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Optimizing Breast Cancer Outcomes: BMI, Tumor Markers, and Quality of Care

Grant #: ACS Grant
PI Name: Buist, Diana
Title: Optimizing Breast Cancer Outcomes: BMI, Tumor Markers, and Quality of Care
Funding Started: 2003

The American Cancer Society awarded CHS a three-year grant for two observational studies of factors associated with breast cancer recurrence and death from breast cancer. One study concerns the relationship between body mass index (BMI) and the risk of recurrence and death. The second focuses on medical information about women with early-stage breast cancer, comparing the treatment they receive with current clinical guidelines; this study is identifying characteristics of women who do not get care consistent with the guidelines. This, in turn, may help physicians target these types of women to ensure appropriate treatment in the future.

Advances in breast cancer screening and detection have allowed a larger proportion of women with breast cancer to become long-term survivors. As a result, more women are at risk for breast cancer recurrences. Learning more about ways to prevent recurrences will help to reduce the number of deaths from breast cancer.

The first study will look at the relationship between tumor growth and body mass index (BMI), an indicator of obesity that is based on a person's height and weight. Understanding how BMI is related to tumor growth could provide critical tools to assist clinicians with pre- and post-diagnostic breast cancer surveillance and would help clarify the role BMI plays as a predictor of recurrence and death from breast cancer. This study will include women who were over age 40 when they were diagnosed with breast cancer between 1988 and 1992. This study will follow them forward in time for 10 years recurrences and death from breast cancer.

The second project will study women aged 18-65 with early stage breast cancer to see what proportion of these women are not receiving appropriate treatment for their stage at diagnosis as defined by current clinical guidelines. There are a lot of randomized clinical trials that take place in women with breast cancer. These studies provide the ultimate evidence for whether one treatment is better than another for treating cancer. Expert panels routinely review the scientific literature and recommend appropriate changes to current clinical guidelines when newer and better treatments are found. Although these recommendations are widely distributed to physicians, there is a lot of variability in how breast cancer is treated. Receiving inadequate care for breast cancer can increase a woman's risk of recurrence and death from breast cancer. Unfortunately, it takes a long time to study recurrence and death as outcomes in studies, so the existing scientific literature about breast cancer care is out of date.

For this study, the investigators will identify the characteristics of the women who are not receiving appropriate treatment, so that physicians can more aggressively target these types of women in the future to ensure they receive the appropriate treatment. At the end of this study they could recommend interventions that could be developed to address the breakdowns in the process of care.