THE MARIN WOMEN’S STUDY

Why was it initiated?Why was it initiated? What is happening now?What is happening now? What will the future bring? What will the future bring?

Why Was it Initiated?Why Was it Initiated?

100

120

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240

90 91 92 93 94 95 96 97 98 99

Year

Age

-adj

uste

d R

ate

per

100,

000 Marin

Bay Area

UrbanCalifornia

US

Breast Cancer Incidence Trends in Marin County*

(2001-02)

* White non-Hispanic women, invasive cancers only

The Breast Cancer Incidence Rates The Breast Cancer Incidence Rates Comparison – 2004-05Comparison – 2004-05

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250

90 91 92 93 94 95 96 97 98 99 0 1Year of diagnosis

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100

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250

90 91 92 93 94 95 96 97 98 99Year of diagnosis

Rat

e pe

r 10

0,00

0

Mortality

Phipps A, Clark C, Ereman R; Breast Cancer Research, June 7, 2005

Marin

SFBA

CA

US

Rates in the1990’s Re-calculated based on new Census

MANY Questions MANY Questions WHY Marin’s Breast Cancer WHY Marin’s Breast Cancer

Rates HighRates High2001-20052001-2005

Why Marin?Why Marin?

More women screening?

Lifestyle Differences?

More Toxins?

NO, slightly higher screening rates, expect 1-2

more cases a year

YES, More women in Marin: drink alcohol daily, have

fewer children, later in life, higher income/education. All would act to increase

Marin’s rates.

Data lacking on exposures

BUT – Marin women are thinner, exercise more and

report eating healthier… These

would act to decrease Marin’s

rates

Left with the questionLeft with the question

Do the women in Marin who get breast Do the women in Marin who get breast cancer have more of the risk factors that cancer have more of the risk factors that are more prevalent here? are more prevalent here?

We needed risk factor information from We needed risk factor information from women getting cancer, so we could women getting cancer, so we could answer this crucial question. answer this crucial question.

2004 - What Next?2004 - What Next? Research suggests that lifestyle risk factors play a role in Marin Research suggests that lifestyle risk factors play a role in Marin

We need to gather individual risk factors and breast health We need to gather individual risk factors and breast health information from each Marin womaninformation from each Marin woman

The County/Community IS where research needs to be – The County/Community IS where research needs to be – Community is determined and cares deeplyCommunity is determined and cares deeply

All women do not respond to risk factors in the same way, We All women do not respond to risk factors in the same way, We need to to look at gene-environment interactions need to to look at gene-environment interactions

Can we pave a way for investigating environmental toxins.Can we pave a way for investigating environmental toxins.

THE MARIN WOMEN’S STUDY WAS BORNTHE MARIN WOMEN’S STUDY WAS BORN

HISTORYHISTORY

Funded by the CDC in July 2005Funded by the CDC in July 2005 Multiple stakeholder planning meetings Multiple stakeholder planning meetings

during 2005-2006during 2005-2006 Data Collection Launched November 2006Data Collection Launched November 2006 First Research Results January 2008First Research Results January 2008

Marin Women’s Study GOALSMarin Women’s Study GOALS Investigate how reproductive, lifestyle,

demographic and biologic factors affect breast cancer risk in Marin

• Alcohol, Hormone Therapy, Reproductive Alcohol, Hormone Therapy, Reproductive Factors, Socio-economic Status, Stress, Factors, Socio-economic Status, Stress, Environmental Exposures.Environmental Exposures.

Understand why breast cancer risk factors Understand why breast cancer risk factors do not affect all women in the same way.do not affect all women in the same way.

MWS COMPONENTSMWS COMPONENTS

Community Campaign

Risk Factor Questions

Breast Health

Outcomes

Biospecimen

Breast CancerBreast Density

Who is Involved?Who is Involved?

COLLABORATIONCOLLABORATION

SCIENTIFIC ADVISORY TEAMSCIENTIFIC ADVISORY TEAM

MARIN MARIN COUNTY COUNTY DHHSDHHS

BUCK BUCK INSTITUTEINSTITUTE

KAISER KAISER MEDICAL MEDICAL GROUPGROUP

MARIN MARIN GENERAL GENERAL HOSPITALHOSPITAL

UCSFUCSF

ZERO ZERO BREAST BREAST CANCERCANCER

COMMUNITY INVOLVEMENT COMMUNITY INVOLVEMENT GROUPGROUP

Marin General Hospital Marin General Hospital Meals of Marin Meals of Marin Marin Family Action Marin Family Action Marin Friends of Women Marin Friends of Women Kaiser Permanente Kaiser Permanente Marin Center for Independent Marin Center for Independent

Living Living Zero Breast CancerZero Breast Cancer

15 Individuals & Community Groups15 Individuals & Community Groups Marin Breast Cancer CouncilMarin Breast Cancer Council Breast Cancer Resource Center Breast Cancer Resource Center American Cancer Society American Cancer Society Tina Action ProgramsTina Action Programs Fair Housing of MarinFair Housing of Marin

…MANY VOLUNTEERS!!AND

What Is Happening What Is Happening Now?Now?

STUDY SUCCESSES – Oct. 2009STUDY SUCCESSES – Oct. 2009

QUESTIONNAIREQUESTIONNAIRE Almost 14,000 Almost 14,000 QuestionnairesQuestionnaires received! received!

BIOSPECIMENBIOSPECIMEN SalivaSaliva Collection 6,000 Samples! Collection 6,000 Samples! AVON AVON fundingfunding received July 2007, Sept 2009 received July 2007, Sept 2009

CAMPAIGNCAMPAIGN CampaignCampaign – Banners, Movie Theatres, Grocers… – Banners, Movie Theatres, Grocers… 80%80% of women surveyed knows about MWS of women surveyed knows about MWS

Hormone Therapy StudyHormone Therapy Study

In ReviewIn Review

Hormone Therapy Use, 2001Hormone Therapy Use, 2001Women, ages 50+Women, ages 50+

Marin: 40.7%, California: Marin: 40.7%, California: 39.3% - used any type of 39.3% - used any type of prescription hormone prescription hormone therapy.therapy.

% of women >50 yrs. % of women >50 yrs. with a Hysterectomy: with a Hysterectomy: Marin 29.4% Marin 29.4% California- 38.1% California- 38.1% Kings County – 53.7%Kings County – 53.7%

Percentage of women with Hysterectomy, 2001 MARIN

Hysterectomy

Intact Uterus

Percentage of women with Hysterectomy, 2001 KINGS

Hysterectomy

Intact Uterus

E + P

E + P

HRT Use by Year

8.048.39

9.66

12.17

15.4

17.6

19.7420.27

20.87

22.4522.922.84 21.520.720.420.7

21.8

24.3

25.92626.426.42625.1

0

5

10

15

20

25

30

1994 1996 1998 2000 2002 2004 2006 2008

Year

%

% Combo

% E only

Women 50+ in that year, all ethnicities

HERS

WHI

HORMONE THERAPY USE BY YEAR

Estrogen Only and Estrogen plus Progestin

ESTROGEN ONLY

Estrogen/Progestin

6%

Alternative Hormone UseAlternative Hormone Use

n=1,748n=1,748 ## %%

Use (2006-07)Use (2006-07) 152152 8.7%8.7%

Soy ProductsSoy Products 4545 2.6%2.6%

Black CohoshBlack Cohosh 3939 2.2%2.2%

Combination HerbalCombination Herbal 2020 1.1%1.1%

PhytoestrogensPhytoestrogens 1111 0.6% 0.6%

OtherOther 4343 1.5%1.5%

Current E+P

Use 6%

What’s Next?What’s Next?

MWS Next StepsMWS Next Steps

Complete cleaning and scanning data into Complete cleaning and scanning data into database.database.

Complete analysis of first saliva studyComplete analysis of first saliva study Embark on second ‘spit study’!Embark on second ‘spit study’! Conduct analyses on key research Conduct analyses on key research

questions.questions. Track Hormone Therapy use - ‘re-starting’, Track Hormone Therapy use - ‘re-starting’,

replacement regimens, - Are emerging replacement regimens, - Are emerging CAMS safe? CAMS safe?

Selected Risk Factors in Women 50-80 in Selected Risk Factors in Women 50-80 in DRAFTDRAFT Marin n=5438 Marin n=5438 DRAFTDRAFT

CASESCASES Non-CasesNon-Cases SignificanceSignificance

Age at first birthAge at first birth 27.427.4 27.527.5 No DifferenceNo Difference

MenarcheMenarche 12.712.7 12.712.7 No DifferenceNo Difference

Number of ChildrenNumber of Children 1.71.7 1.61.6 SIGSIG

Months BreastfedMonths Breastfed 8.48.4 9.09.0 No DifferenceNo Difference

Former SmokerFormer Smoker 56.1%56.1% 45.9%45.9% SIGSIG

Ashkenazi Jewish Ashkenazi Jewish HeritageHeritage

13.6%13.6% 11.1%11.1% No DifferenceNo Difference

HRT Combination HRT Combination Therapy (current use)Therapy (current use)

No Obs for age No Obs for age groupgroup

Alcohol in High SchoolAlcohol in High School 29.4%29.4% 25.1%25.1% No DifferenceNo Difference

Cancer RootCancer Root

FlowerFlower

Growth similar to Growth similar to cancer in humanscancer in humans

To remind us that the To remind us that the cure is in the earth.cure is in the earth.

CONTACT INFOCONTACT INFO Web Site:Web Site:

www.mwstudy.orgwww.mwstudy.org marinwomensstudy.orgmarinwomensstudy.org

Contact Epidemiology Program for materials or Contact Epidemiology Program for materials or information: 507-4077information: 507-4077

Rochelle Ereman, Study Director 499-3056Rochelle Ereman, Study Director 499-3056

Kathy Koblick, Outreach and Campaign 507-2578Kathy Koblick, Outreach and Campaign 507-2578

Mark Powell, MD, MPH, Biospecimen 499-6969Mark Powell, MD, MPH, Biospecimen 499-6969

Percentage of Women with Percentage of Women with Hysterectomies, Hysterectomies, selected CA countiesselected CA counties

San Francisco, Santa San Francisco, Santa Cruz and Marin –Cruz and Marin –counties with lowest counties with lowest hysterectomy rates. hysterectomy rates. (24.5-30.6%)(24.5-30.6%)

Kings, Madera and Kings, Madera and Kern counties – Kern counties – highest hysterectomy highest hysterectomy rates (55-62%) rates (55-62%)

Average 41.5% CAAverage 41.5% CA

Percentage of women with Hysterectomy, 2001 MARIN

Hysterectomy

Intact Uterus

Percentage of women with Hysterectomy, 2001 KINGS

Hysterectomy

Intact Uterus

31%

62%

NOT MORE WOMEN ON HRT: Current use of HRT 35% in 2001 CA, Marin