>>WELCOME.
THANK YOU FOR JOINING US TODAY
AT THE NIH RESEARCH FESTIVAL.
MY NAME IS DARYL ZELDON.
THE NIEHS SCIENTIFIC DIRECTOR.
ON BEHALF OF THE WOMEN SCIENTIST
ASSEMBLY REPRESENTATIVES,
DR. FENTON AND WILLIAMS I'M
PLEASED TO INTRODUCE THE NIH
DIRECTOR'S WEDNESDAY AFTERNOON
LECTURE HONORING J BURROWS.
THIS LECTURE WAS ESTABLISHED IN
1968 IN HONOR OF THE FIRST NIH
DIRECTOR OF LABORATORIES AND
CLINICS.
AND PRESENTED BY AN NIH
INTRAMURAL SCIENTIST IN
RECOGNITION AND OF OUTSTANDING
CONTRIBUTION TO BIOMEDICAL
RESEARCH.
DR. SANDLER HEADS THE CHRONIC
DISEASE EPIDEMIOLOGY GROUP AND
CHIEF OF OUR EPIDEMIOLOGY BRANCH
SINCE 2003.
THAT THE TIME SHE WAS ONLY THE
SECOND WOMAN TO LEAD A
LABORATORY OR BRANCH AT NIEHS.
SHE'S AN ALSO ADJUNCT PROFESSOR
AT THE UNIVERSITY OF NORTH
CAROLINA, CHAPEL HILL AND HELD
POSITIONS AT THE TWO
EPIDEMIOLOGY JOURNALS.
SHE'S PAST PRESIDENT OF THE
AMERICAN COLLEGE OF
EPIDEMIOLOGY.
DR. SANDLER JOINED NIEHS AFTER
RECEIVING HER MASTER'S IN PUBLIC
HEALTH FROM YALE.
DR. SANDLER LEADS THREE
IMPACTFUL PROSPECTIVE COHORT
STUDIES DESIGN TO EXAMINE THE
IMPACT OF ENVIRONMENTAL
EXPOSURES ON HUMAN HEALTH.
ONE STUDY IS THE AGRICULTURAL
HEALTH STUDY DEVELOPED IN 1993
IN COLLABORATION WITH THE
INVESTIGATORS AT NCI EVALUATED
HOW AGRICULTURAL CHEMICALS AND
LIFESTYLE AND GENETIC FACTORS
AFFECT THE LIFE OF FARMING
POPULATION AND LEADS THE EFFORT
TO STUDY NON-CANCER END POINTS
IN THE STUDY.
HER WORK IS DEMONSTRATED
ASSOCIATIONS BETWEEN PESTICIDE
USE AND A RANGE OF CONDITIONS
INCLUDING THINGS LIKE DIABETES,
PARKINSON'S DISEASE, AUTOIMMUNE
DISEASE AND SHINGLES.
THE SISTER STUDY, ANOTHER LARGE
STUDY SHE'LL BE SPEAKING ABOUT
TODAY, HAS RECRUITED OVER 50,000
WOMEN WITH SISTERS WITH BREAST
CANCER BETWEEN 2003 AND 2008 AND
FINDING WAYS TO PREVENT BREAST
CANCER.
NUMEROUS ENVIRONMENTAL
INFLUENCES HAVE BEEN ASSOCIATED
WITH BREAST CANCER RISK IN THE
ONGOING STUDY AND SHE'LL TELL
YOU MORE ABOUT THAT TODAY.
AND FOLLOWING THE DEEP WATER
HORIZON ACCIDENT IN MEXICO HELPS
UNDERSTAND THE IMPACT OF OIL
SPILL CLEAN UP WORKERS AND
RESPONSE WORKERS.
DR. SANDLER REACHED MULTIPLE AND
INDIVIDUAL GROUP NIEHS AND
DIRECTOR'S AWARDS FOR THE WORK
SHE'S DONE.
SHE'S CO-AUTHORED OVER 650
PEER-REVIEWED MANUSCRIPTS AND
RECRUITED AND MENTORED DOZENS
POST GRADUATE FELLOWS AND JUNIOR
INVESTIGATORS MANY OF WHOM ARE
NOW INDEPENDENT INVESTIGATORS.
SHE SPENT MOST OF THE LAST
COUPLE DAYS MENTORING TRAINEES
AND JUNIOR INVESTIGATORS ON THE
MAIN CAMPUS AS PART OF THE
SCIENTIST ASSEMBLY HOSTING HER
VISIT.
SHE WAS SELECTED AS OUR
SCIENTIST OF THE YEAR SEVERAL
YEARS AGO AND RECEIVED A
MENTORING AWARD AND NAMED MENTOR
OF THE YEAR AT NIEHS.
SHE RECEIVED THE AWARD FOR
OUTSTANDING MEDICAL SERVICE FROM
THE MEDICAL ASSOCIATION AND ONE
OF THE FEW LABORATORY BRANCH
CHIEFS AND A SUPPORTER AND ROLE
MODEL FOR JUNIOR FEMALE
INVESTIGATORS WHO WANT TO REACH
LEADERSHIP CAPACITY.
THE TITLE OF HER TALK IS
PROSPECTIVE COHORT STUDIES FOR
ENVIRONMENTAL HEALTH RESEARCH.
I WOULD LIKE TO THANK THE
WOMEN'S SCIENCE ADVISERS.
>> THANK YOU FOR NOMINATING ME
AND SUPPORTING THE NOMINATION.
I WANT TO GET OUT OF THE WAY I
HAVE NO DISCLOSURES FINANCIAL OR
OTHERWISE TO DECLARE I
MYSTERIOUS LARYNGITIS SO IF
START TO LOSE MY VOICE IT'S ALL
GOOD.
DON'T WORRY.
IT'S AN HONOR TO RECOGNIZE
DR. MIDER.
HE WAS THE FIRST DIRECTOR OF NIH
LABORATORIES IN CLINICS FROM
1960 TO 1968 AND HELD OTHER
IMPORTANT NIH POSITIONS.
STARTING OUT AS A RESEARCH
FELLOW BACK IN 1939.
THIS NAMED LECTURE IS A REMINDER
OF THE IS IMPORTANCE OF CLINICAL
RESEARCH AT THE NIH AND
OPPORTUNITIES FOR COLLABORATION
BETWEEN CLINICAL AND BASIC
SCIENTISTS.
I ALSO WANT TO PUT IN A PLUG FOR
THE STRONG EPIDEMIOLOGY AND
STRONG SCIENCE RESEARCH PROGRAMS
IN SOME OF THE INSTITUTES WHERE
SUPPORT FOR LONG-TERM STUDIES
FOSTERS INNOVATIVE, PRODUCTIVE
AND TRANS DISCIPLINARY
POPULATION HEALTH RESEARCH.
AS DR. ZELDIN NOTED MY RESEARCH
HAS TAKEN ADVANTAGE OF THREE
LARGE COHORTS I'VE DEVELOPED
WITHIN THE INTRAMURAL RESEARCH
PROGRAM.
IT WAS MADE POSSIBLE BECAUSE OF
THE WILLINGNESS ON THE PART OF
LEADERSHIP TO THINK BIG, TAKE
RISKS AND PROVIDE SUSTAINED
SUPPORT FOR LONG-TERM RESEARCH.
THE COHORTS ARE LARGE
PROSPECTIVE STUDIES THAT ADDRESS
THE NIEHS MISSION FOCUSSING ON
ENVIRONMENTAL OR SPECIFIC
EXPOSURES OR BROADLY DEFINED
EXPOSURE TO PESTICIDES.
THE GULF DESIGN WAS LOOKING AT
OIL-SPILL RELATED CHEMICALS.
THE STUDIES ALL HAVE IN COMMON
THEY'RE ADDRESSING QUESTIONS OF
PUBLIC HEALTH CONCERN AND THEY
FACILITATE MULTI-DISCIPLINARY
AND COLLABORATIVE RESEARCH WHICH
IS THE MOST EXCITING PART OF MY
JOB.
SO TODAY I PLAN TO FOCUS MOSTLY
ON THE SISTER STUDY.
A COHORT DESIGN TO STUDY
ENVIRONMENTAL EXPOSURES MORE
BROADLY THAT IS CELEBRATING THE
20th ANNIVERSARY THIS YEAR.
IN ADDITION TO ADDRESSING A
SPECIFIC PUBLIC HEALTH CONCERN,
NAMELY THE IMPACT OF
ENVIRONMENTAL EXPOSURES ON HIGH
RATES OF BREAST CANCER IN THE
UNITED STATES, THE STUDY
ILLUSTRATES THE VARIETY OF
RESEARCH THAT ONE CAN DO ONCE
YOU HAVE A RESOURCE SUCH AS ONE
OF THESE LARGE PROSPECTIVE
STUDIES.
SOME BACKGROUND ON BREAST
CANCER.
IT'S THE MOST FREQUENT CANCER IN
WOMEN.
ABOUT 30% OF CANCER CASES ARE
BREAST CANCER CASES OTHER THAN
NON-MELANOMA SKIN CANCER.
IN 2023 THEY EXPECT NEARLY
300,000 CASES OF INVASIVE BREAST
CANCER WILL BE DIAGNOSED AND
ANOTHER 55,000 IN SITU CASES AND
WE OFTEN HEARD ONE IN EIGHT
WOMEN WILL DEVELOP BREAST CANCER
IN THEIR LIFE TIME.
THE INCIDENCE OF BREAST CANCER
HAD LEVELLED OFF.
THE INCIDENTS IN BLACK WOMEN IS
APPROACHING THAT OF WHITE WOMEN.
BREAST CANCER IS ALSO THE SECOND
MOST FREQUENT CANCER DEATH IN
THE UNITED STATES WITH NEARLY
44,000 DEATHS THIS RATE.
MORTALITY IS INCREASING DUE TO
THE TREATMENTS AVAILABLE FOR
WOMEN BUT THE MORTALITY STILL
REMAINS DISTURBINGLY HIGHER IN
BLACK WOMEN THAN OTHERS.
AT THE TIME WE DESIGN OUR STUDY
AND THERE'S RELATIVELY LOW RISKS
AND AS YOU ALL NOTICE ON THIS
LIST THERE'S NO WIDESPREAD
ENVIRONMENTAL EXPOSURES ON THE
LIST.
WHY THE SISTER STUDY THEN?
AT THE TIME IN THE EARLY 2000s
THERE WAS CONCERN INCREASE IN
BREAST CANCER AND THE LARGEST
CHANGE WAS DUE TO CHANGES IN
SCREENING PRACTICES.
NOT ALL CAN BE EXPLAINED BY
THAT.
WOMEN WERE NOT ONLY CONCERNED
ABOUT THE STEEP RISE IN CANCER
INCIDENTS BUT IN ENDOCRINE
DISRUPTING CHEMICALS IN PERSONAL
PRODUCTS AND COMMON HOUSEHOLD
PRODUCT.
THERE WAS PRESSURE ON CONGRESS
AND DHHS AND NIH FROM FROM
BREAST CANCER GROUPS AND WOMEN'S
CANCER GROUPS TO INCREASE
SUPPORT FOR RESEARCH IN
ENVIRONMENTAL EXPOSURES.
THE EXISTING STUDIES AT THE TIME
FOCUSSED ON LIFESTYLE, HORMONES
AND REPRODUCTION IN GENES WHICH
PARALLELS WITH THE LIST OF KNOWN
BREAST CANCER RISK FACTOR.
THE KNOWN RISK FACTORS DEPENDING
ON WHO YOU ASK ACCOUNT FORD 30%
AND 70% OF CASES BUT LIKELY LESS
THAN 50%.
OUR INSTITUTE LEADERSHIP AND KEN
OLDEN WHO SPENT TIME TALKING TO
ADVOCA
ADVOCATES.
WE WERE CHALLENGED TO DO
SOMETHING NEW AND THEY GAVE US
THE OPPORTUNITY TO THINK BIG.
THE BASIC IDEA REPROPOSED WAS A
PROSPECTIVE STUDY OF BREAST
CANCER IN A SUSCEPTIBLE
POPULATION.
AT THE TIME MOST OF THE STUDIES
FOCUSSED SPECIFICALLY ON
ENVIRONMENT IN BREAST CANCER
WERE RETROSPECTIVE CASE CONTROL
STUDIES AND THESE KINDS OF
STUDIES ARE PRONE TO CERTAIN
BIASES BECAUSE THE EXPOSURES ARE
ASSESSED AFTER THE DISEASE IS
DIAGNOSED.
THOUGH PEOPLE WERE ALL RILED UP
IT'S BREAST CANCER IS STILL A
RARE DISEASE AND WITH 120,000
CASES EXPECTED TO BE DIAGNOSED A
YEAR I WOULD NEED A LARGE COHORT
TO STUDY BREAST CANCER IN OUR
LIFE TIME.
AND THERE'S FEWER PARTICIPANTS.
MY COLLEAGUE CLAIR WINEBERG WHO
HELPED DESIGN THE STUDY
DEMONSTRATED AS WELL THAT WOMEN
WHO HAVE A SISTER WITH BREAST
CANCER THEMSELVES HAVE LIKELY TO
HAVE A HIGHER PREVALENCE OF
RELEVANT GENE VARIANCE AND
EXPOSURES TO THINGS THEY HAVE IN
COMMON WITH THEIR SISTER EARLY
IN LIFE.
IT GIVES GREATER POWER TO STUDY
GENE ENVIRONMENT INTERACTIONS.
AND ALSO TO IDENTIFY PREVIOUSLY
UNKNOWN ENVIRONMENTAL RISKS.
AND THEY'RE MORE MOTIVATED TO
PARTICIPATE IN THE STUDY AND WE
WANTED TO HAVE A COHORT OF
50,000 WOMEN WITH A SISTER WHO
HAD BREAST CANCER TO STUDY
MEDICAL AND LIFESTYLE FACTORS
WITH CANCER.
WE WANTED TO HAVE A FRAMEWORK TO
ADDRESS QUESTIONS OF PUBLIC
CONCERN AND WANTED THE STUDY TO
LOOK AT PROGNOSIS FOLLOWING A
BREAST CANCER PROGNOSIS AND
OTHER HEALTH OUTCOMES.
WE WERE SUCCESSFUL IN OUR GOAL
THOUGH IT TOOK US LONGER THAN WE
HAD EXPECTED.
BETWEEN 2003 AND 2009 WE
ENROLLED 254 WOMEN WHO HAD
SISTERS WITH BREAST CANCER
BETWEEN 35 AND 74 AND
IMPORTANTLY HAD NO BREAST CANCER
AT ENROLLMENT.
THEY COME FROM ALL 50 STATES AND
PUERTO RICO.
WE HAD HOPED TO HAVE A LOT OF
DIVERSITY.
IT'S VERY HARD TO DO THAT.
AND WE WORKED HARD AND 16% OF
OUR COHORT ARE WOMEN FROM OTHER
RACES AND ETHNICITIES OTHER THAN
NON-HISPANIC WHITE WOMEN.
WE WISHED TO HAVE DONE BETTER
BUT WE'RE BETTER THAN SOME OTHER
COHORTS EXIST FROM THAT TIME
PERIOD.
AS WITH VOLUNTEER COHORTS
EVERYWHERE OUR SISTERS HAVE A
HIGHER LEVEL OF EDUCATION AND
HIGHER SOCIO ECONOMIC STATUS.
HALF HAD A COLLEGE DEGREE.
WE HAVE TO CONSIDER HOW THAT
IMPACTS OUR GENERALIZABILITY AND
THE IMPORTANT THING THIS GAVE US
WOMEN CAPABLE OF DOING THE
THINGS WE ASKED THEM TO DO AND
MORE INTERESTED IN BEING PART OF
THE STUDY.
THE FOLLOW-UP RESPONSE RATES
HAVE PROVED TO BE VERY GOOD.
85% TO 95% RESPONSE RATES FOR
THE VARIOUS ACTIVITIES OVER THE
YEARS.
AND SINCE WE STARTED ENROLLING
WE'VE ACCUMULATED MORE THAN
4,000 WOMEN DIAGNOSED WITH
BREAST CANCER SINCE THEY
ENROLLED.
IMPORTANTLY FOR FUNDING
PERSPECTIVE, AT LEAST 300 PAPERS
HAVE BEEN WRITTEN FROM THE
STUDY.
I DIDN'T WRITE THEM ALL MYSELF
AND WE'RE AT THE BASIS FOR AT
LEAST 17 FUNDED EXTRAMURAL
GRANTS ON DIVERSE OUTCOMES.
THEY'RE GRANTS WHERE THE WHOLE
FOCUS IS WITHIN THE SISTER STUDY
AND OTHERS WHERE WE JUST
CONTRIBUTE DATA ALONG WITH OTHER
STUDIES TO LARGER STUDIES.
AND WE'VE ALSO BEEN USED FOR
MULTIPLE DOCTORAL DISSERTATIONS.
OUR STUDY WAS SOMETHING WHERE WE
DEFINED EXPOSURES BROADLY.
I OFTEN GUEST ASKED AT THE
NATIONAL INSTITUTE OF
ENVIRONMENTAL HEALTH AND ARE YOU
STUDYING WATER OR AIR POLLUTION?
WELL, WE'RE STUDYING ALCOHOL AND
SMOKING AND IT'S ALL PART OF THE
ENVIRONMENT AND IN THE SOCIAL
VARIETY.
SO WE COLLECT A LOT OF DATA TO
DO THAT AND THIS PUT US IN A
POSITION TO BE VERY RESPONSIVE
TO SOME SUBSEQUENT CALLS FOR
ENVIRONMENTAL BREAST CANCER
RESEARCH THAT WAS MULT
DISCIPLINARY THAT CONSIDERS
GENETIC AND EPIGENETIC FACTORS
AND TAKES A LIFE COURSE
APPROACH.
FOR DATA COLLECTION AT
ENROLLMENT WE COMPLETED
TELEPHONE INTERVIEWS AND WOMEN
COMPLETED SELF-COMPLETED
QUESTIONNAIRES AND WE TOOK
CLINICAL MEASUREMENTS AND DREW
BLOOD SAMPLES AND COLLECTED
URINE SAMPLES AND OTHER SAMPLES
FOR FOLLOW-UP WE HAVE ANNUAL
HEALTH UPDATES.
WE HAVE A MORE COMPREHENSIVE
HEALTH AND EXPOSURE
QUESTIONNAIRE EVERY TWO TO THREE
YEARS AND FOR A SMALL SAMPLE WE
WERE ABLE TO COMPLETE A SECOND
SAMPLE COLLECTION WHICH I'LL
TALK ABOUT LATER.
WE COLLECT MEDICAL RECORDS FOR
WOMEN WHO ARE DIAGNOSED WITH
BREAST CANCER ALONG WITH TUMOR
TISSUE FOR OTHER CANCERS WE
COLLECT PATH REPORTS AND STARTED
COLLECTING OVARIAN CANCER TUMOR
TISSUE.
WE COLLECT EXTENSIVE AMOUNTS OF
DATA ACROSS THE LIFE SPAN.
THIS FIGURE SHOWS THE STAGES OF
BREAST CANCER DIFFERENTIATION
THAT MAY BE ASSOCIATED WITH
DIFFERENT LEVELS OF BREAST
CANCER SUSCEPTIBILITY.
OUR DATA COLLECTION STRATEGY AND
ENROLLMENT WAS TO OBTAIN
INFORMATION ON EXPOSURES DURING
PERIODS OF ENHANCED
SUSCEPTIBILITY RELATED TO THESE
CHANGES.
FOR EXAMPLE, PUBERTY IS A PERIOD
OF RAPID BREAST CHANGE AN GROWTH
AND DURING THIS TIME MAY BE
RELEVANT TO BREAST CANCER RISK
LATER IN LIFE.
THOUGH WE TARGETED FACTORS KNOWN
OR POTENTIALLY RELATED TO BREAST
CANCER THE INFORMATION WE
COLLECTED WAS RELEVANT TO MANY
OTHER HEALTH OUTCOMES.
SO WHAT ARE OUR SOURCES OF
ENVIRONMENTAL DATA?
THERE'S THE QUESTIONNAIRE DATA.
WE ACTUALLY DEVOTE A LOT OF OUR
QUESTIONNAIRE TO THE POTENTIAL
FOR ENVIRONMENTAL EXPOSURES.
ALSO BIOLOGIC SAMPLES AT
ENROLLMENT AND TAKEN AT THE SUB
SAMPLE.
WE HAVE BROOD, URINE AND TOENAIL
CLIPPINGS AND ASKED WOMEN TO
COLLECT DUST FROM HIDDEN
LOCATIONS IN THEIR HOUSE USING
ALCOHOL WIPES.
RECENTLY WE'VE TAKEN ADVANTAGE
OF GEOSPATIAL DATA AND LINK
RESIDENTIAL HISTORIES COLLECTED
TO GEOSPATIAL DATA AND
ENVIRONMENTAL SOCIO ECONOMIC AND
SOCIAL FACTORS.
I WANT TO TAKE A MINUTE TO
EXPLAIN HOW WE DO OUR CASE
CONTROL STUDIES.
I'M DEPICTING IN THE TOP LEFT AT
ENROLLMENT THE WOMEN WHO
ENROLLED IN 2003 AND FOLLOWED
THEM UP OVER TIME AND DURING
THAT TIME SOME OF THEM WILL HAVE
DEVELOPED BREAST CANCER.
SO THEN WE DRAW A RANDOM SAMPLE
OF THE COHORT AND WE THEN TAKE
ALL THE REST OF THE CASES WHO
HAVE BEEN DIAGNOSED AT THAT TIME
FOR OUR CASE COHORT STUDY.
THIS IS FAR MORE EFFICIENT AND
GENERALIZABLE TO THE REST OF THE
COHORT BECAUSE OF THE COST.
THE HIGH COST OF MANY OF THE
ASSAYS OF INTEREST.
WE DREW A CASE COHORT SAMPLE
WITH FOLLOW UP THROUGH 2014 AND
DID THIS AGAIN RECENTLY WITH
FOLLOW THROUGH 2019.
FOR THE 2019 SAMPLE WE HAD THE
ABILITY TO MAXIMIZE THE
INCLUSION OF BLACK WOMEN AND
THOSE WITH ESTROGEN NEGATIVE
BREAST CANCER UNDER REPRESENTED
IN OUR FIRST SAMPLE.
WE'VE USED THESE CASE COHORT
SAMPLES FOR MULTIPLE ANALYSES.
WE END UP WITH SUBSETS OF WOMEN
WHO HAVE LOTS OF BIOMARKER DATA.
IMPORTANTLY, THESE RANDOM
SAMPLES ARE USEFUL TO BE USED AS
COMPARISON GROUP FOR OTHER TYPES
OF HEALTH OUTCOMES.
FOR EXAMPLE, WE HAVE A CASE
COHORT STUDY OF TYPE 2 DIABETES.
WE'VE USED THE CASE COHORT
APPROACH FOR GENOMIC STUDIES,
EPIGENOMIC STUDIES, STUDY DNA
METHYLATION, AGING, VITAMIN D
AND DIABETES METABOLOMICS AND
METALS, FOR EXAMPLE.
AND SO I ALSO SHOULD MENTION
THAT THE RESEARCH THAT WE'VE
DONE IN THE SISTER STUDY IS
INCREDIBLY BROAD.
COVERS A WIDE RANGE OF TOPICS
AND APPROACHES AND WE DON'T DO
IT ALL OURSELVES.
WE HAVE THINGS THAT WE DO
INTRAMURALLY AT NIEHS AND WE
WORK WITH MANY CONSORTIA AND
HAVE PARTNERSHIPS ACROSS NIEHS
FOR FOCUSSED STUDIES.
I'LL TRY TO TALK ABOUT THE
RESEARCH.
THERE'S DIFFERENT WORK WE'VE
DONE AND EMPHASIZING THINGS MY
GROUP HAS DONE AND THINGS I'M
MORE COMFORTABLE WITH.
TO ILLUSTRATE THE OPPORTUNITIES
THAT CAN BE CREATED USING COHORT
DATA.
SO MANY OF OUR EARLIER ANALYSES
FOCUSSED ON THE ROLE OF EARLY
LIFE EXPOSURES IN BREAST CANCER
RISK.
WHEN WE FIRST GOT STARTED WE
DIDN'T HAVE CASES.
WE FOCUSSED AND ENDED UP
FOCUSSING ON BREAST CANCER RISK
FACTORS THINGS LIKE HOW
ENVIRONMENTAL EXPOSURES
CONTRIBUTE TO THINGS.
WITH HAVE MANAGED TO SHOW THAT
FOR EXAMPLE GETTING THE
RECOMMENDED LEVELS OF EXERCISE
FOR CHILDREN AND ADOLESCENCE
FROM 5 TO 19 IS ACTUALLY AN
OPPORTUNITY FOR BREAST CANCER
RISK REDUCTION OR PREVENTION.
WE'VE SHOWN THAT EVEN THOUGH WE
COULD NOT SEE AN ASSOCIATION
FROM EXPOSURE OF SMOKE IN EARLY
LIFE WAS LED TO AN INCREASED
BREAST CANCER RISK AS WELL AS IN
UTERO EXPOSURE BEING RELEVANT.
WE WERE INTERESTED AND HAVE BEEN
INTERESTED ALL ALONG IN STUDYING
ENVIRONMENTAL EXPOSURES.
TRICKY TO DO FOR EXPOSURES THAT
OCCURRED A LONG TIME AGO IN THE
AIR POLLUTION DATA ARE LIMITED
BEFORE 1990 AND OUR ENROLLMENT
COVERS A LARGE RANGE OF BIRTH
YEARS.
PEOPLE ON AVERAGE 55 WHEN THEY
JOINED AND STARTED AS OLD AS 74
WHEN THEY JOINED.
SO WE RELIED ON OURSELF REPORTED
DATA.
WE ASKED A LOT OF QUESTIONS
ABOUT CHARACTERISTICS OF THE
LONGEST LIVED CHILDHOOD HOME AND
ONE OF THE THINGS WE ADDRESSED
WAS THE TRAFFIC AT THE HOME.
WE'VE SHOWN THAT BREAST CANCER
RISK WAS ASSOCIATED WITH LIVING
ON OR NEAR A ROAD WITH A MEDIAN
BARRIER AND AS SHOWN IN THE
GRAPH, LIVING NEAR A ROADWAY
HEAVILY TRAFFICKED.
WE WERE INTERESTED IN EARLY
SOCIO ECONOMIC ADVERSITY.
HERE I'M SHOWING RESULTS FROM
SOCIO ECONOMIC ADVERSITY AND
OBESITY IN ADULTHOOD AND KNOW
THE ECONOMIC POSITION
CONCURRENTLY IS ASSOCIATED WITH
OBESITY THE RELATIONSHIP BETWEEN
CHILDHOOD POSITION AND OBESITY
IS LESS WELL STUDIED.
OUR QUESTIONNAIRE WE COLLEC COL
AND WE SHOWED LOWER SOCIO
ECONOMIC POSITION WAS ASSOCIATED
WITH ADULT OBESITY WITH ABOUT A
RELATIVE RISK FOR EVERY INCREASE
IN THE SCORE OF ABOUT 1.16.
WE ALSO LOOKED TO SEE WHETHER
ADULT OBESITY WHICH TRACKS WITH
CHILDHOOD OBESITY EXPLAINED AND
ONLY 40% WAS EXPLAINED.
THERE WAS STILL A SIGNIFICANT
COMPONENT OF CHILDHOOD IN THE
RELATIONSHIP.
WE ALSO CREATED LATENT VARIABLES
FOR SOCIO ECONOMIC POSITION IN
ADULTHOOD AND LOOKED AT
TRAJECTORIES.
AND THE GRAPH IS PROBABLY HARD
TO SEE.
WE COMPARED TRAJECTORIES AND
SHOWED EVERYTHING OTHER THAN
BEING WELL OFF FOR YOUR WHOLE
LIFE WAS ASSOCIATED WITH AN
INCREASED RISK ADULT OBESITY.
SO THIS SUGGESTS THAT THE
ECONOMIC ADVANTAGE IN ADULTHOOD
CAN'T OVERCOME THE INFLUENCE OF
ADVERSE SOCIO ECONOMIC PRESSURES
IN CHILDHOOD.
I'M GOING TO COME BACK TO SES
AND BREAST CANCER IN A LITTLE
BIT LATER BUT KEEP IN MIND THAT
BREAST CANCER IS ACTUALLY A
DISEASE MORE COMMON IN PEOPLE
WHO ARE WELL OFF.
IN EXPOSURE WE'RE CONSIDERING IS
THE FISCAL OR PSYCHOLOGICAL
TRAUMA IN EARLY LIFE FOR WHICH
WE'VE USED LATENT CLASS
APPROACH.
I'M NOT GOING TO WALK YOU
THROUGH THE FIGURE IT'S VERY
COMPLICATED TO TELL YOU WE
COLLECTED A LOT OF INFORMATION
ON ABOUT 20 TRAUMAS THAT PEOPLE
EXPERIENCED AT DIFFERENT TIME
POINTS BUT HERE IN CHILDHOOD AND
LOOKED THE PATTERNS WHICH
CO-OCCURRED AND CAME UP WITH
CONCLUSIVE OF CLUSTERS.
YOU HAD SUFFICIENT OVERLAP IN
THE EXPERIENCES.
AND WE SHOWED THAT SEXUAL TRAUMA
OR HOUSEHOLD DYSFUNCTION AND
ANOTHER ONE CALLED MODERATE
TRAUMA WERE ASSOCIATED WITH
ELEVATED RISK FOR BREAST CANCER
AND THE ASSOCIATION MORE
APPARENT AMONG WOMEN WHO
REPORTED HAVING NO SOCIAL
SUPPORT DURING CHILDHOOD.
I ALSO WANT TO POINT OUT THAT
PART OF THE IMPETUS FOR DOING
THIS WAS WHEN WE MET WITH
INTEREST GROUPS IN DESIGNING THE
STUDY, EVERYBODY WANTED TO KNOW
IF STRESS CAUSED THEIR BREAST
CANCER.
SO IT WASN'T SOMETHING THAT CAME
OUT OF OUR EARLIER RESEARCH.
HIGH EARLY LIFE TRAUMAS WERE
ALSO ASSOCIATED WITH SHORTER
TELOMERES AND SOME CONSIDERED A
MEASURE OF BIOLOGIC AGING.
THIS ASSOCIATION WAS NOT
MEDIATED THROUGH ADULT TRAUMA.
SOCIO ECONOMIC POSITION OR
HEALTH STATUS.
IN WORK BEING LED BY CHANDRA
JACKSON A COLLABORATOR AT NIEHS
MULTIPLE EARLY LIFE TRAUMA WAS
ASSOCIATED WITH POOR SLEEP AND
DIABETES AND GOING BACK TO WHAT
WE KNEW ABOUT GREAT CANCER AND
EARLY MENARCHE IS ESTABLISHED AS
RISK FOR BREAST CANCER IT CAN'T
ACCOUNT FOR TRENDS IN BREAST
CANCER INCIDENTS.
BREAST DEVELOPMENT THELARCHE MAY
BE A VULNERABLE EXPOSURE WINDOW
AND IT'S DECLINED RAPIDLY OVER
TIME.
WE SHOWED IN FACT EARLY
TELEARCHE HAS A HAZARD OF HAVING
BREAST DEVELOPMENT BEFORE THE
AGE OF 10.
THE STRONGEST ASSOCIATION WITH
BREAST CANCER WAS FOR WOMEN WHO
HAD EARLY TELEARCHE AND EARLY
MENARCHE WITH A 30% INCREASE IN
THE HAZARD.
AND I FORGOT THIS SLIDE.
GIVEN THE TRENDS IN AGE OF
TELEARCHE AND THE ASSOCIATION
WITH BREAST CANCER WE SOUGHT TO
IDENTIFY RISK FACTORS FOR EARLY
THELARCHE WITH EARLY
ENVIRONMENTAL EXPOSURES WOULD
LEAD TOW EXPOSURES WOULD
LEAD TO EXPOSURES WOULD
LEAD TO THIS AND HAVING AN EARLY
YOUNG MATERNAL AGE BE AN EFFECT
AND THE OTHER WINDOW OF
SUSCEPTIBILITY WERE THINGS THAT
HAPPEN BEFORE THE FIRST FULL
TERM PREGNANCY WHEN BREAST
TISSUE IS FULLY DIFFERENT SH
DIFFERENTIATED AND WE LOOKED AT
EXPOSURE AND WE ONLY SAW AN
EFFECT IN WOMEN WHO WERE EXPOSED
TO OCCUPATIONALLY SOLVENTS
BEFORE THE FIRST FULL-TERM
PREGNANCY.
ANOTHER EXPOSURE IS THE
RELATIONSHIP BETWEEN SHIFT WORK,
LIGHT AT NIGHT AND BREAST
CANCER.
IN 2016 THE NTP CONVENED A
WORKSHOP AND PUBLISHED A FINAL
HAZARD ASSESSMENT REPORT IN 2021
THAT CONCLUDED PERSISTENT NIGHT
SHIFT WORK CAN CAUSE BREAST
CANCER IN WOMEN AND THAT CERTAIN
LIGHTING CONDITIONS SUCH AS
OUTDOOR LIGHTING, SELF-LUMINOUS
THE LIGHT ON YOUR TABLE CAN
CAUSE CANCER.
SO WE ADDRESSED THIS IN SOME
STUDIES THAT WE CARRIED OUT.
FIRST, WE FOUND THAT SLEEPING
WITH A LIGHT OR TV ON WAS
ASSOCIATED WITH A SMALLER BUT
NOT QUITE STATISTICALLY
SIGNIFICANT INCREASE IN ESTROGEN
RECEPTOR POSITIVE BREAST CANCER
BUT NOT OTHER FORM OF BREAST
CANCER AND WOMEN WHO REPORTED
HAVING DIFFICULTY SLEEPING AT
LEAST FOUR NIGHTS A WEEK ALSO
HAD AN INCREASED CHANCE OF
DEVELOPING POST-MENOPAUSAL
BREAST CANCER.
WE FOUND A LITTLE SUPPORT FOR AN
OVER ALL ASSOCIATION OF SHIFT
WORK OR NIGHT WORK IN BREAST
CANCER AND THIS COULD
POTENTIALLY IN HIGHER SES COHORT
OF WOMEN BUT WE FOUND SUGGESTIVE
ASSOCIATIONS FOR WOMEN WHO HAD
SHORT-TERM EXPERIENCES WORKING
AT NIGHT OR DOING ROTATING SHIFT
WORK.
IMPORTANTLY WE ALSO FOUND NO
ASSOCIATION WITHOUT NIGHTTIME
LIGHT.
WE INITIALLY SAW THIS BUT ONCE
WE TOOK INTO ACCOUNT OTHER
THINGS ASSOCIATED WITH URBAN
LIVING AND HAVING A LOT OF LIGHT
AT NIGHT LIKE AIR POLLUTION THAT
THERE WAS NO LONGER ANY
RELATIONSHIP.
RESEARCH THAT RECEIVED A LOT OF
ATTENTION WHEN WE PUBLISHED IT
WAS LOOKING AT SELF-REPORTED
EXPOSURE TO LIGHT AT NIGHT AND
BREAST CANCER WHERE WE FOUND
SLEEPING WITH A LIGHT AT NIGHT
WAS ASSOCIATED WITH INCREASED
CHANCE OF BEING OBESE AND
BECOMING OBESE.
LIGHT AT NIGHT CAN AFFECT
MELATONIN AND CIRCADIAN RIDGE
AND INCREASE OBESITY.
ANY LIGHT AT NIGHT REGARDLESS OF
THE SOURCE WAS ASSOCIATED WITH A
SMALL CHANCE OF BEING OBESE WHEN
YOU ENROLLED WITH THE STUDY WITH
THE BIGGEST HAZARD FOR LIGHT AT
NIGHT OR TV OR LIGHT ON IN THE
ROOM.
WHEN WE STARTED WITH WOMEN NOT
OBESE AT ENROLLMENT AND FOLLOWED
THEM OVER TIME, SLEEPING WITH A
TV AND LIGHT ON WAS ASSOCIATED
WITH MULTIPLE MEASURES OF WEIGHT
GAIN.
OUR STUDY WE HAD DECIDEDLY NOT
PLANNED TO BE A DIET STUDY.
THERE WERE COHORTS ESTABLISHED
SPECIFICALLY TO LOOK AT DIET AND
BREAST CANCER BUT SOME HOW WE
FELT WE COULDN'T AVOID LOOKING
AT IT AND THERE'S SPECIFIC
COMPONENTS AND NUTRIENT AND THE
RESULTS ARE SORT OF
CONTRADICTORY.
LESS IS KNOWN ABOUT DIETARY
PATTERNS WHICH IS A MORE
REALISTIC PICTURE OF WHAT PEOPLE
ARE EATING.
WE DID COLLECT A FOOD
QUESTIONNAIRE AT ENROLLMENT TO
STUDY DIET PATTERNS NOT
INDIVIDUAL FOODS.
WE HAD TWO CLASSES OF DIETS WE
LOOKED AT AND
RECOMMENDATION-BASED DIETS A
HEALTHY EATING INDEX OR
MEDITERRANEAN DIET AND LOOKED AT
MORE MECHANISTICALLY BASED DIETS
SUCH AS AN ANTI-INFLAMMATORY
DIET.
SO WHEN WE LOOKED AT THE
RECOMMENDATION-BASED DIETS WHAT
I'M SHOWING HERE IS THAT WOMEN
MOST ADHERENT TO A MEDITERRANEAN
DIET COMPARED TO THOSE LEAST
ADH
ADHERENT HAD A SMALL DECREASE IN
THE RISK OF THE ESTROGEN
RECEPTOR NEGATIVE OR TRIPLE
NEGATIVE BREAST CANCER.
ASSOCIATIONS WERE STILL SEEN FOR
OTHER RECOMMENDATION-BASED DIETS
THAT MIGHT BE CONSIDERED LESS
RIGOROUS THAN THE DASH DIET
WHICH IS A HYPERTENSION DIET.
I'M BLANKING ON WHAT THE ACRONYM
IS.
WE SAW LESS.
SO YOU WILL THE DIETS HAVE IN
COMMON EATING LOTS OF FRUITS AND
VEGETABLES AND WHOLE GRAIN NUTS
AND LEGUME AND TRYING TO EAT
LESS MEAT.
WE CONSIDERED DIET PATTERNS
ASSOCIATED WITH INFLAMMATION OR
OXIDATIVE STRESS AND DIET IS
IMPORTANT IN REGULATING CHRONIC
INFLAMMATION AND WE HAVE AN
DIETARY INDEX WE CALCULATED FOR
OUR STUDY AND OXIDATIVE BALANCE
SCORE.
FOR BOTH THEY WERE SCORED
OPPOSITE.
FOLLOWING THE POOR DIET FOR
INFLAMMATORY INDEX INCREASES THE
RISK OF ESPECIALLY ESTROGEN
RECEPTOR AND TRIPLE NEGATIVE
BREAST CANCER.
FOLLOWING A GOOD DIET FOR
OXIDATIVE BALANCE IS ASSOCIATED
WITH A DECREASE SLIGHTLY OF
TRIPLE NEGATIVE BREAST CANCER.
WHEN YOU PUT THEM TOGETHER WE
SEE THEY'RE BOTH PRETTY
BENEFICIAL.
SO IF YOU HAVE THE WORSE OF
BOTH, YOU HAVE A SUBSTANTIALLY
INCREASED RISK OF DEVELOPING
ESTROGEN RECEPTOR OR TRIPLE
NEGATIVE BREAST CANCER.
IT'S IMPORTANT THESE TWO
CONDITIONS ARE RARER.
THEY HAVE HIGHER MORTALITY AND
MORE OFTEN FOUND IN BLAM BLACK
WOMEN.
I THINK OUR SPLASHIEST WORK TO
DATE IS OUR WORK ON HAIR
PRODUCTS AND CANCER INSTITUTE.I
DATE IS OUR WORK ON HAIR
PRODUCTS AND CANCER INSTITUTE.
IT TURNED OUT TO BE A GREAT
INTEREST TO THE PUBLIC AND THE
INTEREST GOES ON.
WE STARTED THE STUDY BECAUSE OF
PRIOR WORK LINKING THE EFFORT
LINKING HAIR DYES TO CANCER.
PERMANENT DYES AND OTHER HAIR
PRODUCTS ARE KNOWN SOURCES OF
EXPOSURE TO MUTE I GENS AND
ENDOCRINE DISRUPTORS.
MOST OFTEN BLADDER CANCER BUT
ALSO LEUKEMIA, LYMPHOMA AND
BREAST CANCER.
IT LOOKED AT HAIR DRESSES AND
THE RESULT OF PERSON USE FOR
HAIR DYES WERE LESS CONSISTENT.
IN 2010 WORKPLACE HAIR DRESSER
CANCER WERE A FACTOR AND HAIR
CHEMICALS ARE CAPABLE OF
REACHING THE BREAST TISSUE AND
WEAR WAVING PRODUCTS KNOWN AS
PERM CONTAIN A CARCINOGEN AND
OTHER THINGS THAT ARE NOT
ESPECIALLY HEALTHFUL AND
CHEMICAL STRAIGHTERS IN AND
RELAXERS CONTAIN A LOT OF
THINGS.
SOME RELEASE FORMALDEHYDE WHEN
HEATED.
WE ADDED A PERSONAL PRODUCTS
QUESTIONNAIRE AT ENROLLMENT TO
OUR STUDY BASICALLY BECAUSE OF
THE INFLUENCE OF THE WOMEN WE
TALKED TO ABOUT DESIGNING THE
STUDY.
AND IN THE QUESTIONNAIRE WE
ASKED ABOUT FREQUENCY OF USE OF
HAIR PRODUCTS 10 TO 13 AND IN
THE 12 MONTHS BEFORE ENROLLMENT.
WE INCLUDED HAIR DYES AND WE
INCLUDED HAIR STRAIGHT NERS AND
RELAXERS AND OTHER PRODUCTS.
I WANT TO MENTION THAT MORE THAN
HALF THE WOMEN IN THE UNITED
STATES, AGE 40 AND OLDER USED
HAIR DYES, MYSELF INCLUDED.
AND HAIR STRAIGHTENER IS
PREDOMINANT AMONG BLACK AND
AFRICAN AMERICAN WOMEN AND
CONTINUES LIFE LONG.
IT'S A GRAPH SHOWING DATA FROM
ANOTHER NIH STUDY THE STUDY OF
ENVIRONMENT, LIFESTYLE AND
FIBROIDS AND SHOWING THAT BY AGE
10 A THIRD OF THE WOMEN ALL
BLACK WOMEN IN THIS STUDY USED
STRAIGHTENERS AT LEAST TWICE A
YEAR.
IN TERMS OF BREAST CANCER AND
HAIR PRODUCTS, WE DID SEE A
SMALL OVER ALL ASSOCIATION
BETWEEN PERMANENT HAIR DYES AND
BREAST CANCER RISK.
BY FAR THOUGH IT WASN'T QUITE
STATISTICALLY SIGNIFICANT BY FAR
OUR GREATEST ASSOCIATION WAS FOR
HAIR STRAIGHTENERS.
WHEN WE LOOKED AT FREQUENCY
USING HAIR STRAIGHT NER --
STRAIGHTENERS WAS ASSOCIATED
WITH A 35% INCREASE WITH BREAST
CANCER RISK.
FOR THE PERMANENT HAIR DYES
THERE WAS A 7% INCREASE FOR
WHITE WOMEN AND POTENTIALLY IT
REFLECTED THE DIFFERENT PRODUCTS
THAT ARE MARKETED TO BLACK WOMEN
AS WELL AS DIFFERENCES IN HAIR
TEXTURE AND ABSORPTION.
FOR STRAIGHTENERS THE
ASSOCIATIONS DIDN'T VARY BY
RACE.
BUT BECAUSE SO MANY MORE BLACK
WOMEN THAN WHITE WOMEN IN OUR
STUDY USE THESE PRODUCTS IT'S
POTENTIALLY A MUCH MORE
MEANINGFUL RISK.
WE ALSO LOOKED AT HAIR PRODUCT
USE AT AGE 10 TO 13 IN RELATION
TO BREAST CANCER AND DID SEE
THAT PREMENOPAUSAL BUT NOT POST
MENOPAUSAL CANCER WAS ASSOCIATED
WITH THE USE OF THE HAIR
STRAIGHTENERS AND PERMS AND IT
WAS SAME BY RACE BUT IN OUR
STUDY, 75% OF WOMEN REPORTED
CHILDHOOD USE OF HAIR
STRAIGHTENERS VERSUS 3% IN WHITE
WOMEN.
ADOLESCENT HAIR DIE USE WAS UB
COMMON IN NOT-ASSOCIATED BREAST
CANCER BUT SAW A HAZARD RATIO OF
1. 77 AND THIS RAISED A LOT OF
CONCERN AND GOT PRESS AND
ANOTHER NIEHS EPIDEMIOLOGIST AND
HER TEAM STUDIED THE USE OF HAIR
PRODUCTS ON OUTERIN CANCER AND
NO ASSOCIATION ON OVARIAN CANCER
BUT THE MOST RECENT RESULTS WERE
ESPECIALLY CONCERNING GIVEN THE
RISING RATES OF UTERINE CANCER
IN THE U.S.
I WANT TO WORK ON AMBIENT
ENVIRONMENTAL EXPOSURES BECAUSE
I'M RUNNING OUT OF TIME.
WE COLLECTED SELF-REPORTED
INFORMATION ON EXPOSURES AT
RESIDENCE LEVEL AND THEN WE HAVE
GEOSPATIAL INFORMATION WE'RE
TAKING ADVANTAGE OF.
VARIOUS LEVELS OF SPATIAL
RESOLUTION FOR THIS.
ONE OF EARLIER PAPERS WE LOOKED
AT INDOOR AIR POLLUTION AND
FOUND THAT HAVING A FIRE PLACE
IN THE HOME OR USING A FIRE
PLACE OR STOVE IN THE HOME WAS
ASSOCIATED WITH BREAST CANCER
RISK AND THAT THE TYPE OF
MATERIAL THAT WAS ASSOCIATED
WITH RISK WAS WOOD AND GAS.
DR. WHITE'S GROUP IS FOCUSSED ON
AIR POLLUTION IN RELATION TO
BREAST CANCER.
IT'S CLASSIFIED AS AN CARCINOGEN
TO HUMANS AND IN THE INHALED
POLLUTANTS FOUND IN BREAST FLUID
BUT IT'S A COMPLEX HETEROGENEOUS
MIXTURE OF CARCINOGENIC AND
ENDOCRINE DISRUPTING COMPOUNDS.
IT'S NOT ONE SINGLE THING.
ECO LOGIC EVIDENCE SHOW IT'S
HIGHER IN URBAN AREAS AND THE
INCREASE HAS BEEN SHOWN TO
INCREASE WITH TRAFFIC RELATED
EMISSIONS.
YOU CAN SEE IN THE GRAPH THE
PARALLEL RISES IN BREAST CANCER
INCIDENTS.
EPIDEMIOLOGIC STUDIES SHOW OTHER
MEASURES OF TRAFFIC POLLUTION
BUT PARTICULATE MATTER AND PM2.5
ARE INCONSISTENT AND RECENT
META-ANALYSIS FOUND NO EVIDENCE
OF AN EFFECT.
PARTICULATE MATTER IS AN
AGGREGATE OF DIFFERENT THINGS
THAT ARE MEASURED OR REPORTED
BASED ONLY ON PARTICLE SIZE.
THIS GEOGRAPHIC VARIABILITY IN
THE COMPOSITION AND VARYING
EXPOSURE SOURCES.
IN OUR EARLY REPORTS WE ALSO
CONFIRMED AN ASSOCIATION JUST
WITH ESTROGEN RECEPTOR AND P
PROGES
PROGESTERONE ASSOCIATION IN THE
CHEMICAL COMPOSITION.
I WANT TO TALK ABOUT HEALTH
DISPARITY.
WHERE YOU LIVE MATTERS.
IT'S A SOURCE OF EXPOSURE TO
MULTIPLE STRESSORS AND
DETERMINES YOUR ACCESS TO HEALTH
CARE, OTHER RESOURCES AND
SERVICES.
ONE OF THE MEASURES A GEOGRAPHIC
MEASURE OF SOCIO ECONOMIC
DISPARITIES WE'VE USED IS
SOMETHING CALLED THE AREA
DEPRIVATION INDEX IT COMBINES 17
CENSUS AND AMERICAN COMMUNITY
SURVEY VARIABLES AND YOU CAN SEE
HIGH DISADVANTAGE AND SCORED IN
THE OPPOSITE AND THE BLUE IS LOW
DISADVANTAGE.
IN THE SISTER STUDY PARTICIPANTS
ARE PRETTY WELL OFF AND HALF THE
SISTER PARTICIPANTS HAVE AN AREA
DEPRIVATION INDEX LESS THAN THE
U.S. 30th PERCENTILE.
HARD TO COMPUTE BUT SUFFICE TO
SAY WHEN WE'RE LOOKING AT THIS
WE'RE COMPARING PEOPLE WITH
SCORES IN THE TOP 50% AND
DISADVANTAGED BROADLY TO OTHER
GROUPS MORE POPULATED AND THE
AREA OF DEPRIVATION INDEX WAS
ASSOCIATED WITH HYPERTENSION IN
OUR STUDY.
HARDER TO GET A HANDLE ON BREAST
CANCER AND IT'S THE HIGH SES
DISEASE.
IT'S HY IN HIGH-INCOME --
ASSOCIATED WITH HIGH-INCOME
COUNTRIES AND WE SAW AN INVERSE
ASSOCIATION AS WE EXPECTED
BETWEEN THE AREA DEPRIVATION
INDEX AND OVER ALL BREAST CANCER
INCIDENTS BUT WHEN WE TRY TO
TEASE IT A PART FOR ESTROGEN
RECEPTOR POSITIVE BREAST CANCER,
THAT'S THE CASE, BUT FOR ER
NEGATIVE BREAST CANCER WE START
TO SEE EVIDENCE OF A POSITIVE
TREND WITH WORSE DISADVANTAGE
AND NOTABLY THOUGH WE'RE WAY
UNDERPOWERED TO DO THIS THE
GREATEST HAZARD RATIO WAS AMONG
BLACK WOMEN WITH ESTROGEN
NEGATIVE RECEPTOR BREAST CANCER
WHICH IS CONSISTENT WITH RESULTS
FROM ANOTHER STUDY COMPRISED
SOLELY OF BLACK WOMEN.
I'D LIKE TO LEAVE TIME FOR
QUESTIONS BUT I WANT TO TALK
ABOUT OUR EPIGENETIC WORK AND
MECHANISMS ARE AFFECTED BY
ENVIRONMENTAL AND AGING AS WELL
AS LIFESTYLE EXPOSURES AND WE
CARRIED OUT A CASE COHORT STUDY
AND FIRST THING WE DID WITH THE
CASE COHORT WAS TO CARRY OUT
GENOME WIDE ASSOCIATION STUDY OF
BREAST CANCER.
WE IDENTIFIED MANY MARKERS THAT
WERE ASSOCIATED WITH INCIDENT
INVASIVE BREAST CANCER AND
REPLICATED THE RESULTS IN AN
INDEPENDENT STUDY AND LOWER
INVASIVE AND LOWER METHYLATION
AND INVASIVE CASES.
WE HAVE BEEN MORE FOCUSSED
RECENTLY ON USING THOSE
INDIVIDUAL CPGs IN COMBINATIONS
TO PREDICT BIOLOGIC PROCESSES
AND PHENOTYPES.
THESE CAN BE COMBINED UP TO
MEASURE PERIPHERAL IMMUNE CELL
COMPOSITION, CIRCULATING LEVELS
AND AGING PHENOTYPES AND
MORTALITY PREDICTORS.
I'M GOING TO FOCUS ON THE
SO-CALLED EPIGENETIC CLOCK
MEASURE BIOLOGIC AGE AND AGE
ACCELERATION IS CONSIDERED THE
DIFFERENCE BETWEEN BIOLOGICAL
AGE AND CHRONOLOGICAL AGE.
OUR GOAL IS WE'VE BEEN LOOKING
AT ENVIRONMENTAL AND LIFE STYLE
EXPOSURES TO AGE ACCELERATION
AND IN TERM LOOKING AT
DEMETHYLATION ACCELERATION IN
RELATION TO BREAST CANCER
INCIDENTS USING THE BLOCKS
LISTED HERE THAT DO SLIGHTLY
DIFFERENT THING, PREDICTING AGE
AND MORTALITY OR AGING RATES.
IN CONSIDERING ENVIRONMENTAL AND
LIFESTYLE EXPOSURES WE FOUND A
LOT OF ASSOCIATIONS WITH DNA
METHYLATION ACCELERATION AND
GOING BACK TO THE SOCIAL
VARIABLES WE USED THE AREA
DEPRIVATION INDEX AND SLOWED FOR
SEVERAL OF THESE CLOCKS THE
INCREASING LEVELS OF DNA
METHYLATION AGING WERE
ASSOCIATED ERROR INCREASING
LEVELS OF AREA DEPRIVATION WERE
ASSOCIATED WITH MORE -- I'M
TIRED.
WITH GREATER RATES OF AGING.
WE ALSO USED DNA METHYLATION AGE
IN RELATION TO BREAST CANCER
INCIDENTS IN WORK LED BY MY
COLLEAGUE JEFF TAYLOR AND OTHERS
WHO MOVED ON FROM BEING A
POSTDOC WITH US TO BEING A
RESEARCHER AT THE MOFFETT CANCER
INSTITUTE.
WE SHOWED DNA METHYLATION AGE
ACCELERATION WAS ASSOCIATED WITH
BREAST CANCER INCIDENTS USING
SEVERAL OF THESE CLOCKS.
THE MOST RECENT STUDY IS ONE
THAT'S EXCITING WHERE WE'VE BEEN
ABLE TO TAKE ADVANTAGE OF OUR
TWICE-MEASURED PARTICIPANTS THAT
GAVE US A SECOND BLOOD SAMPLE
ABOUT EIGHT YEARS LATER AFTER
THE FIRST.
WE'VE BEEN ABLE TO LOOK AT
CHANGES IN MYTHALATION --
METHYLATION IN TIME ACCOUNTING
FOR DIFFERENCES AFROM THE START
AND SHOWING DIFFERENCES FROM AGE
AT THE SECOND BLOOD DRAW
COMPARING CASES TO NON-CASES.
THERE WAS DIFFERENTIAL AGING
AMONG THE CASES USING THE SECOND
TIME POINT USING SEVERAL OF
THESE CLOCKS.
AND IMPORTANTLY AND SOMETHING WE
NEED TO THINK ABOUT MORE IS WHEN
WE LOOK ONLY AT THE CASES THE
ASSOCIATIONS WERE STRONGER AMONG
WOMEN TREATED WITH RADIATION.
WE EXPECT THEM TO SEE IT FOR
CHEMOTHERAPY AND CONSISTENTLY
RADIATION POPPED UP.
EVEN IN LARGE COHORTS, WE'RE
UNDER POWERED TO STUDY RARE
EXPOSURES OR OUTCOMES.
OUR WORK IN THE SISTER STUDY LED
US TO DEVELOP A CONSORTIUM
FOCUSSED ON PREMENOPAUSAL BREAST
CANCER AND I WANT TO SHARE TWO
EXAMPLES.
THE FIRST IS THAT THERE'S BEEN A
CONUNDRUM THAT PARITY IS
PROTECTIVE FOR BREAST CANCER BUT
INCREASES SHORTLY AFTER THE
FIRST FULL-TERM BIRTH.
WE WANTED TO LOOK AT THIS IN THE
SISTER STUDY BUT WERE
UNDERPOWERED AND IT PROMPTED US
TO DO THIS AND THERE'S AN
INCREASED RISK FOR BREAST CANCER
AMONG WOMEN THAT PEAKED AT FIVE
YEARS AFTER THE MOST RECENT
BIRTH AND THIS PROTECTION --
INCREASE LASTED A LONG TIME AND
LASTED 24 YEARS AND WE LOOKED AT
ANOTHER BIT OF CONFLICTING
EVIDENCE IN THE BREAST CANCER
LITERATURE WHERE INCREASING BODY
MASS INCREASE IS A RISK FACTOR
FOR BREAST CANCER POST
MENOPAUSAL AND THERE'S THERE'S
LINEAR ASSOCIATION BETWEEN
INCREASING BODY MASS INDEX
BEFORE MENOPAUSE AND IN
PREMENOPAUSAL WOMEN UNDER THE
AGE OF 55.
I'M COMING TO A CLOSE,
THANKFULLY.
WE'RE WORKING TOWARDS THE FUTURE
TO ENHANCE OUR EXPOSURE AND
WE'RE ADDING INFORMATION ON HAIR
TEXTURE WHICH WE THINK IS
IMPORTANT IN OUR HAIR PRODUCT
USE RESULTS WE'RE ADDING
INFORMATION ON SUNSCREEN USE AND
HOUSING CHARACTERISTICS AND
CLIMATE RESILIENCE.
WE WANT IT KNOW IF PEOPLE ARE
PROTECTED BY HEAT WAVES BY
HAVING FANS AND AIR CONDITIONS
AND HOW THAT'S GOING TO AFFECT
YOUR HEALTH IN THE FUTURE.
WE'RE ALSO PLANNING TO PILOT A
SECOND OR SOMETIMES THIRD
BIOLOGIC SAMPLE QUESTION
COLLECTION WHICH IS REALLY
IMPORTANT IN THESE TYPES OF
STUDIES BECAUSE THE SPOT SAMPLE
DOESN'T DO IT FOR YOU IN
UNDERSTANDING HEALTH.
THIS TIME WE'RE GOING TO FOCUS
ON MAKING SURE THAT WE INCLUDE A
LARGER SAMPLE OF OUR BLACK WOMEN
AND HISPANIC WOMEN INCLUDING
WOMEN WHO ALREADY GAVE A SECOND
SAMPLE AND FOCUS ON THE RARE
BREAST CANCER SUB TYPES.
THANKS TO A COLLABORATION WE'VE
LINED UP WITH COLLABORATORS AT
THE NCI WE'LL BE COLLECTING
FECAL SAMPLES FOR MICROBIOME
RESEARCH.
THAT'S IT.
I'M NOT GOING TO GO THROUGH ALL
THE THANK YOU BUT TO MENTION MY
SISTER STUDY CO-INVESTIGATORS
AND PICTURES I'M SHOWING ARE A
SNAPSHOT OF ONE POINT IN TIME OF
THE MANY STUDY INVESTIGATORS AND
FELLOWS AT NIEHS WHO USE THE
STUDY AS WELL AS THE ORIGINAL
STUDY DEVELOPMENT ATTEMPT.
SO YOU CAN FIND OUT MORE ON OUR
WEBSITE.
IT'S OUR 20th ANNIVERSARY AND
THE COMMUNICATION HAS RUN OF IT
AND THEY DEVELOPED A FABULOUS
VIDEO.
THERE IS A PREVIEW OF THE VIDEO
THAT CAN BE SEEN ON YOUTUBE.
I'VE WATCHED AND SHOWN THIS TO
EVERYBODY TODAY BUT YOU CAN'T
GET IT UNTIL SEPTEMBER 29th AND
CAN FIND THAT AND THE FULL VIDEO
AND THANK YOU AND HAPPY TO TAKE
QUESTIONS IF THERE'S TIME.
>> REBECCA HERE.
THANK YOU FOR THE WONDERFUL
PRESENTATION.
AND I'M AT THE INFECTIOUS
DISEASE INSTITUTE AND WANT TO
LINK WITH WHAT YOU'VE DONE.
WHAT DATA DO YOU COLLECT ON THE
INFECTIOUS DISEASE, DIAGNOSIS
AND ICT CODES OR ANYTHING ELSE.
>> WE HAVEN'T YET LINKED IN THIS
COHORT MEDICARE AND IN THE
AGRICULTURAL HEALTH STUDY WE CAN
DO SOME OF THAT IN RELATION TO
PESTICIDE USE.
WE HAVE SOME SELF-REPORTED DATA.
INTERESTED IN COLLABORATION
THOUGH.
WE ASK ABOUT VACCINES AND DURING
COVID WE ASKED A LOT OF
QUESTIONS ABOUT COVID INFECTION
AND STRESSORS RELATED TO
COVID-19 AND THE DATA IS UNDER
UTILIZED AND WE'LL WELCOME YOUR
COLLABORATION.
>> THANK YOU.
AND CAN YOU EXTEND IT TO THE
NEXT GENERATION FROM SISTERS TO
DAUGHTERS AND GRAND DAUGHTERS.
>> FROM YOUR MOUTH TO MY
SCIENTIFIC DIRECTOR'S EARS.
THE ADVANTAGE WOULD BE OF COURSE
WE COLLECTED ALL THESE
REPRODUCTIVE HISTORIES AND LINK
IT BACK TO WHAT'S IN THEIR
DAUGHTERS AND HAVE THE GENETIC
INFORMATION.
IT'S A FABULOUS THING WE TALK
ABOUT.
THERE'S A LOT OF ON OUR PLATE
RIGHT NOW AND IT'S NOT A GOOD
BUDGET YEAR COMING UP.
>> AT LEAST IN SOME AREA THERE'S
CONNECTION MAINLY IN TERMS OF
DIABETES RISK FACTORS IN THE
FRAMINGHAM HEART STUDY.
>> THE FRAMINGHAM IS A DIFFERENT
STUDY BECAUSE THE PARTICIPANTS
ARE INTENSIVELY STUDIED
CLINICALLY AND WE'RE GETTING
MORE OBSERVATIONAL WORK BUT
YEAH, THE OPPORTUNITIES ARE
THERE AND THIS IS A SOLELY
INTRAMURAL COHORT OPPOSED TO
OTHER COHORTS THE NIH SUPPORTS.
>> CONGRATULATIONS.
MORE POWER TO YOU.
>> CHARLES FROM NCI HERE.
YOU SHOWED ACCELERATED AGING FOR
CHEMOTHERAPY FOR RADIATION AND
NOT CHEMOTHERAPY --
>> THE OTHER WAY.
LESS SO IN CHEMOTHERAPY.
>> RIGHT.
WE'RE DOING THE DNA METHYLATION
WORK AND INTERESTED IN RADIATION
AND THE EFFECT ON DNA
METHYLATION AND AGING.
WHY DO YOU THINK RADIATION HAS
SUCH AN EFFECT AND CHEMOTHERAPY
DOESN'T?
WHAT'S DRIVING THIS?
>> I'M NOT REALLY SURE BUT
THERE'S THE POSSIBILITY OF
WHAT'S GOING DIRECTLY AFFECTING
THE CARDIOVASCULAR SYSTEM.
THERE'S CARDIOVASCULAR AGING IN
WOMEN TREATED FOR CANCER.
AND WE HAD IMMUNE CELL
POPULATIONS.
>> WE SHOULD TALK MORE ABOUT
THAT.
>> I LOOK FORWARD TO IT AND WE
TALKED ABOUT OPPORTUNITIES AT
LUNCH.
I LOOK FORWARD TO THAT.
>> THANK YOU.
>> DALE, THANK YOU FOR SUCH A
BEAUTIFUL AND IMPORTANT STUDY.
HAVE MAYBE A NAIVE QUESTION.
YOU'VE DESCRIBED IN NICE DETAIL
A LOT OF FACTORS THAT INCREASE
THE CHANCE OF RISK FACTOR.
IF A WOMAN HAS MULTIPLE
INDEPENDENT RISK FACTORS AND
DOES EVERYTHING WRONG COMPARED
TO HER SISTER DO THE INCIDENTS
CONTINUE TO GO UP OR THERE A
MAXIMUM?
>> THAT'S THE FUNDAMENTAL
QUESTION, RIGHT.
HOW CAN WE COMBINE ALL THESE
EXPOSURES AND COME UP WITH AN
INDEX OF THINGS THAT WOULD
ENHANCE YOUR RISK.
PEOPLE HAVE LOOKED AT GENE
ENVIRONMENT INTERACTIONS OR
LOOKED AT THE LARGE GENOMIC
STUDIES WHERE THEY'VE LOOKED AT
THE POLY GENIC RISK SCORES PLUS
BEHAVIORAL RISK CANCER BREAST
CANCER AND DO SHOW INCREASED
RISK.
AS THE A LONG TERM GOAL WE NEED
TO PUT IT TOGETHER.
THE EPIDEMIOLOGISTS WORK ONE WAY
BECAUSE THE OTHER WAY IS HARDER
AND WORKING ONE AT A TIME GUIDES
US INSTEAD OF PUTTING INTO A BIG
ARTIFICIAL INTELLIGENCE MACHINE
LEARNING PROGRAM AND SEEING WHAT
COMES OUT WE'LL HAVE INFORMATION
TO GUIDE WHAT WE WANT TO PUT
TOGETHER BUT I THINK WE SHOULD
DO THAT.
THANK YOU.
>> MAYBE ONE QUESTION ONLINE.
THERE'S AN EXCITING EVENT AT
3:30.
NOT ALL BEAUTY PRODUCTS ARE
CREATED EQUALLY.
HAIR DYES, STRAIGHTENERS AND
SOME ARE MORE NATURAL AND SAFER
AND THE FORMULATIONS HAVE
CHANGED OVER THE YEARS.
HOW DO YOU DIFFERENTIATE AMONG
THEM?
DO YOU KNOW THE FORMULA NAME?
>> THAT WOULD BE NICE.
THAT'S AN IMPORTANT POINT.
WE'RE LOOKING ON AVERAGE.
IN ANOTHER CITY WHICH I DON'T
WANT TO GIVE AWAY BECAUSE IT
HASN'T BEEN PEER REVIEWED WE
TRIED TO LOOK AT BIRTH COHORTS
BECAUSE THE PRODUCTS CHANGED
OVER TIME SO IT'S A POOR
SUBSTITUTION FOR WHAT'S IN THE
PRODUCTS.
WE CAN READ WHAT'S ON THE BOX
BUT WE'D HAVE TO GO BACK IN TIME
AND GET HISTORICAL AIR -- HAIR
PRODUCTS IT'S TRICKIER TO DO.
I WISH WE COULD.
WE RECENTLY COMPLETED OUR FOURTH
FOLLOW-UP AND COLLECTED MORE
INFORMATION BUT WE STILL WERE
AFRAID PEOPLE CAN'T TELL IS THE
PRODUCTS USED BUT GOT MORE
INFORMATION ABOUT PRODUCTS USED.
>> LET'S THANK DALE AGAIN FOR A
WONDERFUL MIDER LECTURE.