Publications by authors named "Marilyn Kwan"
Purpose: Breast cancer survivors experience higher rates of cardiovascular disease (CVD) than women without breast cancer, due in part to cardiotoxic cancer treatments and shared lifestyle risk factors. Physical activity is associated with lower mortality risk in breast cancer survivors, but associations with CVD have not been examined in detail.
Methods: The Pathways Study is a prospective cohort study of 4,504 women diagnosed with invasive breast cancer between 2005 and 2013.
Article Synopsis
- This study investigated how social support affects the timing of surgery and chemotherapy in women with breast cancer at a healthcare system in Northern California.
- Out of 3,983 women analyzed, those with lower social support had a higher likelihood of experiencing delays in surgery and chemotherapy after diagnosis.
- Specifically, younger women (under 54) with low social support were significantly more likely to face delays in chemotherapy compared to older women.
Background: Medical imaging is an integral part of healthcare. Globalization has resulted in increased mobilization of migrants to new host nations. The association between migration status and utilization of medical imaging is unknown.
View Article and Find Full Text PDFPurpose: Bladder cancer is 1 of the most costly cancers, however there is limited research on medical care costs by type of urinary diversion. The objective of our study was to compare medical care costs of the 2 most common urinary diversions in the year following radical cystectomy.
Methods: The Bladder Cancer Quality of Life Study included patients diagnosed with bladder cancer who underwent radical cystectomy and received an ileal conduit (IC, n = 821) or neobladder (NB, n = 181) in 3 integrated health systems.
Article Synopsis
- - The study analyzed a diverse group of 9,639 women with first primary invasive breast cancer to identify risk factors for second primary breast cancer (SBC), focusing on both contralateral and ipsilateral cases.
- - Results showed that younger women with ER/PR-negative cancer and family history had increased risk of contralateral SBC, while older women showed higher risk linked to family history and lifestyle factors like being overweight and alcohol consumption.
- - The research highlighted persistent elevated risks for SBC among African American, Asian American, and Hispanic women compared to non-Hispanic White women, suggesting the need for better screening and tailored risk assessments for different racial and ethnic groups.
Purpose: To examine the association of race and ethnicity groups with self-reported racial/ethnic discrimination in patient-provider interactions during the diagnosis and treatment for breast cancer.
Methods: We analyzed data from the Pathways Study, a prospective cohort of women diagnosed with breast cancer from 2006-2013 in the Kaiser Permanente Northern California Health Care System. Racial/ethnic discrimination in patient-provider interactions was assessed with two questions from the Interpersonal Processes of Care survey at baseline and 6-months and 24-months post-diagnosis.
Purpose: Women with breast cancer (BC) are at high risk of developing cardiovascular disease (CVD). We examined adherence to CVD medications and their association with major CVD events over 14 years of follow-up in the Pathways Heart Study, a prospective study of 4,776 stage I-III BC patients diagnosed from 2005-2013.
Methods: Eligibility included being alive 6 months post-BC diagnosis, with dyslipidemia, hypertension, or diabetes at diagnosis along with ≥1 prior outpatient order or dispensing for a statin, anti-hypertensive, or diabetes medication, respectively, in the 30 months prior.
Background: Hypertension is an important contributor to cardiovascular disease (CVD) in breast cancer (BC) survivors; however, research on blood pressure (BP) and CVD outcomes in BC survivors is limited.
Objectives: The purpose of this study was to better characterize the association between BP and CVD in a large, longitudinal cohort of BC patients.
Methods: Women with invasive BC diagnosed from 2005 to 2013 at Kaiser Permanente Northern California were matched 1:5 to women without BC.
Article Synopsis
- - The AYA Horizon Study analyzed cancer treatment patterns and birth outcomes for 555 individuals diagnosed with cancer during pregnancy, compared to 2,667 matched individuals without cancer.
- - The study found that cancer diagnosis during pregnancy significantly increased risks of preterm delivery, low birth weight, and cesarean deliveries, while no link was found with low Apgar scores.
- - A significant portion of patients received chemotherapy (41%), with many starting during pregnancy, and most underwent surgery (86%), whereas radiation treatment occurred only after pregnancy.
Article Synopsis
- This study analyzes breast cancer-specific survival (BCSS) in hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (mBC) patients, focusing on changes after the introduction of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) in 2015.
- Researchers used SEER registry data from 11,467 HR+/HER2- mBC patients, finding a 10% reduction in risk of BC-specific death for those diagnosed post-2015 compared to those diagnosed pre-2015, indicating improved survival due to CDK4/6i.
- In contrast, no significant improvements in BC
Background: Vitamin D is critical to bone health by regulating intestinal absorption of calcium, whereas proinflammatory cytokines, including IL-1, IL-6, IL-12, and TNF-α, are known to increase bone resorption. We hypothesized that vitamin D and these cytokines at the time of breast cancer diagnosis were predictive for fragility fractures in women receiving aromatase inhibitors (AIs).
Methods: In a prospective cohort of 1,709 breast cancer patients treated with AIs, we measured the levels of 25-hydroxyvitamin D (25OHD), IL-1β, IL-6, IL-12, and TNF-α from baseline blood samples.
Article Synopsis
- Allostatic load (AL) is a measure of stress in the body and may affect cancer survivorship, particularly among women with breast cancer.
- The study involved 2,553 participants and found that women who lived in low socioeconomic neighborhoods or areas with high traffic, crime, crowding, or fast-food restaurants had higher AL scores.
- The research suggests that improving neighborhood conditions could potentially enhance health outcomes for breast cancer survivors, highlighting the need for further studies on neighborhood stressors and their physiological effects.
Article Synopsis
- Nonmuscle-invasive bladder cancer (NMIBC) is frequently treated with mitomycin C (MMC) and bacillus Calmette-Guérin (BCG), but high recurrence rates remain a challenge.
- Research suggests that dietary isothiocyanates from cruciferous vegetables may enhance the effectiveness of these treatments by boosting enzyme metabolism and immune responses.
- In a study with 1158 NMIBC patients, those on BCG who consumed more than 2.4 servings of raw cruciferous vegetables per month showed significantly lower risks of both first and multiple recurrences, indicating a potential benefit of diet in managing this cancer.
Article Synopsis
- The study investigates the differences in prognostic factors influencing early (<5 years) and late (≥5 years) recurrence in women with early stage estrogen receptor-positive breast cancer using data from 2992 participants in the Pathways Study.
- Results show that higher cancer stage and grade consistently increase the risk of recurrence, while progesterone receptor negativity is specifically linked to early recurrence; however, endocrine therapy generally lowers the risk of overall recurrence.
- Notably, minoritized racial and ethnic groups, particularly Asian women, display a higher risk of early recurrence, indicating potential disparities in cancer outcomes even in a subtype typically associated with better prognosis.
Article Synopsis
- Women with breast cancer have a higher risk of cardiovascular disease (CVD), and this study explores whether better diet quality at diagnosis can reduce that risk.
- The analysis involved 3,415 women diagnosed with invasive breast cancer, assessing their diet quality scores at diagnosis to evaluate the relationship with CVD outcomes.
- Results indicated that higher diet quality, particularly from specific diet indices like the Dietary Approaches to Stop Hypertension, was linked to a significantly lower risk of various cardiovascular issues and CVD-related deaths.
Purpose: To compare the effectiveness and safety of a single injection of subconjunctival triamcinolone acetonide (TA) with that of postoperative topical prednisolone acetate (PA) with and without nonsteroidal anti-inflammatory drugs (NSAIDs) for cataract surgery prophylaxis.
Design: Retrospective, comparative effectiveness cohort study.
Participants: Patients at Kaiser Permanente Northern California from 2018 through 2021.
Article Synopsis
- Dietary isothiocyanates (ITCs) from cruciferous vegetables could positively impact the prognosis of non-muscle invasive bladder cancer (NMIBC) by possibly reducing progression risk, especially in individuals with certain genetic variations.
- The study analyzed data from 1,472 NMIBC patients, assessing their dietary intake of cruciferous vegetables and measuring ITC levels in their blood, using advanced statistical methods to determine the relationship between these factors and cancer outcomes based on specific gene variants.
- Results showed that while some genetic variations did affect the relationship between dietary ITCs and progression risk, a high intake of cruciferous vegetables was associated with a significant reduction in progression risk for most participants, suggesting dietary recommendations could enhance NMIBC survivorship.
Importance: It is unclear whether breast cancer (BC) with low ERBB2 expression (ERBB2-low) is a distinct clinical, pathological, and epidemiological entity from BC classified as no ERBB2 expression (ERBB2-negative).
Objective: To evaluate the clinical, pathological, and epidemiologic features of BC with ERBB2-low expression compared with ERBB2-negative BC in a large population study.
Design, Setting, And Participants: This cohort study was conducted as part of the Pathways Study, a prospective, racially and ethnically diverse cohort study of women with BC enrolled between 2006 and 2013 in Kaiser Permanente Northern California (KPNC).
Article Synopsis
- Identifying high-risk women for osteoporotic fractures from aromatase inhibitor therapy involves assessing known risk factors, but these may not accurately reflect the actual risk in breast cancer patients.
- A study of 2152 women with hormonal receptor positive breast cancer found that a polygenic score related to heel ultrasound speed of sound (gSOS) was a significant predictor of fracture risk after AI therapy over an average follow-up of 6.1 years.
- Women in higher tertiles of gSOS exhibited significantly lower fracture risks, indicating that gSOS could serve as an independent genetic predictor, suggesting further research is needed to integrate it into fracture risk assessment for breast cancer patients on AI therapy.
Article Synopsis
- Many adolescent and young adult (AYA) women diagnosed with cancer desire biological children but often lack information about how their cancer history may affect fertility and pregnancy outcomes.
- A study analyzed the birth outcomes of 1,648 births from AYA cancer survivors compared to 7,879 births from women without cancer, focusing on risks like preterm birth, low birth weight, and small for gestational age.
- Results indicated that while most outcomes were similar between groups, women with gynecologic cancers had a higher risk of low birth weight and a suggested increased risk of preterm birth, but chemotherapy was not linked to worse outcomes.
Bladder cancer is primarily diagnosed as non-muscle-invasive bladder cancer (NMIBC), with high recurrence and progression rates. Environmental and occupational exposures to carcinogens are well-known risk factors for developing bladder cancer, yet their effects on prognosis remain unknown. In the Be-Well Study, a population-based prospective cohort study of 1472 Kaiser Permanente patients newly diagnosed with NMIBC in California from 2015 to 2019, we examined history of environmental and occupational exposures in relation to tumor stage and grade at initial diagnosis by multivariable logistic regression, and subsequent recurrence and progression by Cox proportional hazards regression.
View Article and Find Full Text PDFBackground: The number of breast cancer survivors is increasing, yet evidence to inform dietary and lifestyle guidelines is limited.
Methods: This analysis included 3,658 participants from the Pathways Study, a prospective cohort of women diagnosed with invasive breast cancer. A healthy plant-based dietary index score (hPDI), an American Cancer Society (ACS) nutrition guidelines score, a 2015 Healthy Eating Index score (HEI), hours per week of moderate to vigorous physical activity (PA), and lifetime cumulative pack-years of cigarette smoking (SM) were each measured at diagnosis, 6, 24, and 72 months.
Objective: To evaluate the frequency of medical imaging or estimated associated radiation exposure in children with Down syndrome.
Methods: This retrospective cohort study included 4,348,226 children enrolled in six U.S.
Background: The impact of alcohol consumption on breast cancer (BC) prognosis remains unclear.
Methods: The authors examined short-term alcohol intake in relation to recurrence and mortality in 3659 women who were diagnosed with stage I-IV BC from 2003 to 2013 in the Pathways Study. Alcohol drinking in the past 6 months was assessed at cohort entry (mean, 2 months postdiagnosis) and 6 months later using a food-frequency questionnaire.
Unlabelled: Previous studies suggest associations of metabolic syndromes with breast cancer prognosis, yet the evidence is mixed. In recent years, the maturation of genome-wide association study findings has led to the development of polygenic scores (PGS) for many common traits, making it feasible to use Mendelian randomization to examine associations between metabolic traits and breast cancer outcomes. In the Pathways Study of 3,902 patients and a median follow-up time of 10.
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