Grant Number:	5U01CA195565-09 Interpret this number
Primary Investigator:	Kushi, Lawrence
Organization:	Kaiser Foundation Research Institute
Project Title:	Infrastructure for Pathways, a Prospective Study of Breast Cancer Survivorship
Fiscal Year:	2024

ABSTRACT The Pathways Study is a prospective cohort study of women diagnosed with first primary invasive breast cancer in the Kaiser Permanente Northern California (KPNC) health care system. Enrolled from January 2006 through May 2013, the 4,505 women in the cohort are racially and ethnically diverse, and include 351 (7.8%) African American, 512 (11.4%) Latina, and 599 (13.3%) Asian women. Data have been collected on food intake, physical activity, use of nutritional supplements and complementary and alternative therapies, and quality of life, social support, doctor-patient communications, and other factors. We have banked biospecimens at Roswell Park Comprehensive Cancer Center including blood (n=4,034, or 90% of the cohort), saliva (n=4,310, or 96%), and extracted germline DNA (n=4,437, or 99%), and have conducted genome-wide assays through the NIH Center for Inherited Disease Research program. We have established a biorepository of slides and tumor blocks from initial surgery (n=4,150, or 92%). We have also geocoded baseline addresses and linked these data to contextual databases to create neighborhood-level social and built environment variables. The KPNC setting provides access to electronic health records (EHRs), and we have detailed data available on diagnostic characteristics, treatment regimens, high-grade toxicities, and comorbid conditions. As of February 24, 2020, 572 recurrences, 424 second primary invasive cancers, and 886 deaths have been identified, with 1,286 women with at least one of these outcomes. In this infrastructure competitive renewal application, we propose to maintain and augment the Pathways Study to support research questions that build upon this resource. Study participants will continue to be followed for updates and outcomes through biennial follow-up questionnaires. We will maintain our biorepositories at Roswell Park and KPNC, and expand our tumor specimen bank by collecting slides and tumor blocks from ~600 recurrences. We will enhance our data resources with ongoing linkage with the KPNC EHR, and establish new linkages with geospatial environmental exposure databases and California statewide data on hospitalizations, emergency department visits, and ambulatory surgery. To address relevance to changes in breast cancer treatment and care, we will complement the cohort by establishing a data-only cohort of about 48,000 invasive breast cancer cases diagnosed and treated in KPNC from 2006-2023, will extract data from the KPNC EHR, and link to geospatial and statewide health care data, as with the Pathways Study. We will continue engagement with our External Advisory Board and Community Advisory Board to help guide infrastructure activities and prioritize research use of this cohort. We will also create a Pathways Study data enclave that will enable investigators to readily explore data and biospecimen availability for analyses or research projects. Continued support will enhance this unique, outstanding, multi-level, multi-dimensional, innovative resource, and facilitate its availability for the broader research community.




A validation study for measuring Asian- and Hispanic-serving sociocultural institutions in neighborhoods using business listing data and potential implications for health.
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Differences in Smoking Behavior by Nativity, Race/Ethnicity, and Education Among Women Diagnosed with Breast Cancer.
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A polygenic score associated with fracture risk in breast cancer patients treated with aromatase inhibitors.
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Assessment of breast cancer chemotherapy dose reduction in an integrated healthcare delivery system.
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Hypothetical interventions on diet quality and lifestyle factors to improve breast cancer survival: the Pathways Study.
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Alcohol consumption and prognosis and survival in breast cancer survivors: The Pathways Study.
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Development of cardiometabolic risk factors following endocrine therapy in women with breast cancer.
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A Mendelian Randomization Analysis of 55 Genetically Predicted Metabolic Traits with Breast Cancer Survival Outcomes in the Pathways Study.
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Development and testing of a polygenic risk score for breast cancer aggressiveness.
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Neighborhood attributes and cardiovascular disease risk in breast cancer survivors: The Pathways Study.
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Authors: Greenlee H. , Rillamas-Sun E. , Cheng R. , Iribarren C. , Rana J.S. , Nguyen-Huynh M. , Kushi L.H. , Kwan M.L. .
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Risk of Cardiometabolic Risk Factors in Women With and Without a History of Breast Cancer: The Pathways Heart Study.
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Authors: Leoce N.M. , Jin Z. , Kehm R.D. , Roh J.M. , Laurent C.A. , Kushi L.H. , Terry M.B. .
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Authors: Anyene I.C. , Ergas I.J. , Kwan M.L. , Roh J.M. , Ambrosone C.B. , Kushi L.H. , Cespedes Feliciano E.M. .
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Authors: Wright J.D. , Kroenke C.H. , Kwan M.L. , Kushi L.H. .
Source: Qualitative Health Research, 2021 05; 31(6), p. 1056-1068.
EPub date: 2021-02-28 00:00:00.0.
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Clustering of Social and Physical Pain Variables and Their Association With Mortality in Two Population-Based Cohorts.
Authors: Kroenke C.H. , Alexeeff S. , Kushi L.H. , Kwan M.L. , Matthews K.A. .
Source: Psychosomatic Medicine, 2021-04-01 00:00:00.0; 83(3), p. 228-238.
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Authors: Kwan M.L. , Lo J.C. , Laurent C.A. , Roh J.M. , Tang L. , Ambrosone C.B. , Kushi L.H. , Quesenberry C.P. , Yao S. .
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PMID: 33565036
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Distinct trajectories of moderate to vigorous physical activity and sedentary behavior following a breast cancer diagnosis: the Pathways Study.
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PMID: 32130627
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Authors: Yao S. , Laurent C.A. , Roh J.M. , Lo J. , Tang L. , Hahn T. , Ambrosone C.B. , Kushi L.H. , Kwan M.L. .
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Germline Genetic Variants in GATA3 and Breast Cancer Treatment Outcomes in SWOG S8897 Trial and the Pathways Study.
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Medical Care Costs for Recurrent versus De Novo Stage IV Cancer by Age at Diagnosis.
Authors: Ritzwoller D.P. , Fishman P.A. , Banegas M.P. , Carroll N.M. , O'Keeffe-Rosetti M. , Cronin A.M. , Uno H. , Hornbrook M.C. , Hassett M.J. .
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Personal and clinical social support and adherence to adjuvant endocrine therapy among hormone receptor-positive breast cancer patients in an integrated health care system.
Authors: Kroenke C.H. , Hershman D.L. , Gomez S.L. , Adams S.R. , Eldridge E.H. , Kwan M.L. , Ergas I.J. , Kubo A. , Kushi L.H. .
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Reparameterization of PAM50 expression identifies novel breast tumor dimensions and leads to discovery of a genomewide significant breast cancer locus at 12q15.
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Understanding racial/ethnic differences in breast cancer-related physical well-being: the role of patient-provider interactions.
Authors: Check D.K. , Chawla N. , Kwan M.L. , Pinheiro L. , Roh J.M. , Ergas I.J. , Stewart A.L. , Kolevska T. , Ambrosone C. , Kushi L.H. .
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PMID: 29623576
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Authors: Ritzwoller D.P. , Hassett M.J. , Uno H. , Cronin A.M. , Carroll N.M. , Hornbrook M.C. , Kushi L.C. .
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PMID: 29873757
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Changes in bone mineral density in women with breast cancer receiving aromatase inhibitor therapy.
Authors: Kwan M.L. , Yao S. , Laurent C.A. , Roh J.M. , Quesenberry C.P. , Kushi L.H. , Lo J.C. .
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PMID: 29249058
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Genetic Ancestry Is not Associated with Breast Cancer Recurrence or Survival in U.S. Latina Women Enrolled in the Kaiser Permanente Pathways Study.
Authors: Engmann N.J. , Ergas I.J. , Yao S. , Kwan M.L. , Roh J.M. , Ambrosone C.B. , Kushi L.H. , Fejerman L. .
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PMID: 28864455
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Patterns And Reasons For Switching Classes Of Hormonal Therapy Among Women With Early-stage Breast Cancer
Authors: Kwan M.L. , Roh J.M. , Laurent C.A. , Lee J. , Tang L. , Hershman D. , Kushi L.H. , Yao S. .
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PMID: 28349440
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Body Mass Index, Pam50 Subtype, Recurrence And Survival Among Patients With Nonmetastatic Breast Cancer
Authors: Cespedes Feliciano E.M. , Kwan M.L. , Kushi L.H. , Chen W.Y. , Weltzien E.K. , Castillo A.L. , Sweeney C. , Bernard P.S. , Caan B.J. .
Source: Cancer, 2017-03-13 00:00:00.0; , .
PMID: 28295245
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Association Of Serum Level Of Vitamin D At Diagnosis With Breast Cancer Survival: A Case-cohort Analysis In The Pathways Study
Authors: Yao S. , Kwan M.L. , Ergas I.J. , Roh J.M. , Cheng T.D. , Hong C.C. , McCann S.E. , Tang L. , Davis W. , Liu S. , et al. .
Source: Jama Oncology, 2017-03-01 00:00:00.0; 3(3), p. 351-357.
PMID: 27832250
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