Prevention and Research Center

Dunkirk Town Center, MD, United States

Prevention and Research Center

Dunkirk Town Center, MD, United States
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Helzlsouer K.,Prevention and Research Center
American Journal of Public Health | Year: 2010

Objectives. We sought to determine whether social class modifies the effect of BMI on breast cancer incidence. Methods. Participants included 5642 postmenopausal White women recruited in 1989 to CLUE II, a prospective cohort study in Washington County, Maryland. We obtained exposure data from CLUE Il and the 1990 US Census. We used survival and random-effects Cox proportional hazards analyses to determine the association of social class and BMI with breast cancer incidence. Results. Education was independently associated with increased risk of breast cancer incidence (hazard ratio [HR] = 1.06; 95% confidence interval [Cl] = 1.01, 1.11; P<.05); contextual measures of social class were not. Education modified the effect of BMI at age 21 years (HR=0.98; 95% Cl=0.97, 0.99}; area-level social class modified the effect of BMI at baseline (HR =0.97; 95% Cl=0.94, 0.99) and BMI change (HR=0.98; 95% Cl=0.95, 1.00). Subpopulation analyses that were adjusted for hormone use, parity, and breast-feeding found similar effects. Conclusions. Social class moderates the influence of body size on breast cancer incidence. Public health efforts, therefore, should advocate for policies that improve social conditions to decrease the burden of breast cancer.


Gallicchio L.,Prevention and Research Center | Gallicchio L.,University of Maryland, Baltimore | Calhoun C.,Prevention and Research Center | Helzlsouer K.J.,Prevention and Research Center
Supportive Care in Cancer | Year: 2014

Purpose: The goal of this study was to examine differences in physical functioning limitations among African-American and white breast cancer survivors. Methods: Data were analyzed from 115 African-American and 712 white breast cancer survivors who responded to a hospital registry-based survey. Physical functioning limitations were assessed using a series of eight questions in which individuals were asked about their ability to perform a physical task such as walking a quarter of a mile. A four-category summary score, representing overall severity of limitation, was created using participant responses to the eight questions. Ordinal logistic regression was used to estimate the odds ratio (OR) and 95 % confidence interval (CI) for the association between race and physical functioning limitation adjusted for potential confounders. Results: In the unadjusted model, the African-American breast cancer survivors were more than twice as likely to have a greater degree of physical functioning limitation compared to their white counterparts (OR 2.31; 95 % CI 1.59, 3.38). After adjustment for covariates, including body mass index (BMI), the race OR was attenuated and no longer statistically significant (OR 1.44; 95 % CI 0.92, 2.27). Conclusions: Findings from this study showed that African-American breast cancer survivors were more likely to have worse physical functioning limitations than their white counterparts; however, much of this disparity was due to racial differences in other variables such as BMI. Future research should focus on effective interventions targeting modifiable risk factors of physical functioning limitations among breast cancer survivors with the goal of improving quality of life. © 2013 Springer-Verlag.


Gallicchio L.,Prevention and Research Center | Gallicchio L.,University of Maryland, Baltimore | MacDonald R.,Prevention and Research Center | Helzlsouer K.J.,Prevention and Research Center
Journal of Cancer Research and Clinical Oncology | Year: 2013

Purpose: Musculoskeletal pain is a common side effect of aromatase inhibitors (AIs), the adjuvant hormonal treatment of choice for postmenopausal estrogen-receptor-positive breast cancer. Although the pain is usually attributed to the estrogen depletion associated with AIs, not all women on AIs experience these symptoms. Thus, the goal of this study was to examine whether changes in the insulin-like growth factor (IGF) axis were associated with pain among women initiating AI therapy or a comparison group of women without a history of cancer. Methods: Data were analyzed from a cohort study of 52 breast cancer patients for whom AI therapy was planned and 88 women without a history of cancer. Questionnaire data on pain symptoms were collected, and blood was drawn at baseline (prior to AI therapy for patients) and 6 months after baseline. The blood samples were assayed for IGF-1 and IGF-binding protein-3 (IGFBP-3). Results: While results showed no statistically significant changes in any of the measures across time for either the breast cancer or the comparison group, increases in both IGF-1 concentrations and the IGF-1/IGFBP-3 ratio over the first 6 months of AI treatment were significantly associated with the onset or increase in musculoskeletal pain among the breast cancer patients. Associations between IGF-1, IGFBP-3, and the IGF-1/IGFBP-3 ratio and pain were not observed in the comparison group. Conclusions: Although preliminary, findings from this study implicate the IGF axis in the development of AI-associated musculoskeletal pain and represent a first step in developing effective interventions to alleviate this side effect. © 2013 Springer-Verlag Berlin Heidelberg.


Braid S.,University of Maryland, Baltimore | Harvey E.M.,Johns Hopkins University | Bernstein J.,Prevention and Research Center | Matoba N.,Northwestern University
Journal of Pediatric Gastroenterology and Nutrition | Year: 2015

Objectives: The aim of the present study was to determine the odds of early introduction of solid foods in a nationally representative sample of preterm infants when compared with term infants and to examine whether factors associated with early introduction are the same for preterm and term infants. Methods: Our sample of 7650 came from the first wave of the Early Childhood Longitudinal Study, Birth Cohort (2001-2002). We performed multivariable logistic regression to determine whether preterm infants were introduced to solid foods more frequently before 4 months than term infants using adjusted age for preterm infants and chronological age for term infants. In a separate analysis in preterm infants, we used multivariable logistic regression to determine whether the factors associated with early introduction in term infants were the same in the preterm sample. Results: Infants born 22 to 32 weeks' gestation had a 9.90 (95% confidence interval 5.54-18.0) odds of being fed solid food before 4 months compared with term infants, and infants born 33 to 36 weeks' gestation had a 6.19 (95% confidence interval 4.58-8.36) odds. Race/ethnicity and maternal smoking were the only factors that predicted early solid feeding in both preterm and term infants; the remaining predictors differed. Conclusions: Preterm infants are significantly more likely to be introduced to complementary foods early compared with term infants. The predictors of early solid feeding differ for preterm infants. Given the health implications, specific guidelines for preterm infants should be developed and future research should examine predictors of early introduction in preterm infants. Copyright © 2015 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.


Yeh H.-C.,Johns Hopkins University | Platz E.A.,Johns Hopkins University | Wang N.-Y.,Johns Hopkins University | Visvanathan K.,Johns Hopkins University | And 3 more authors.
Diabetes Care | Year: 2012

OBJECTIVE - To quantify the association of treated diabetes with cancer incidence and cancer mortality as well as cancer case fatality and all-cause mortality in adults who subsequently develop cancer and to calculate attributable fractions due to diabetes on various cancer outcomes. RESEARCH DESIGN AND METHODS - Prospective data on 599 diabetic and 17,681 nondiabetic adults from the CLUE II (Give Us a Clue to Cancer and Heart Disease) cohort in Washington County, Maryland, were analyzed. Diabetes was defined by self-reported use of diabetes medications at baseline. Cancer incidence was ascertained using county and state cancer registries. Mortality data were obtained from death certificates. RESULTS - From 1989 to 2006, 116 diabetic and 2,365 nondiabetic adults developed cancer, corresponding to age-adjusted incidence of 13.25 and 10.58 per 1,000 person-years, respectively. Adjusting for age, sex, education, BMI, smoking, hypertension treatment, and high cholesterol treatment using Cox proportional hazards regression, diabetes was associated with a higher risk of incident cancer (hazard ratio 1.22 [95% CI 0.98-1.53]) and cancer mortality (1.36 [1.02-1.81]). In individuals who developed cancer, adults with diabetes had a higher risk of cancer case fatality (1.34 [1.002-1.79]) and all-cause mortality (1.61 [1.29-2.01]). For colorectal, breast, and prostate cancers, the attributable fractions resulting fromdiabeteswere larger for cancer fatality and mortality than cancer incidence. CONCLUSIONS - In this prospective cohort, diabetes appears to exert a greater influence downstream on the risk of mortality in people with cancer than on upstream risk of incident cancer. © 2012 by the American Diabetes Association.


Gallicchio L.,Prevention and Research Center | MacDonald R.,Prevention and Research Center | Wood B.,Prevention and Research Center | Rushovich E.,Center for Endocrinology | Helzlsouer K.J.,Prevention and Research Center
Climacteric | Year: 2012

Objectives: To examine self-reported menopausal-type symptoms among breast cancer patients on aromatase inhibitors (AIs) compared to women of the same age who had not been diagnosed with cancer, and to determine whether the percentage of breast cancer patients experiencing these symptoms changed over the first 6 months of AI treatment. Methods: Data from a 6-month cohort study of 100 breast cancer patients initiating AI therapy and of 200 women of a similar age without a history of cancer were analyzed. At baseline (prior to the initiation of AI therapy among the breast cancer patients), 3 months, and 6 months, a comprehensive questionnaire was administered to participants that ascertained data on the experiencing of specific menopausal-type symptoms. Results: The data showed statistically significant increases in the prevalence of certain symptoms from baseline to either follow-up point among the breast cancer patients; these symptoms included hot flushes, night sweats, pain during intercourse, hair loss, forgetfulness, depression, difficulty falling asleep, and interrupted sleep. Additionally, breast cancer patients were more likely than the women in the comparison group to report the new onset of many of these same symptoms during the follow-up time period. Conclusions: Because bothersome symptoms and side-effects are a major reason for discontinuation and non-adherence to treatment, symptoms should be monitored and addressed by oncologists so that the breast cancer patient can maintain her quality of life and remain adherent to the treatment schedule. © 2012 International Menopause Society.


Smith R.L.,Urbana University | Flaws J.A.,Urbana University | Gallicchio L.,Prevention and Research Center
Maturitas | Year: 2015

Epidemiological studies have shown that cigarette smoking is associated with an increased risk of midlife hot flashes; however, the effect of quitting smoking on this risk is unclear. The purpose of this study was to examine the effect of quitting smoking on hot flashes using data from 761 women aged 45 to 54 years of age at baseline followed for 1 to 7 years. Results showed that women who quit smoking were less likely to suffer from hot flashes, less likely to have severe hot flashes, and less likely to have frequent hot flashes than women who continued to smoke (OR = 0.55, 0.80, 0.76), but were more likely to suffer from any hot flashes, more severe hot flashes, and more frequent hot flashes than women who never smoked (OR = 2.55, 1.68, 1.46). Subset analysis of the 353 women who had ever smoked found that women who had quit smoking for longer than 5 years had significantly lower odds, severity, and frequency of hot flashes than women who had continued smoking (OR = 0.36, 0.62, 0.63) or women who had quit in the previous 5 years (OR = 0.66, 0.77, 0.69). These findings suggest that that early smoking cessation programs may improve women's well-being during the menopausal transition. © 2015 Elsevier Ireland Ltd.


Helzlsouer K.J.,Prevention and Research Center | Gallicchio L.,Prevention and Research Center | MacDonald R.,Prevention and Research Center | Wood B.,Prevention and Research Center | Rushovich E.,Center for Endocrinology
Breast Cancer Research and Treatment | Year: 2012

This study compared type, severity and location of musculoskeletal symptoms and associations with 25-hydroxyvitamin D (25(OH)D) and C-reactive protein (CRP) concentrations between women initiating aromatase inhibitor (AI) therapy and an unexposed comparison group. A 6-month prospective cohort study was conducted, enrolling 100 breast cancer patients prior to initiating AI treatment and an unexposed comparison group of 200 postmenopausal women. Multivariate associations were assessed with generalized linear models. At baseline, 55% of breast cancer patients and 63% of the comparison group reported any musculoskeletal symptoms. Among the unexposed group, prevalence and severity of symptoms remained constant with no statistically significant change over 6 months. Among breast cancer patients, but not unexposed women, the pain severity score significantly increased over the 6 month period for joint (P trend < 0.001), muscle (P trend = 0.004), and bone pain (P trend = 0.01). Women treated with AIs were more likely to report pain in wrists/palms (63% at 6 months) compared to unexposed women (31% at 6 months) (P < 0.001). 25(OH)D concentrations increased over the study period among breast cancer patients (P trend = 0.004). An increase in pain severity and prevalence was observed among breast cancer patients despite an increase in 25 (OH)D concentration. CRP concentrations were not associated with symptoms. Musculoskeletal symptoms are common among postmenopausal women. Breast cancer patients initiating AI treatment were at increased risk for developing new onset and more severe joint, muscle and bone pain compared to unexposed women, with a distinct distribution. AI-associated symptoms were not associated with 25(OH)D or CRP concentrations. © 2011 Springer Science+Business Media, LLC.


Gallicchio L.,Prevention and Research Center | MacDonald R.,Prevention and Research Center | Wood B.,Prevention and Research Center | Rushovich E.,Center for Endocrinology | Helzlsouer K.J.,Prevention and Research Center
Breast Cancer Research and Treatment | Year: 2011

Aromatase inhibitors (AIs), the adjuvant hormonal treatment of choice for postmenopausal estrogen receptor-positive breast cancer, are associated with an increased risk of musculoskeletal symptoms. The underlying cause of the symptoms is often attributed to estrogen depletion, yet all women treated with AIs have low estrogen levels and only a subset develop symptoms. Concentrations of circulating androgens may be mediating factors contributing to these side effects. The purpose of this study was to examine changes in androgen concentrations among women initiating AI therapy and to determine if concentrations are associated with musculoskeletal symptoms. Data were analyzed from a cohort study of 74 breast cancer patients for whom AI therapy was planned. Questionnaire data on symptoms were collected and blood was drawn prior to AI therapy (baseline) and then again at 3 and 6 months after baseline. Blood was assayed for testosterone, androstenedione, dehydroepiandrosterone-sulfate (DHEAS), and sex hormone-binding globulin (SHBG). Free testosterone index (FTI) values were calculated using testosterone and SHBG measurements. The results showed that concentrations of all of the androgens increased over the study period, with statistically significant differences from baseline concentrations observed for the FTI at 3 and 6 months and for DHEAS at 6 months. Additionally, breast cancer patients with new onset or worsening of pain over the study period had a significantly smaller change in mean DHEAS concentration from baseline to 3 months (P = 0.04) and a marginally significant smaller change in mean DHEAS concentration from baseline to 6 months (P = 0.1) compared to those who reported no pain at all time points or no worsening of pain across the study period. Changes in testosterone, androstenedione, and the FTI were not associated with the onset or worsening of pain during the study period. Findings from this study suggest that higher DHEAS concentrations are associated with less AI-associated pain and should be further investigated. © Springer Science+Business Media, LLC. 2011.


Helzlsouer K.J.,Prevention and Research Center
American Journal of Epidemiology | Year: 2010

The Cohort Consortium Vitamin D Pooling Project of Rarer Cancers (VDPP) brought together 10 cohorts to conduct a prospective study of the association between vitamin D status, measured as serum concentrations of 25-hydroxyvitamin D (25(OH)D), and the development of 7 rarer cancer sites: endometrial, esophageal, gastric, kidney, non-Hodgkin lymphoma, ovarian, and pancreatic cancers. The cohorts come from 3 continents, with participants from a wide range of latitude who are racially diverse. Across each cancer site, there was no evidence of a protective association between higher concentrations of 25-hydroxyvitamin D (>75 nmol/L) and cancer outcome. An increased risk at very high levels (≥100 nmol/L) was noted for pancreatic cancer, confirming previous reports. The articles included in this issue detail the overall design and governance of the project, correlates of vitamin D status, and results from the cancer site-specific investigations. The Vitamin D Pooling Project realizes a major goal of consortium efforts, namely, to rigorously test hypotheses for rarer cancer outcomes that may not be adequately addressed in any one prospective cohort study. The results of this study have application for the planning and conduct of intervention trials, especially in determining potential risks. © The Author 2010.

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