancers only

6. The Breast Cancer Incidence Rates Comparison – 2004-05 Mortality Phipps A, Clark C, Ereman R; Breast Cancer Research, June 7, 2005 Marin SFBA CA US Rates in the1990’sRe-calculated based on new Census

7. MANY Questions WHY Marin’s Breast Cancer Rates High 2001-2005

8. Why Marin? More women screening? Lifestyle Differences? More Toxins? NO, slightly higher screening rates, expect 1-2 more cases a year YES, More women in Marin: drink alcohol daily, have fewer children, later in life, higher income/education. All would act to increase Marin’s rates. Data lacking on exposures BUT – Marin women are thinner, exercise more and report eating healthier… These would act to decrease Marin’s rates

9. Left with the question  Do the women in Marin who get breast cancer have more of the risk factors that are more prevalent here?  We needed risk factor information from women getting cancer, so we could answer this crucial question.

10. 2004 - What Next?  Research suggests that lifestyle risk factors play a role in Marin  We need to gather individual risk factors and breast health information from each Marin woman  The County/Community IS where research needs to be – Community is determined and cares deeply  All women do not respond to risk factors in the same way, We need to to look at gene-environment interactions  Can we pave a way for investigating environmental toxins. THE MARIN WOMEN’S STUDY WAS BORN

11. HISTORY  Funded by the CDC in July 2005  Multiple stakeholder planning meetings during 2005-2006  Data Collection Launched November 2006  First Research Results January 2008

12. Marin Women’s Study GOALS   Investigate how reproductive, lifestyle, demographic and biologic factors affect breast cancer risk in Marin Alcohol, Hormone Therapy, Reproductive Factors, Socio-economic Status, Stress, Environmental Exposures.Alcohol, Hormone Therapy, Reproductive Factors, Socio-economic Status, Stress, Environmental Exposures.  Understand why breast cancer risk factors do not affect all women in the same way.

13. MWS COMPONENTS Breast Cancer Breast Density

14. Who is Involved?

15. COLLABORATION

16. SCIENTIFIC ADVISORY TEAM  MARIN COUNTY DHHS  BUCK INSTITUTE  KAISER MEDICAL GROUP  MARIN GENERAL HOSPITAL  UCSF  ZERO BREAST CANCER

17. COMMUNITY INVOLVEMENT GROUP  Marin General Hospital  Meals of Marin  Marin Family Action  Marin Friends of Women  Kaiser Permanente  Marin Center for Independent Living  Zero Breast Cancer 15 Individuals & Community Groups  Marin Breast Cancer Council  Breast Cancer Resource Center  American Cancer Society  Tina Action Programs  Fair Housing of Marin

18. …MANY VOLUNTEERS!! AND

19. What Is Happening Now?

20. STUDY SUCCESSES – Oct. 2009 QUESTIONNAIRE  Almost 14,000 Questionnaires received! BIOSPECIMEN  Saliva Collection 6,000 Samples!  AVON funding received July 2007, Sept 2009 CAMPAIGN  Campaign – Banners, Movie Theatres, Grocers…  80% of women surveyed knows about MWS

21. Hormone Therapy Study In Review

22. Hormone Therapy Use, 2001 Women, ages 50+  Marin: 40.7%, California: 39.3% - used any type of prescription hormone therapy.  % of women >50 yrs. with a Hysterectomy: Marin 29.4% Marin 29.4% California- 38.1% California- 38.1% Kings County – 53.7% Kings County – 53.7% E + P

23. Women 50+ in that year, all ethnicities HERS WHI HORMONE THERAPY USE BY YEAR Estrogen Only and Estrogen plus Progestin ESTROGEN ONLY Estrogen/Progestin 6%

24. Alternative Hormone Use n=1,748#% Use (2006-07) 152 8.7% 8.7% Soy Products Soy Products45 2.6% 2.6% Black Cohosh Black Cohosh39 2.2% 2.2% Combination Herbal Combination Herbal20 1.1% 1.1% Phytoestrogens Phytoestrogens11 0.6% 0.6% Other Other43 1.5% 1.5% Current E+P Use 6%

25. QUITTING BEHAVIOR Why Quit: (E+P) users who quit in past… 5 yrs>10 yrs ago Side Effects 11.5% 32.3% Dr. Recommended31.9 25.8 Health Effects38.1 19.4 News Reports46.9 12.9 Switched types6.2 6.5 Health or News Reports59.3 25.8 Multiple reasons allowed

26. Number of Breast Cancer Cases In each two year period 1998-992001-022003-042005-06 Total Cases 424434351373 61-83 fewer cases Women’s Health Initiative Results Published NOTE: Mammography Screening did not decrease during this time

27. What’s Next?

28. MWS Next Steps  Complete cleaning and scanning data into database.  Complete analysis of first saliva study  Embark on second ‘spit study’!  Conduct analyses on key research questions.  Track Hormone Therapy use - ‘re-starting’, replacement regimens, - Are emerging CAMS safe?

29. Selected Risk Factors in Women 50-80 in DRAFT Marin n=5438 DRAFT CASESNon-CasesSignificance Age at first birth 27.427.5 No Difference Menarche12.712.7 Number of Children 1.71.6SIG Months Breastfed 8.49.0 No Difference Former Smoker 56.1%45.9%SIG Ashkenazi Jewish Heritage 13.6%11.1% No Difference HRT Combination Therapy (current use) No Obs for age group Alcohol in High School 29.4%25.1% No Difference

30. Cancer Root Flower  Growth similar to cancer in humans  To remind us that the cure is in the earth.

31. CONTACT INFO  Web Site: www.mwstudy.org marinwomensstudy.org marinwomensstudy.org  Contact Epidemiology Program for materials or information: 507-4077  Rochelle Ereman, Study Director 499-3056  Kathy Koblick, Outreach and Campaign 507-2578  Mark Powell, MD, MPH, Biospecimen 499-6969

33. Percentage of Women with Hysterectomies, selected CA counties  San Francisco, Santa Cruz and Marin – counties with lowest hysterectomy rates. (24.5-30.6%)  Kings, Madera and Kern counties – highest hysterectomy rates (55-62%)  Average 41.5% CA 31% 62% NOT MORE WOMEN ON HRT: Current use of HRT 35% in 2001 CA, Marin