The Association of American Medical Colleges (AAMC) and Drexel University College of Medicine have designed and implemented national career development programs (CDPs) to help women faculty acquire and strengthen skills needed for success in academic medicine. The authors hypothesized that skills women acquired in CDPs would vary by career stage and program attended.
In 2011, the authors surveyed a national cohort of 2,779 women listed in the AAMC Faculty Roster who also attended one of three CDPs (Early- and Mid-Career Women in Medicine Seminars, and/or Executive Leadership in Academic Medicine) between 1988 and 2010 to examine their characteristics and CDP experiences. Participants indicated from a list of 16 skills whether each skill was newly acquired, improved, or not improved as a result of their program participation.
Of 2537 eligible CDP women, 942 clicked on the link in an invitation e-mail and 879 (35%) completed the survey. Respondents were representative of women faculty in academic medicine. Participants rated the CDPs highly. Almost all reported gaining and/or improving skills from the CDP. Four skills predominated across all three programs: interpersonal skills, leadership, negotiation, and networking. The skills that attendees endorsed differed by respondents’ career stages, more so than by program attended.
Women participants perceived varying skills gained or improved from their attendance at the CDPs. Determining ways in which CDPs can support women’s advancement in academic medicine requires a deeper understanding of what participants seek from CDPs and how they use program content to advance their careers.
Cancer prevention postdoctoral fellowships have existed since the 1970s. The National Cancer Institute facilitated a meeting by a panel of experts in April 2013 to consider four important topics for future directions for cancer prevention postdoctoral training programs: 1) future research needs; 2) underrepresented disciplines; 3) curriculum; and 4) career preparation. Panelists proffered several areas needing more research or emphasis, ranging from computational science to culture. Health care providers, along with persons from non-traditional disciplines such as engineers and lawyers, were among disciplines recognized as being underrepresented in training programs. Curriculum suggestions were that fellows receive training in topics such as leadership and human relations, in addition to learning the principles of epidemiology, cancer biological mechanisms, and behavioral science. For career preparation, there was a clear recognition of the diversity of employment options available besides academic positions, and that program leaders should do more to help fellows identify and prepare for different career paths. The major topics and strategies covered at this meeting can help form the basis for cancer prevention training program leaders to consider modifications or new directions, and keep them current with the changing scientific and employment climate for doctoral degree recipients and postdoctoral fellows.
neoplasms; prevention and control; education
Risk factors for obesity and weight gain are typically evaluated individually while “adjusting for” the influence of other confounding factors, and few studies, if any, have created risk profiles by clustering risk factors. We identified subgroups of postmenopausal women homogeneous in their clustered modifiable and non-modifiable risk factors for gaining ≥ 3% weight.
This study included 612 postmenopausal women 50–79 years old, enrolled in an ancillary study of the Women's Health Initiative Observational Study between February 1995 and July 1998. Classification and regression tree and stepwise regression models were built and compared.
Of 27 selected variables, the factors significantly related to ≥ 3% weight gain were weight change in the past 2 years, age at menopause, dietary fiber, fat, alcohol intake, and smoking. In women younger than 65 years, less than 4 kg weight change in the past 2 years sufficiently reduced risk of ≥ 3% weight gain. Different combinations of risk factors related to weight gain were reported for subgroups of women: women 65 years or older (essential factor: < 9.8 g/day dietary factor), African Americans (essential factor: currently smoking), and white women (essential factor: ≥ 5 kg weight change for the past 2 years).
Our findings suggest specific characteristics for particular subgroups of postmenopausal women that may be useful for identifying those at risk for weight gain. The study results may be useful for targeting efforts to promote strategies to reduce the risk of obesity and weight gain in subgroups of postmenopausal women and maximize the effect of weight control by decreasing obesity-relevant adverse health outcomes.
Weight gain, insulin-like growth factor-I (IGF-I) levels, and excess exogenous steroid hormone use are putative cancer risk factors, yet their interconnected pathways have not been fully characterized. This cross-sectional study investigated the relationship between plasma IGF-I levels and weight gain according to body mass index (BMI), leptin levels, and exogenous estrogen use among postmenopausal women.
This study included 794 postmenopausal women who enrolled in an ancillary study of the Women's Health Initiative Observational Study between February 1995 and July 1998. The relationship between IGF-I levels and weight gain was analyzed using ordinal logistic regression. We used the molar ratio of IGF-I to IGF binding protein-3 (IGF-I/IGFBP-3) or circulating IGF-I levels adjusting for IGFBP-3 as a proxy of bioavailable IGF-I. The plasma concentrations were expressed as quartiles.
Among the obese group, women in the third quartile (Q3) of IGF-I and highest quartile of IGF-I/IGFBP-3 were less likely to gain weight (>3% from baseline) than were women in the first quartiles (Q1). Among the normal weight group, women in Q2 and Q3 of IGF-I/IGFBP-3 were 70% less likely than those in Q1 to gain weight. Among current estrogen users, Q3 of IGF-I/IGFBP-3 had 0.5 times the odds of gaining weight than Q1.
Bioavailable IGF-I levels were inversely related to weight gain overall.
Although weight gain was not consistent with increases in IGF-I levels among postmenopausal women in this report, avoidance of weight gain as a strategy to reduce cancer risk may be recommend.
postmenopausal women; insulin-like growth factor-I; exogenous estrogen; weight gain; obesity
Needs assessments are essential to developing lifestyle interventions for minority populations. To our knowledge, no physical activity (PA) needs assessment studies have been conducted for African American (AA) breast cancer survivors. The purpose of this study was to determine the PA intervention preferences of AA breast cancer survivors and determine whether these preferences differ according to medical and socio-demographic factors.
AA breast cancer survivors (N = 475, Mean age = 54 years) were recruited using ads sent via email and social media sites. Preferences for the mode of intervention delivery were assessed via web-based questionnaires. Descriptive statistics were used to characterize their interests in PA interventions, and subgroup differences were assessed.
About 49% (142/291) of the participants who completed the survey were obese and 54% did not meet the recommended guidelines for PA. Most (90%) participants reported that they could participate in PA, and many (67%) indicated that they were interested in receiving program materials. Participants expressed the greatest interest in email (50%) or web-based (48%) programs over mail (45%), group (39%), and telephone (10%). Women also expressed the greatest interest in participating in studies that promoted walking and resistance or strength training. Intervention preferences did not differ significantly (P > 0.05) across socio-demographic or medical factors.
Most AA breast cancer survivors can participate in PA, and many are interested in interventions that promoted walking and resistance training and were delivered via the email or web. The development of culturally sensitive interventions that provide activities consistent with preferences can assist AA breast cancer survivors to adopt and maintain a healthy lifestyle.
Implications for cancer survivors
Despite evidence that AA breast cancer survivors are at increased risk for poor breast cancer-specific outcomes they are underrepresented in clinical trials promoting positive health behaviors. In this study, we propose to assess their exercise preferences and receptivity to a culturally appropriate physical activity intervention developed in collaboration with the Sisters Network. Health promotion programs developed in collaboration with a community based organization may aid in the development of research tools and resources that AA breast cancer survivors are receptive to using.
Breast cancer; African American women; cancer survivorship; cancer survivor; health disparities; physical activity
Despite evidence that prolonged periods of sitting may influence biological mediators of cancer development, few studies have considered these relationships in a cancer-specific context.
This cross-sectional study included 755 post-menopausal women enrolled in an ancillary study of the Women’s Health Initiative. Plasma levels of Insulin-like growth factor-I (IGF-I), IGF-binding protein-3, leptin, insulin, C-peptide, C-reactive protein (CRP), and Interleukin (IL)-6 were measured. The time spent sitting per day was categorized as quartiles (Qs). The relationships between sedentary time and biomarkers were modified by race, physical activity, and exogenous estrogen use.
IGF-I levels among African American (AA) women were higher than those of white women across the Qs of sedentary time. Likewise, IL-6 levels in AA women were higher than those in white women at Q3 and Q4 of sedentary time. IGFBP-3 levels were higher and insulin levels were lower across the Qs of sedentary time among women meeting guidelines for physical activity than women who were not. Additionally, CRP levels were higher among estrogen users than nonusers at Q1, Q2, and Q4 of sedentary time.
These results suggest that relationship between time spent sitting and cancer-related biomarkers may not be simply linear, but differ in the context of effect modifiers.
Sedentary behavior; Cancer-relevant biomarkers; Effect modifier; Postmenopausal women
Obesity and estrogen are strong risk factors for endometrial cancer (EC). While diabetes also increases risk, little is known about related insulin resistance (IR). The purpose of this study was to determine the prevalence of IR in newly diagnosed EC patients.
EC patients from a large, metropolitan county were prospectively enrolled from 2005–2008. Fasting serum was analyzed for glucose and insulin. IR was defined as a history of diabetes or a QUICKI [1/(log fasting insulin + log fasting glucose)] value of <0.357.
Among 99 patients, diabetes was present in 30, and an abnormal QUICKI was found in 36 additional patients. Increased risk of IR was significantly associated with higher BMI (p<0.001), lower socioeconomic status (p=0.007), and nulliparity (p=0.029).
IR was highly prevalent in endometrial cancer patients, including non-obese women. Better characterization of metabolic risks in addition to obesity may provide avenues for targeted cancer prevention in the future.
diabetes; endometrial cancer; insulin resistance; obesity
Scientific communication, both written and oral, is the cornerstone of success in biomedical research, yet formal instruction is rarely provided. Trainees with little exposure to Standard Academic English may find developing scientific communication skills challenging. In this exploratory, hypothesis-generating qualitative study, the authors examined the process by which mentored junior researchers learn scientific communication skills, their feelings about the challenges, and their mentor’s role in the process.
In 2010, the authors conducted semi-structured focus groups and interviews to explore research trainees’ and faculty mentors’ perceptions and practices regarding scientific communication skills development, as part of the development phase of a larger quantitative study. The facilitator took detailed notes and verified their accuracy with participants during the sessions; a second member of the research team observed and verified the recorded notes. Three coders performed a thematic analysis, and the other authors reviewed it.
Forty-three trainees and 50 mentors participated. Trainees and mentors had diverging views on the role of mentoring in fostering communication skills development. Trainees expressed varying levels of self-confidence but considerable angst. Mentors felt that most trainees have low self-confidence. Trainees expressed interest in learning scientific communication skills, but mentors reported that some trainees were insufficiently motivated and seemed resistant to guidance. Both groups agreed that trainees found mentors’ feedback difficult to accept.
The degree of distress, dissatisfaction, and lack of mutual understanding between mentors and trainees was striking. These themes have important implications for best practices and resource development.
Previous results from research on menopausal hormone therapy (MHT) and lung cancer survival have been mixed and most have not studied women who used estrogen therapy (ET) exclusively. We examined the associations between MHT use reported at baseline and lung cancer-specific mortality in the prospective California Teachers Study cohort. Among 727 postmenopausal women diagnosed with lung cancer from 1995 through 2007, 441 women died before January 1, 2008. Hazard Ratios (HR) and 95% Confidence Intervals (CI) for lung-cancer-specific mortality were obtained by fitting multivariable Cox proportional hazards regression models using age in days as the timescale. Among women who used ET exclusively, decreases in lung cancer mortality were observed (HR, 0.69; 95% CI, 0.52–0.93). No association was observed for estrogen plus progestin therapy use. Among former users, shorter duration (<5 years) of exclusive ET use was associated with a decreased risk of lung cancer mortality (HR, 0.56; 95% CI, 0.35–0.89), whereas among recent users, longer duration (>15 years) was associated with a decreased risk (HR, 0.60; 95% CI, 0.38–0.95). Smoking status modified the associations with deceases in lung cancer mortality observed only among current smokers. Exclusive ET use was associated with decreased lung cancer mortality.
Surprisingly little research is available to explain the well-documented organizational and societal influences on persistent inequities in advancement of women faculty.
The Systems of Career Influences Model is a framework for exploring factors influencing women's progression to advanced academic rank, executive positions, and informal leadership roles in academic medicine. The model situates faculty as agents within a complex adaptive system consisting of a trajectory of career advancement with opportunities for formal professional development programming; a dynamic system of influences of organizational policies, practices, and culture; and a dynamic system of individual choices and decisions. These systems of influence may promote or inhibit career advancement. Within this system, women weigh competing influences to make career advancement decisions, and leaders of academic health centers prioritize limited resources to support the school's mission.
Results and Conclusions
The Systems of Career Influences Model proved useful to identify key research questions. We used the model to probe how research in academic career development might be applied to content and methods of formal professional development programs. We generated a series of questions and hypotheses about how professional development programs might influence professional development of health science faculty members. Using the model as a guide, we developed a study using a quantitative and qualitative design. These analyses should provide insight into what works in recruiting and supporting productive men and women faculty in academic medical centers.
Training programs in cancer prevention research play an important role in addressing impending shortages in the cancer prevention workforce. Published reports on the effectiveness of these programs, however, often focus on a program’s success in recruiting and retaining a demographically diverse trainee population or on academic successes of the trainees, in general. Little has been reported about programs’ success in stimulating long-term interest in cancer prevention per se, whether in research or in other choATsen applications. We set out to examine the success of our National Cancer Institute (NCI) R25E American Recovery and Reinvestment Act (ARRA)-funded summer research experiences program for undergraduates at fostering awareness of and career interest in cancer prevention. Fourteen summer research undergraduates participated in a 12-week structured training program which featured a variety of experiences designed to create awareness of and interest in cancer prevention and cancer prevention research as career tracks. Experiences included career talks by faculty, informational interviewing of role model faculty, career exploration workshops, and structured interactions with graduate students, postdoctoral fellows, and junior faculty. Students were surveyed about the effectiveness of the program via SurveyMonkey 8 months after completing the program. This article reports on the results of the survey and analyzes the relative effectiveness of the various types of programming strategies used. Implications for use in training program development are discussed.
Research experience; Cancer education; Undergraduate research; Cancer prevention training; Cancer prevention careers
Health-related quality of life (HRQOL), body mass index (BMI), and physical activity (PA) levels have all been associated with prognosis following breast cancer and may partially explain higher mortality for breast cancer in certain race/ethnic sub-groups. In this study, we examined associations between PA, BMI, and HRQOL by race in a sample of breast cancer survivors.
Measures of PA, BMI, and HRQOL as well as demographic and medical characteristics of women (N=3013, 13% nonwhite) who participated in the Women’s Healthy Eating and Living Study were assessed at baseline. Analysis of covariance was used to examine the relationship between PA and obesity with HRQOL outcomes. Statistical tests were two-sided.
African-American women were less likely to meet guidelines for PA and more likely to be obese than women from other ethnic groups (P < 0.05). In adjusted models, women who met guidelines for PA reported significantly higher physical health composite (point differences ranged from 10.5 to 21.2 points, all P <0.05) and vitality (point differences ranged from 9.9 to 16.5 points, all P <0.05) scores than those who did not, regardless of race/ethnicity. Associations between obesity and HRQOL were mixed with fewer associations for Asian-American and African-American women and stronger associations for whites.
Breast cancer survivors from racially and ethnically diverse populations have lower levels of PA and higher rates of obesity that are generally associated with poorer HRQOL. Culturally sensitive PA and weight loss interventions may improve these lifestyle characteristics and result in improved HRQOL.
breast neoplasm; African American; disparities; Hispanic; obesity; quality of life; cancer survivors
African American breast cancer survivors experience poor cancer outcomes that may, in part, be remedied by healthy lifestyle choices. Few studies have evaluated the health and lifestyle behaviors of this population. The purpose of this study was to characterize the health and lifestyle habits of African American breast cancer survivors and evaluate the socio-demographic and medical correlates of these behaviors.
A total of 470 African American breast cancer survivors (mean age = 54 years) participated in an online survey. All participants completed measures assessing medical and demographic characteristics, physical activity, and sedentary behavior. Chi-square tests for association, nonparametric tests, and logistic regression models were used to assess associations. All statistical tests were two sided.
Almost half (47%) of the women met the current guidelines for physical activity, almost half (47%) were obese, and many reported having high blood pressure (53%) or diabetes (21%). The prevalence of high blood pressure, diabetes, and high cholesterol increased by age (P<0.001), and obese women had a higher prevalence of high blood pressure (63% vs. 44%) and diabetes (21% vs. 12%) than did non-obese women (all P<0.05). Obese women participated in significantly fewer total minutes of physical activity per week (100 minutes/week) than did non-obese women (150 minutes/week; P<0.05). The number of comorbid conditions was associated with increased odds for physical inactivity (odds ratio = 1.40) and obesity (odds ratio = 2.22).
Many African American breast cancer survivors had chronic conditions that may be exacerbated by poor lifestyle choices. Our results also provide evidence that healthy lifestyle interventions among obese African American breast cancer survivors are urgently needed.
The purpose of this study was to determine whether women participating in the Women’s Healthy Eating and Living (WHEL) Study, exhibited similar dietary changes, second breast cancer events, and overall survival regardless of race/ethnicity.
This secondary analysis used data from 3013 women self-identifying as Asian Americans, African American, Hispanic, or white and who were randomly assigned to a dietary intervention or comparison group. Changes in dietary intake over time by race/ethnicity and intervention status were examined using linear mixed-effects models. Cox proportional hazards models were used to examine the effects of the intervention on the occurrence of second breast cancer events and overall survival. Statistical tests were 2-sided.
African Americans and Hispanics consumed significantly more calories from fat (+3.2%) and less fruit (−0.7 servings/day) than Asians and whites at baseline (all P < 0.01). Overall, intervention participants significantly improved their dietary pattern from baseline to the end of year 1: reducing calories from fat by 4.9% and increasing intake of fiber (+6.6 grams/day), fruit (+1.1 servings/day), and vegetables (+1.6 servings/day) (all P < 0.05). Despite improvements in the overall dietary pattern of these survivors, the intervention did not significantly influence second breast cancer events and overall survival.
Overall, all racial groups significantly improved their dietary pattern over time, but the maintenance of these behaviors were lower among African American women. More research and larger minority samples are needed to determine the specific factors that improve breast cancer-specific outcomes in diverse populations of survivors.
breast cancer; diet; ethnicity; race; randomized controlled trial; survival
No studies have evaluated roles of insulin-like growth factor binding protein 5 (IGFBP-5) polymorphisms in risk of squamous cell carcinoma of the head and neck (SCCHN).
A hospital-based study of 1082 SCCHN patients and 1120 cancer-free controls was performed to investigate associations between two functional polymorphisms -1195T>C and -709G>C in the IGFBP5 promoter region and SCCHN risk.
We demonstrated that the transcription factor AP-1 differentially bound to T or C variants at -1195 in the promoter to regulate the IGFBP5 promoter activity and that the C variant genotypes were associated with deferential risk of late-stage SCCHN, compared with the TT genotype, particularly for HPV-unrelated sites (adjusted OR, 2.21; 95% CI, 1.19-4.11 for CC vs. TT).
The IGFBP5 -1195T>C polymorphism is functional and may potentially be a biomarker for susceptibility to late-stage SCCHN.
IGFBP5; head neck cancer; TNM stage; polymorphism; association
Results from studies examining the association between hormone therapy (HT) and lung cancer risk disagree.
We examined the associations between HT use and lung cancer risk among 60,592 postmenopausal women enrolled in the prospective California Teachers Study cohort. Between 1995 and 2007, 727 women were diagnosed with lung cancer. Multivariable Cox proportional hazards regression models were fit using age as the time metric.
No measure of HT use was associated with lung cancer risk (all p-values for trend≥0.4). In addition, no variations in risk by smoking status (never, ever, former, current), type of HT (E-alone, E+P use), type of menopause, or lung cancer histology were observed.
Our findings do not support an association between HT and lung cancer.
This large-scale, prospective study, which capitalizes on the detailed hormone use, smoking history, and type of menopause information available within this unique cohort, was unable to find any association between intake of HT and lung cancer risk.
The need for cancer professionals has never been more urgent than it is today. Reports project serious shortages by 2020 of oncology health care providers. Although many plans have been proposed, no role for prevention has been described. In response, a 2-day symposium was held in 2009 at The University of Texas MD Anderson Cancer Center to capture the current status of the cancer prevention workforce and begin to identify gaps in the workforce. Five working groups were organized around the following topic areas: (a) health policy and advocacy; (b) translation to the community; (c) integrating cancer prevention into clinical practice; (d) health services infrastructure and economics; and (e) discovery, research, and technology. Along with specific recommendations on these topics, the working groups identified two additional major themes: the difficulty of defining areas within the field (including barriers to communication) and lack of sufficient funding. These interdependent issues synergistically impede progress in preventing cancer; they are explored in detail in this synthesis, and recommendations for actions to address them are presented. Progress in cancer prevention should be a major national and international goal. To achieve this goal, ensuring the health of the workforce in cancer prevention and control is imperative.
Training; Education; Preparation; Evaluation
To increase the adoption of transdisciplinary research methods among future cancer prevention investigators, faculty members from The University of Texas MD Anderson Cancer Center developed a graduate-level course in biobehavioral methods in cancer prevention research. Two instructors paired by topic and area of expertise offered an hour-long lecture-based seminar every week for 15 weeks during the spring semester of 2010. Students and presenters both evaluated the overall course content and delivery method, as well as each session. A total of 11 students and 22 presenters participated in the course. In each class session, one presenter was from a behavioral science background,and the other was from a biological sciences background. Both presenters and students expressed overall satisfaction with the content and format of the course. The presentation of topics from a transdisciplinary perspective and interaction with presenters from both biological and behavioral sciences are valuable and can help junior researchers prepare to meet the emerging challenges in cancer prevention research.
Electronic supplementary material
The online version of this article (doi:10.1007/s13187-011-0251-x) contains supplementary material, which is available to authorized users.
Cancer; Addiction; Biobehavioral; Cancer education; Transdisciplinary
Identity theorists maintain that domain-specific self-concepts help explain the differential investment of people’s time and effort in various activities.
This study examined the contribution of athletic identity and three key demographic variables to physical activity and sports team participation.
Students in Grades 4–5 (n=391, mean age 9.9 years, range 8–13 years, collected in 2003) and Grades 7–8 (n=948, mean age 13.6 years, range 11–15 years, collected in 2002 and 2006) completed the 40-item Athletic Identity Questionnaire, which measures self-perceptions of athletic appearance; competence; importance of physical activity and sports; and encouragement for activity from parents, teachers, and friends. Hierarchic multiple regression analyses in 2008 assessed the effects of athletic identity, race/ethnicity group, gender, and overweight status on 7-day moderate-to-vigorous physical activity (MVPA) and organized sport team participation in each age group.
In children and adolescents, the global score of athletic identity was independently, positively related to MVPA (p<0.0001, p<0.0001, respectively) and team participation (p<0.0001, p<0.0001, respectively), after controlling for demographic variables. More variance in MVPA was explained in children (23%) than in adolescents (5%), in contrast to team sports (5% in children, 15% in adolescents). In the subscale analyses, positive relationships for appearance, competence, importance, and parental encouragement persisted independent of demographic factors.
Results support the role of athletic self-concept in promoting physical activity and organized sport participation in children and adolescents.
cancer prevention; workforce; training; education
Cigarette smoking has been investigated as a major risk factor for renal cell carcinoma (RCC). 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) is one of the most abundant carcinogenic N-nitrosamines present in cigarette smoke. However, the association between repair capacity of NNK-induced DNA damage and RCC risk remains unknown. We used the comet assay to assess whether sensitivity to a NNK precursor 4-[(acetoxymethyl) nitrosamino]-1-(3-pyridyl)-1-butanone (NNKOAc) induced DNA damage, which partly reflects host sensitivity to NNK, was associated with increased risk of RCC in a population-based case-control study. The study included 95 RCC cases and 188 matched controls. Epidemiologic data were collected via in-person interview. Baseline and NNK-induced DNA damage in peripheral blood lymphocytes were measured using the comet assay and quantified by the Olive tail moment. The NNKOAc-induced median Olive tail moments were significantly higher in cases than in controls (2.27 versus 1.76, P = 0.002). Using the 75th percentile Olive tail moments of the controls as the cutoff point, we found that higher levels of NNKOAc-induced DNA damage were associated with a significantly increased risk of RCC [odds ratio, 2.06; 95% confidence interval, 1.17–3.61]. In quartile analysis, there was a dose–response association between NNKOAc-induced damage and risk of RCC (P for trend, 0.006). Our data strongly suggest that higher levels of NNKOAc-induced damage are associated with higher risks of RCC. Future studies with larger sample sizes are warranted to further investigate whether repair of NNKOAc-induced damage, as quantified by the comet assay, could be used as a predictive marker for RCC risk.