Disease Prevention

Improving Detection and Understanding Risk

Fred Hutch investigators have conducted groundbreaking research on cancer and disease prevention over many decades. This includes research that identified the link between hormone replacement therapy and lobular breast cancer and studies of how risk factors such as poor diet, lack of physical activity and smoking relate to chronic diseases such as type 2 diabetes, cardiovascular disease and obesity-associated types of cancer. We also have a robust research program in cancer screening — aimed at catching more cancers early, when they are easier to treat.

We are home to the country’s first cancer prevention research program funded by the National Cancer Institute. Established in 1983 within our Public Health Sciences Division, the program focuses on investigating cancer risk factors, developing risk-reduction interventions, and creating and testing novel screening and surveillance methods.

Investigating Risk Factors

Much of our research on risk factors for cancer and other diseases is based on data from huge cohorts that can number in the hundreds of thousands, such as the Women’s Health Initiative. Using these large populations as a laboratory, our researchers look for links between disease and its possible triggers, from diet and lifestyle to environmental and genetic factors. Research topics include genetic and epigenetic biomarkers of cancer risk, breast cancer survivorship and diet, the effects of vitamin and mineral supplements on cancer risk, and the role of gut microbiota in obesity and chronic inflammation. These findings can lead to better screening guidelines, more individually tailored screening recommendations and more precise screening tests.

Women’s Health Initiative

This landmark study, whose coordinating center is based at Fred Hutch, has changed the way health care providers prevent and treat many diseases and other health issues affecting postmenopausal women.

Novel Screening Methods

Fred Hutch researchers who are developing novel screening technologies include Dr. Amanda Paulovich, whose lab is developing technologies aimed at rapidly screening large numbers of telltale proteins, or biomarkers, for clues that may indicate the earliest stages of cancer and other diseases. Postdoctoral fellow Dr. Kristy Lastwika and her mentors, Drs. Paul Lampe and McGarry Houghton, are developing a blood test to help detect lung cancer in high-risk adults whose imaging scans are inconclusive. The team wants to create an alternative to subjecting those patients to a painful, expensive, and risky lung biopsy. Important discoveries on prostate cancer screening made by Dr. Ruth Etzioni and her colleagues have included the finding that a variant of the conventional PSA test could render more accurate results for men with borderline PSA levels.

Left: Dr. Amanda Paulovich, oncologist and cancer geneticist. Right: Blood work in a Fred Hutch lab.
Left: Dr. Amanda Paulovich, oncologist and cancer geneticist. Right: Blood work in a Fred Hutch lab.

Photo at left by Bo Jungmayer / Fred Hutch

Risk Reduction Strategies

Fred Hutch researchers are studying many approaches to reducing cancer risk. One major area of investigation is lifestyle interventions. For example, we are studying the impact of eating smaller and more frequent meals on disease risk and investigating whether consuming full-fat dairy products could reduce the risk of type 2 diabetes. We are also developing interventions to help people exercise regularly and keep their weight in check to decrease cancer risk. Our scientists are even developing smartphone apps to help people manage their cravings and quit tobacco. Other major areas of research on risk reduction include drugs to block the development or recurrence of cancer, including tamoxifen to reduce breast cancer risk and aspirin to reduce colorectal cancer risk. We also study the role of prophylactic surgery to prevent breast, ovarian and other cancers.

Surveillance Studies

Fred Hutch is home to several centers for surveillance data, including the Cancer Surveillance System (CSS), which collects population-based data on cancer incidence and survival in 13 counties in western Washington state. The data allow public health researchers to track trends in the incidence of all forms of cancer, identify and investigate patterns of cancer occurrence, and monitor trends in mortality and survival for specific cancers. CSS data feed into the larger national cancer registry, the Surveillance, Epidemiology and End Results (SEER) Program. Analysis of registry data has led our researchers to many important findings about prevention and risk, including that prostate cancer is more common and deadly in black men, breast cancer treatments and outcomes differ widely among women of different races and ethnicities, and airborne allergies in women may be linked to higher risk of blood cancers.

Although a valuable resource, SEER also has well-documented gaps — it tracks incidence, diagnosis, and mortality but does not capture metastatic recurrence. Dr. Ruth Etzioni and others are working on ways to enhance the registry by using claims data and patient-reported outcomes. This is critical for many types of cancer — including breast cancer, where 20 percent of patients diagnosed with early-stage disease (stage 1 to stage 3) will experience a metastatic recurrence within 20 years.

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