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1.  Associations between time spent sitting and cancer-related biomarkers in postmenopausal women: an exploration of effect modifiers 
Cancer causes & control : CCC  2014;25(11):1427-1437.
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1007/s10552-014-0434-y
PMCID: PMC4316818  PMID: 25238978
Sedentary behavior; Cancer-relevant biomarkers; Effect modifier; Postmenopausal women
2.  Prospective evaluation of insulin resistance among endometrial cancer patients 
Objective
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.
Study Design
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.
Results
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).
Conclusion
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.
doi:10.1016/j.ajog.2010.11.033
PMCID: PMC4286377  PMID: 21324431
diabetes; endometrial cancer; insulin resistance; obesity
3.  The Development of Scientific Communication Skills: A Qualitative Study of the Perceptions of Trainees and Their Mentors 
Purpose
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.
Method
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.
Results
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.
Conclusions
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.
doi:10.1097/ACM.0b013e3182a34f36
PMCID: PMC3809893  PMID: 23969363
4.  Menopausal Hormone Therapy and Lung Cancer-Specific Mortality Following Diagnosis: The California Teachers Study 
PLoS ONE  2014;9(7):e103735.
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.
doi:10.1371/journal.pone.0103735
PMCID: PMC4117568  PMID: 25079077
5.  Systems of Career Influences: A Conceptual Model for Evaluating the Professional Development of Women in Academic Medicine 
Journal of Women's Health  2012;21(12):1244-1251.
Abstract
Background
Surprisingly little research is available to explain the well-documented organizational and societal influences on persistent inequities in advancement of women faculty.
Methods
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.
doi:10.1089/jwh.2012.3638
PMCID: PMC3518539  PMID: 23101486
6.  Introducing Students to Cancer Prevention Careers through Programmed Summer Research Experiences 
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.
doi:10.1007/s13187-011-0297-9
PMCID: PMC3760032  PMID: 22147335
Research experience; Cancer education; Undergraduate research; Cancer prevention training; Cancer prevention careers
7.  Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors 
Cancer  2012;118(16):4024-4031.
Background
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.
Methods
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.
Results
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.
Conclusion
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.
doi:10.1002/cncr.27389
PMCID: PMC3330155  PMID: 22252966
breast neoplasm; African American; disparities; Hispanic; obesity; quality of life; cancer survivors
10.  Lifestyle Behaviors of African American Breast Cancer Survivors: A Sisters Network, Inc. Study 
PLoS ONE  2013;8(4):e61854.
Introduction
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.
Methods
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.
Results
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).
Conclusion
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.
doi:10.1371/journal.pone.0061854
PMCID: PMC3633932  PMID: 23626740
11.  Was Race a Factor in the Outcomes of the Women’s Health Eating and Living Study? 
Cancer  2011;117(16):3805-3813.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
doi:10.1002/cncr.25957
PMCID: PMC3135701  PMID: 21319157
breast cancer; diet; ethnicity; race; randomized controlled trial; survival
12.  Association between a Functional Polymorphism (-1195T>C) in the IGFBP5 Promoter and Head and Neck Cancer Risk 
Head & neck  2010;33(5):650-660.
Background
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).
Methods
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.
Results
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).
Conclusion
The IGFBP5 -1195T>C polymorphism is functional and may potentially be a biomarker for susceptibility to late-stage SCCHN.
doi:10.1002/hed.21514
PMCID: PMC3023825  PMID: 20949447
IGFBP5; head neck cancer; TNM stage; polymorphism; association
13.  MENOPAUSAL HORMONE THERAPY DOES NOT INFLUENCE LUNG CANCER RISK: RESULTS FROM THE CALIFORNIA TEACHERS STUDY 
Background
Results from studies examining the association between hormone therapy (HT) and lung cancer risk disagree.
Methods
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.
Results
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.
Conclusions
Our findings do not support an association between HT and lung cancer.
Impact
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.
doi:10.1158/1055-9965.EPI-10-1182
PMCID: PMC3065239  PMID: 21266521
14.  Addressing the Future Burden of Cancer and Its Impact on the Oncology Workforce: Where Is Cancer Prevention and Control? 
Journal of Cancer Education  2012;27(Suppl 2):118-127.
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.
doi:10.1007/s13187-012-0342-3
PMCID: PMC3316776  PMID: 22367593
Training; Education; Preparation; Evaluation
15.  Educating Cancer Prevention Researchers in Emerging Biobehavioral Models: Lessons Learned 
Journal of Cancer Education  2011;26(4):633-640.
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.
doi:10.1007/s13187-011-0251-x
PMCID: PMC3221859  PMID: 21720937
Cancer; Addiction; Biobehavioral; Cancer education; Transdisciplinary
16.  Contribution of Athletic Identity to Child and Adolescent Physical Activity 
Background
Identity theorists maintain that domain-specific self-concepts help explain the differential investment of people’s time and effort in various activities.
Purpose
This study examined the contribution of athletic identity and three key demographic variables to physical activity and sports team participation.
Methods
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.
Results
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.
Conclusions
Results support the role of athletic self-concept in promoting physical activity and organized sport participation in children and adolescents.
doi:10.1016/j.amepre.2009.05.017
PMCID: PMC2759382  PMID: 19595559
18.  Sensitivity to NNKOAc is associated with renal cancer risk 
Carcinogenesis  2009;30(4):706-710.
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.
doi:10.1093/carcin/bgp045
PMCID: PMC2722144  PMID: 19237609

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