Optimizing breast cancer outcomes: BMI, tumor markers and quality of care (IT Supplement)

This Clinical Research Training Grant application is multidisciplinary in design. Collaborators with expertise in breast cancer epidemiology, prognostic factors, breast pathology and quality of breast cancer care will provide mentorship and support to assist Dr. Buist to develop as an independent academic researcher. In a defined population-based managed care setting, Dr. Buist plans to pursue a three-year mentored program that consists of two research projects, teaching epidemiology, and formal and informal training in cancer pathology, pharmacology, and analysis. This application is jointly sponsored by faculty from the Center for Health Studies at Group Health Cooperative, the Fred Hutchinson Cancer Research Center, and the University of Washington.

Advances in breast cancer screening and detection have increased the proportion of long-term breast cancer survivors. Thus, more women are at risk for breast cancer recurrence, second primary breast tumors, and long-term sequelae of their original treatment. Learning more about whether there are preventable factors that influence the sequelae of outcomes will help us with the secondary prevention of breast cancer and will lead to a reduction in morbidity.

Research at Group Health Cooperative (GHC) is supported by extensive automated clinical data systems, including routine linkage between GHC enrollment files and the Western Washington Surveillance Epidemiology and End Results registry. GHC investigators also have access to a large patient population and automated data systems. Care can be tracked from in- and out-patient visits to primary and specialty providers, hospital stays, prescription drug fills, radiology, and results of lab tests (including biopsy data for benign and malignant lesions). The two longitudinal observational studies described in this application are designed to provide Dr. Buist with experience in breast cancer treatment (projects 1 & 2), breast pathology and prognostic factors (project 1), and quality of breast cancer care (project 2). Both studies in this application take advantage of an array of computerized data systems and medical records at GHC to follow two cohorts of women with breast cancer from their date of their diagnosis for 5 years (project 2) and 10 years (project 1) to ascertain breast cancer outcomes, specifically recurrence and mortality (breast cancer specific and all-cause).

The proposed mentored research and educational program outlined in this application will facilitate Dr. Buist’s growth and maturation as an academic researcher and will play a critical role in her understanding of traditional therapies for breast cancer. At the end of this three-year award, Dr. Buist will have gained experience in appropriately measuring breast cancer treatment in an observational setting, biologic characteristics of tumors, and quality of cancer care. Each of these will be essential for incorporating disease-free survival as an endpoint in epidemiologic studies and for building a successful independent research program focused on reducing morbidity and mortality from breast cancer. Upon completion of this grant, she will also have gained an understanding of where the fields of prognostic factors and breast cancer-free survival are, where observational data could best be used to track long- and short-term outcomes of breast cancer, and she will have a good understanding of where HMO research could best contribute to the field. The purpose of this application is not solely to seek answers to novel research questions, but also to build infrastructure and collaborative ties with multi-disciplinary researchers in the scientific community who will help Dr. Buist develop a successful independent research program in breast cancer control and secondary prevention.

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