Cancer control

It all started with pioneering work in breast cancer surveillance. It continues with finding new ways to ensure that patients with various types of cancer receive care that meets their needs. Group Health Research Institute (GHRI) is discovering how patients, providers, and organizations can help improve early detection and cancer outcomes, including illness, death, and the quality and delivery of cancer care.

GHRI cancer researchers explore questions that span cancer's natural history, from biology, prevention, and early detection to treatment and providing care at the end of life. Projects range from the most prevalent cancers—breast, lung, colon, and prostate—to less common cancers such as pancreatic cancer and multiple myeloma. Answering these questions demands a multidisciplinary approach. The Institute's extensive expertise in behavioral medicine, biostatistics, epidemiology, and health services and economics gives scientists in the GHRI cancer group a sound foundation for studying a variety of interventions.

Group Health established one of the nation's first prospective, individually tailored, population-based breast cancer screening programs in 1986. Since then, GHRI investigators have helped the program to develop and improve based on evidence collected at Group Health and elsewhere. "Translation—spreading research findings into practice—permeates our research," said Diana Miglioretti, PhD, senior investigator at GHRI.

"The national impact of the Institute has grown in recent years, thanks in part to its involvement in multisite collaborative studies," said Margaret T. Mandelson, PhD, associate investigator at GHRI. The main examples are the Breast Cancer Surveillance Consortium (BCSC), the Cancer Biomedical Informatics Grid (caBIG), the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium, the Cancer Intervention and Surveillance Modeling Network (CISNET), and the Cancer Research Network (CRN).

The BCSC is a research resource for studies that assess the delivery and quality of breast cancer screening and related patient outcomes in the United States. This collaborative network includes five mammography registries with active data collection and two affiliated sites with historical data. The outcomes of the cancer cases can be found by linking to registries for tumors, pathology, or both. At GHRI Miglioretti leads the BCSC's central Statistical Coordinating Center. This Center pools data from the registries for analysis, develops and implements novel statistical methodology to characterize breast cancer screening, and facilitates use of BCSC data by investigators outside the Consortium. "Scientists in the BCSC have generated more than 300 peer-reviewed publications that are being used to guide U.S. and international policy decisions around breast cancer screening," said Diana Buist, PhD, a GHRI associate investigator who leads the Group Health registry: the Breast Cancer Surveillance Project. "We are also actively involved in translational research, including conducting a randomized trial across the country aimed at identifying variability in the quality and outcomes of care." She called BCSC research "critically important" for continuing to detect breast cancer early and reduce deaths from the disease.

GHRI founded and oversees the CRN, a National Cancer Institute (NCI) cooperative agreement of 14 community-based health care systems that participate in the HMO Research Network. It aims to improve the effectiveness of cancer prevention, control, and care through research that identifies system, provider, treatment, and patient factors affecting outcomes among 11 million people enrolled in the member organizations nationwide. The participating sites have access to large, stable, and diverse patient populations. Together, the CRN sites represent nearly 4 percent of the U.S. population. The CRN's rich integrated databases facilitate studies with long follow-up, and results from CRN research are promoting changes to health care delivery. GHRI investigators are providing administrative and scientific leadership for various investigations supported by more than $20 million from the National Cancer Institute (NCI) shared by the 14 HMO research centers over five years. Ed Wagner, MD, MPH, MacColl Institute director and GHRI senior investigator, leads the CRN.

Conquering cancer and alleviating its substantial physical and psychosocial burdens will require novel multidisciplinary approaches. This goes to the heart of a collaboration between the CRN and another NCI initiative, the Centers of Excellence in Cancer Communications Research. The result is the Cancer Communication Research Center, which comprises core projects designed to ensure that clinical practice incorporates research findings meaningfully. Wagner directs one of these core projects, which will test adding a nurse navigator to a patient's cancer care team.

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Researchers in cancer control

GHRI

Affiliate researchers

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Recent publications on cancer control

2008

Aiello Bowles EJ, Miglioretti DL, Sickles EA, Abraham L, Carney PA, Yankaskas B, Elmore J. Accuracy of short-interval follow-up mammograms by patient and radiologist characteristics. AJR Am J Roentgenol. 2008;190(5):1200-8. PubMed

Aiello Bowles EJ, Tuzzio L, Wiese CJ, Kirlin B, Greene SM, Clauser SB, Wagner EH. Understanding high-quality cancer care: a summary of expert perspectives. Cancer. 2008;112(4):934-42. Epub 2008 Jan 7. PubMed

Bonomi AE, Boudreau DM, Fishman PA, Ludman E, Mohelnitzky A, Cannon EA, Seger D. Quality of life valuations of mammography screening. Qual Life Res. 2008;17(5):801-14. Epub 2008 May 20. PubMed

Boudreau DM, Koehler E, Rulyak SJ, Haneuse S, Harrison R, Mandelson MT. Cardiovascular medication use and risk for colorectal cancer. Cancer Epidemiol Biomarkers Prev. 2008 Oct 28; [Epub ahead of print]. PubMed

Geiger AM, Buist DS, Greene SM, Altschuler A, Field TS. Survivorship research based in integrated healthcare delivery systems: the Cancer Research Network. Cancer. 2008;112(11 Suppl):2617-26. Epub 2008 Apr 21. PubMed

Goldman LE, Haneuse SJ, Miglioretti DL, Kerlikowske K, Buist DS, Yankaskas B, Smith-Bindman R. An assessment of the quality of mammography care at facilities treating medically vulnerable populations. Med Care. 2008;46(7):701-8. PubMed

Lehman CD, Rutter CM, Eby PR, White E, Buist DS, Taplin SH. Lesion and patient characteristics associated with malignancy after a probably benign finding on community practice mammography. AJR Am J Roentgenol. 2008;190(2):511-5. PubMed

Miglioretti DL, Rutter CM, Bradford SC, Zauber AG, Kessler LG, Feuer EJ, Grossman DC. Improvement in the diagnostic evaluation of a positive fecal occult blood test in an integrated health care organization. Med Care. 2008;46(9 Suppl 1):S91-6. PubMed

Park AN, Buist DS, Tiro JA, Taplin SH. Mediating factors in the relationship between income and mammography use in low-income insured women. J Womens Health (Larchmt). 2008;17(8):1371-8. PubMed

Terry MB, Buist DS, Trentham-Dietz A, James-Todd TM, Liao Y. Nonsteroidal anti-inflammatory drugs and change in mammographic density: a cohort study using pharmacy records on over 29,000 postmenopausal women. Cancer Epidemiol Biomarkers Prev. 2008;17(5):1088-95. PubMed

Welsh ML, Buist DS, Aiello Bowles EJ, Anderson ML, Elmore JG, Li CI. Population-based estimates of the relation between breast cancer risk, tumor subtype, and family history. Breast Cancer Res Treat. 2008; [Epub ahead of print]. PubMed

2007

Aiello EJ, Buist DS, Wagner EH, Tuzzio L, Greene SM, Lamerato LE, Field TS, Herrinton LJ, Haque R, Hart G, Bischoff KJ, Geiger AM. Diffusion of aromatase inhibitors for breast cancer therapy between 1996 and 2003 in the Cancer Research Network. Breast Cancer Res Treat. 2008;107(3):397-403. Epub 2007 Mar 28. PubMed

Boudreau DM, Yu O, Miglioretti DL, Buist DS, Heckbert SR, Daling JR. Statin use and breast cancer risk in a large population-based setting. Cancer Epidemiol Biomarkers Prev.2007;16(3):416-21. PubMed

Chubak J, Buist DS, Boudreau DM, Rossing MA, Lumley T, Weiss NS. Breast cancer recurrence risk in relation to antidepressant use after diagnosis. Breast Cancer Res Treat. 2007; [Epub ahead of print]. PubMed

Field TS, Doubeni C, Fox MP, Buist DS, Wei F, Geiger AM, Quinn VP, Lash TL, Prout MN, Yood MU, Frost FJ, Silliman RA. Under utilization of surveillance mammography among older breast cancer survivors. J Gen Intern Med. 2008;23(2):158-63. Epub 2007 Dec 1. PubMed

Kerlikowske K, Ichikawa L, Miglioretti DL, Buist DS, Vacek PM, Smith-Bindman R, Yankaskas BC, Carney P, Ballard-Barbash R. Longitudinal measurement of clinical mammographic breast density to improve estimation of breast cancer risk. J Natl Cancer Inst. 2007;99(5):386-95. PubMed

Kerlikowske K, Miglioretti DL, Buist DS, Walker R, Carney PA. Declines in invasive breast cancer and use of postmenopausal hormone therapy in a screening mammography population. J Natl Cancer Inst. 2007;99(17):1335-9. Epub 2007 Aug 14. PubMed

Lash TL, Fox MP, Buist DS, Wei F, Field TS, Frost FJ, Geiger AM, Quinn VP, Yood MU, Silliman RA. Mammography surveillance and mortality in older breast cancer survivors. J Clin Oncol. 2007;25(21):3001-6. Epub 2007 Jun 4. PubMed

Miglioretti DL, Smith-Bindman R, Abraham L, Brenner RJ, Carney PA, Bowles EJ, Buist DS, Elmore JG. Radiologist characteristics associated with interpretive performance of diagnostic mammography. J Natl Cancer Inst. 2007;99(24):1854-63. Epub 2007 Dec 11. PubMed

Owusu C, Buist DS, Field TS, Lash TL, Thwin SS, Geiger AM, Quinn VP, Frost F, Prout M, Ulcickas Yood M, Wei F, Silliman RA. Predictors of tamoxifen discontinuation among older women with estrogen receptor positive breast cancer. J Clin Oncol. 2008;26(4):549-55. Epub 2007 Dec 10. PubMed

Yood MU, Owusu C, Buist DS, Geiger AM, Field TS, Thwin SS, Lash TL, Prout MN, Wei F, Quinn VP, Frost FJ, Silliman RA. Mortality impact of less-than-standard therapy in older breast cancer patients. J Am Coll Surg. 2008;206(1):66-75. Epub 2007 Oct 3. PubMed

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Our major research interests

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