Prevention, Psychological & Ethical Issues
Research Project Awards
Alteration of Dietary Fat to Reduce Breast Cancer Metastasis
Kent L. Erickson, Ph.D.
University of California, Davis
The overall goal of this project is to determine how altered dietary fat may reduce the growth and metastasis (the spread to other parts of the body) of human breast cancer. Despite advances in surgical techniques and the development of aggressive therapies for the treatment of primary breast cancer, most deaths are caused by metastasis. Since less than 10% of women with breast cancer have full-blown metastasis in distant organs when their cancer is first detected, if methods were developed to reduce or block metastasis, great advances could be made in the prevention of disease progression.
Some studies of human populations and disease patterns have reported an association between breast cancer and dietary fat intake, while others have reported that no such association ("positive correlation") exists. A major focus of this proposal is to enable us to understand how certain dietary fats reduce human breast cancer metastasis.
We, as well as others, have shown that when animals are fed diets with high concentrations of a specific fatty acid, linoleic acid, which is abundant in dietary oils derived from plants, their breast tumor incidence increases and the time required for tumor appearance is greatly diminished when compared to animals fed low levels of linoleic acid. The main differences between the human studies and animal studies are that fat intake in the animal studies are controlled during the progression of the tumor whereas human studies rely on food intake histories (which are limited in their accuracy), often taken after the tumors have started to develop. However, numerous studies with human cell lines indicate a role of dietary fat in the alteration of mammary tumor metastasis. Thus, we hypothesize that dietary fats, particularly those containing fish oils (n-3 fatty acids), may differentially alter primary breast tumor growth and metastasis. We have chosen to focus on two mechanisms that alter the production and responsiveness to a fatty acid based mediator, prostaglandin E2: blood vessel growth, and expression of enzymes associated with metastasis.
From this work we hope to determine how altering the amount and type of dietary fat may have a significant effect on the spread of breast cancer throughout the body, and thus provide information that could be used to decrease the mortality of women diagnosed with the disease.
Innovative Developmental and Exploratory Awards (IDEAs)
Group Intervention For Women at High Risk For Breast Cancer
David K. Wellisch, Ph.D.
University of California, Los Angeles
This study is a group intervention for women at high risk for breast cancer. It addresses the Breast Cancer Research Program's priority issue involving improved access for underserved populations, specifically women at a high risk of developing breast cancer. Thus far, no viable group interventions have been developed for this population. The purpose of this study is to identify and develop a multidisciplinary and multispecialty organizational model of service delivery by defining the content and characteristics of the best group model to increase education, prevent the development of psychological symptoms and problems, and increase adaptation and coping to the threat these women live with daily. A special effort will be made to recruit minority women, since to date, most work in this areas has been on Caucasian women. The study additionally addresses the psychosocial and behavioral consequences of elevated genetic risk for breast cancer.
Specific aims of the project include: 1) to test the viability of the group model in terms of content, interest, effectiveness, attendance, and optimal participant mix; 2) to test the feasibility of the group model in terms of decreasing the participants' adverse psychological and behavioral symptomatology; 3) to test the feasibility of the group model in terms of increasing knowledge of nutrition and its relationship to increased cancer risk; 4) to test the feasibility of the group model to facilitate a more realistic assessment of personal cancer risk; 5) to test the feasibility of the group model in terms of increasing knowledge of positive coping methods; and 6) to test the feasibility of the group model in reduction of grief symptoms.
If this group model proves feasible, it will be possible to shift focus to long-tem retention of high risk women in appropriate clinics and other settings which would promote earlier detection and diagnosis, thus reducing mortality and morbidity from this disease.
New Investigators Awards
Benign Breast Disease, Biopsy & Cancer Preventive Self-Care
Jacqueline O'Connor, Ph.D.
University of California, Davis
The rates of benign breast disease indicate that a substantial number of pre- and postmenopausal women have experienced the discovery, biopsy, and diagnosis of benign (i.e., non-cancerous) breast disease -- a sequence of events that our research team refers to collectively as a breast health crisis. The limited psychological research to date supports the idea that these experiences constitute a stressful life event, and for some, a life crisis. Our multidisci-plinary research team proposes to conduct a longitudinal study of psychological and behavioral processes in breast self-care following biopsy and diagnosis of benign breast disease. The goal of this study is to identify the most important elements of the psychological self-appraisal system that regulates preventive breast self-care, and to describe the dynamic relations among those elements that predict continuity and discontinuity in self care following an acute threat to breast health. (We define self-care in terms of all three components of cancer preventive behavior: performing breast self-examination, obtaining a mammogram, and having a clinical breast examination.)
There is evidence from previous research that self-care routines may be disrupted in the aftermath of a breast health crisis, although to date there are no published long-term follow-up studies to assess patterns of stability or change following a benign breast diagnosis.
In addition, although some types of benign breast disease have been associated with an increased risk of breast cancer, many women with a history of benign breast disease do not comply with recommended guidelines for breast self-examination, screening mammography, and clinical breast examinations.
We plan to prospectively monitor breast health knowledge, beliefs, and behaviors in approximately 200 women who have recently undergone investigative medical procedures including breast biopsy, for benign breast disease, as well as a large control sample of approximately 300 women, for the entire duration of the 3-year study period. Data collection will include measures of stress and coping through a breast health crisis: breast cancer knowledge, beliefs, and attitudes; personal appraisal of susceptibility, breast cancer-related anxiety, and efficacy regarding self-care practices; and interval tracking of breast self-care behaviors.
The significance of this project in terms of the Breast Cancer Research Program's emphasis on early detection is that the occurrence of a benign breast disease may present an opportunity for positive intervention related to subsequent breast self-care, or may, on the other hand, overwhelm a woman's coping resources, leaving her feeling vulnerable, powerless, and unmotivated to adopt or continue preventive self-care. Therefore, the study we propose of psychological and behavioral processes in breast self-care in the presence -- and absence -- of a benign breast disease history can make a valuable contribution to our understanding of important aspects of personal behavior that affect early detection, and through such understanding to help achieve the broader goal of reducing the human and economic costs of breast cancer among all women.
Breast Cancer Chemotherapy: Does It Impair Brain Function?
Mary H. Wieneke, Ph.D., M.S.
California School of Professional Psychology
Complaints of impaired mental functioning following chemotherapy ("chemo brain") have long been common among adult cancer patients, but they are poorly documented in the literature; such complaints have most often been attributed to depression or anxiety. Impaired cognitive functioning (thought, concentration, memory) may be an important treatment risk that paradoxically results, in part, from the outcomes of early detection and aggressive treatment. The long term impact of such phenomena on emotional and psychological functioning, quality of life, and employment should be considered in evaluating the human and economic costs of breast cancer.
This research will expand and more thoroughly address questions raised in a previous single-group study in which significant impairments were found in treated women's functioning for up to one year following completion of chemotherapy. Women who had received chemotherapy for early stage breast cancer showed deficits in several areas of mental functioning despite high-to-normal pre-cancer lQs: attention and concentration; memory, both visual and verbal; mental flexibility and speed of processing; visual function; and motor speed. For the planned research, standard cognitive tests will be used to evaluate brain-behavior relationships in 150 Bay Area women with breast cancer to: 1) assess the long-term effects on brain functioning of conventional chemotherapy and tamoxifen for early stage breast cancer, and 2) identify the contribution of psychological and emotional distress such as depression/anxiety, on mental functioning. Type and amount of chemotherapy, length of treatment, chemotherapy toxicity, and menopausal status will also be assessed for their effects on cognitive functioning. Three groups of women with early stage (I or II) breast cancer who receive: 1) adjuvant chemotherapy (with or without tamoxifen), 2) tamoxifen only, or 3) no chemotherapy, will be compared at three points in time: shortly after diagnosis, and at approximately 1 and 12 months following chemotherapy completion. The value of the proposed research is that techniques to minimize or treat these effects could be developed once the specific cognitive effects are fully documented.
Postdoctoral Fellowship Awards
Does Change in Emotional Expression Mediate Cancer Survival?
Janine E. Giese-Davis, Ph.D.
Stanford University
This proposal addresses the BCRP priority issues of prevention of breast cancer and prevention of disease progression. The overarching goal of this project is to determine the specific therapeutic component linking participation in supportive/expressive group therapy to observed differences in disease progression in wo-men with metastatic breast cancer. Past research with supportive/expressive group therapy has shown that survival was extended in metastatic breast cancer patients by 18 months, doubling the survival time of a matched control group (Spiegel et al, 1989). It is vital that we begin to understand the possible therapeutic mechanisms and the underlying related physiological mechanisms responsible for this sur-prising finding of increased survival. Therefore, I propose to determine if change in emotional expression, amount of talk-time, or emotional control are therapeutic mechanisms related to survival, immune and endocrine function, and well-being in metastatic breast cancer patients who participate in a year of this group therapy.
A long-standing hypothesis links both incidence and progression of cancer with lower levels of emotional expression, or higher levels of repressive or suppressive coping styles. This literature has guided the present hypothesis. In the proposed study, each participant has been videotaped as they take part in the supportive/expressive group therapy sessions. A sample of these videotapes will be used to code the specific emotions and the intensity of those emotions expressed for each of these women. The emotions expressed will be related to each woman's endocrine and immune functioning, her psychosocial well-being, and her survival. If it is found that change in emotional expression is important to enhanced physical or emotional well-being, this information could lead to more specific psychosocial interventions for breast cancer patients. The ability to provide such specific interventions would reduce the human and economic costs of breast cancer in California not only in terms of extended lives, but of quality of life.
