The relationship of exposures before and after diagnosis of breast cancer to the risk of recurrence is an important topic that has received little attention. Recognition of patient characteristics that are related to recurrence could potentially improve prognostication and elucidate mechanisms of disease progression. Identification of potentially modifiable exposures after diagnosis related to the risk of recurrence could ultimately offer women an additional means to influence their outcome.
Although more than two-thirds of all breast cancers are diagnosed in women over age 55, and nearly half are in women 65 years of age and older, there has been little research focused on the identification of determinants of disease progression in middle- and older-aged women. The National Cancer Institute awarded Fred Hutch funding for a study of predictors of disease progression and recurrence in women diagnosed with breast cancer at ages 45-79 to:
- Identify pre- and post-diagnosis exposures and events that may increase the risk of recurrence;
- Assess pre-diagnosis exposures for their association with tumor characteristics and risk of recurrence; and
- Evaluate how tumor markers, both ones currently used in clinical care and novel ones not currently in use, relate to breast cancer progression or recurrence across age groups.
The most effective way to meet the goals of this study is to build upon information already collected in previous breast cancer studies. Our name, The Quilt Study, symbolizes joining participants from three prior studies conducted at the Center to form a new, larger study group. The Quilt Study is a unique cohort of over 2,300 women diagnosed with breast cancer between the ages of 45-79 during the years 1993-1999, all of whom generously participated in one of three risk factor studies:
- The Women's Contraceptive and Reproductive Experiences Study (CARE)
- The Puget Sound Area Breast Cancer Evaluation Study (PACE)
- Electric Power and the Risk of Breast Cancer (EMF)
Women in this cohort are eligible for the study whether or not they have experienced a recurrence. For the Quilt Study, telephone interviews will be conducted to obtain information on exposures after diagnosis (weight, physical activity, use of hormone replacement therapy and other medications, alcohol consumption, family history of cancer), other medical conditions, and breast cancer recurrences. Medical records will be reviewed to obtain detailed data on treatment, recurrences and other medical conditions. Tumor tissue will be tested for molecular features known or hypothesized to relate to prognosis or treatment response.
Associations we might find between patient characteristics and recurrence of breast cancer could provide additional prognostic data to alert physicians to high- (or low-) risk women who might benefit from more (or less) aggressive treatment, suggest future means by which women could influence their disease, and generate insights into biologic pathways of disease progression. The analyses of tumor markers could help to identify new tools for prognostication and treatment assignment and also determine if the predictive value of markers varies across age groups.