Volume 18, Issue 4
Fall 2006
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CHS Research News
Vol 18, Issue 4, Fall 2006
Center News
by Joan DeClaire
New Findings & Highlights
Breast density is a significant predictor of breast cancer risk, Breast Cancer Surveillance Consortium shows
Breast density is nearly as important as age in determining a woman’s risk of developing breast cancer,
according to a new model developed by scientists from Group Health Center for Health Studies and seven other health
care organizations in the Breast Cancer Surveillance Consortium (BCSC). Presented in the September 6 issue of the
Journal of the National Cancer Institute, the model is based on the largest
study of this issue to-date in
terms of population size and the number of risk factors examined.
The researchers collected data from more than 1 million women at the time of their screening mammograms. They then
identified 11,638 who were diagnosed with breast cancer within the next year. Information on women who did and did not get
breast cancer was analyzed to develop and validate risk-prediction models.
Breast density is a measure of how well tissue can be seen on mammogram. Some tissue, such as the milk gland, is dense
and appears white on an x-ray. This density makes it hard for doctors to see tumors, which also appear white. Fatty tissue
is less dense and appears clear on the x-ray, allowing better tumor detection.
“Although breast cancer is harder to detect in women with dense breasts, our research showed that women with dense
breasts are more likely to develop breast cancer,” said William E. Barlow, PhD,
a researcher with Group Health and the lead author of the article. After adjustment for age, the risk for breast cancer was
almost four times greater for women with extremely dense breasts than for a woman with breasts that are almost entirely fat.
The scientists found that several risk factors influenced breast cancer diagnosis. In pre-menopausal women, risk factors
included age, breast density, family history of breast cancer, and a prior breast procedure. In postmenopausal women, risk
factors included ethnicity, greater body mass index, natural menopause, use of hormone therapy, a prior false-positive mammogram,
as well as the risk factors found in pre-menopausal women.
In an accompanying article, Jinbo Chen, PhD, and Mitchell Gail, MD, PhD, of the National Cancer Institute (NCI), presents an
updated version of the “Gail model,” a breast cancer risk assessment tool that’s been widely used since the
1980s. The updated version now includes breast density as well.
The new models may eventually help doctors identify women at high risk for breast cancer who might benefit from preventive
interventions or more intensive screening, the researchers concluded. However, they cautioned that more research is needed
before doctors can predict the development of cancer in individual women.
The study was funded by the National Cancer Institute (NCI).
About the Breast Cancer Surveillance Consortium (BCSC)
The BCSC was established in 1994 by NCI to
assess community mammography practice and outcomes, collect risk factors prospectively at the time of each screening
mammogram, and ascertain cancer outcomes for all women. The seven BCSC mammography registries that participated in
this study included Group Health’s Breast Cancer Surveillance Project, Carolina Mammography Registry,
Colorado Mammography Project, New Hampshire Mammography Network, New Mexico mammography Project, San Francisco
Mammography Registry, and the Vermont Breast Cancer Surveillance System. More information can be found at:
www.breastscreening.cancer.gov.
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Study shows fruit and vegetable juice consumption may reduce risk of Alzheimer’s
disease
Drinking fruit and vegetable juices frequently may delay the onset of Alzheimer’s disease, according to a
study
co-authored by CHS Executive Director Eric B. Larson, MD, MPH.
Published in the September issue of The American Journal of Medicine, the study followed almost 2,000 subjects
for up to 10 years and found that the risk for developing Alzheimer’s disease was reduced by 76 percent for those who
drank fruit and vegetable juices more than three times per week compared with those who drank juices less than once per week.
A lower reduction (16 percent) was obtained for juice consumption once or twice per week.
Recent studies of Alzheimer’s disease biochemistry have focused on the accumulation of beta-amyloid peptide in the
brain, and the action of hydrogen peroxide in mediating this process. Various studies have suggested that polyphenols, strong
anti-oxidants available in many foods, might disrupt these processes and provide some protection against Alzheimer’s
disease. Although some studies of anti-oxidant vitamins have been disappointing, this study is the first to examine juices
rich in polyphenols as a preventive measure for Alzheimer’s disease.
The subjects were already part of the Kame Project, a prospective study Larson ran of of Japanese populations living in
Hiroshima, Japan; Oahu, Hawaii; and the metropolitan area of Seattle. Drawing from the Seattle population, 1,836 people
were identified as free of dementia in 1992-1994, and were followed at two-year time intervals until the end of 2001. Dietary
consumption of fruit and vegetable juices was determined from self-administered questionnaires developed for Asian populations.
Cognitive function was assessed by trained interviewers using a standardized test, with clinical follow-up resulting in clinical
diagnoses for those patients showing impairment.
Writing in the article, lead author Qi Dai, MD, PhD, of Vanderbilt University, states, “We found that frequent drinking
of fruit and vegetable juices was associated with a substantially decreased risk of Alzheimer’s disease. This inverse
association was stronger after adjustments for potential confounding factors, and the association was evident in all strata
of selected variables. These findings are new and suggest that fruit and vegetable juices may play an important role in delaying
the onset of Alzheimer’s disease.”
Dai said that the next step is to investigate whether high blood concentrations of polyphenols high in major fruit and vegetable
juices are associated with a reduced risk of cognitive decline and Alzheimer’s disease.
Other co-authors of the study are Amy R. Borenstein, PhD, and Yougui Wu, PhD, of the University of South Florida, and James C.
Jackson, PhD, of Vanderbilt University.
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Dr. Don Berwick to appear at Group Health Annual Meeting, Foundation Gala
Don Berwick, MD, MPP, president and CEO of the Institute for Healthcare Improvement, will be the keynote speaker
at Group Health’s Annual Membership Meeting on Saturday, October 21. The event will held from 8 a.m.
to 12:30 p.m. at the University of Washington Husky Union Building.
Register online by October 13 to receive meeting information and a parking permit.
Recognized as a leading authority on health care quality and improvement issues, Dr. Berwick will discuss the advantages of
consumers taking a more active role in their own health care. Berwick’s organization has been a key partner with CHS’
MacColl Institute in chronic care
initiatives nationwide.
Berwick will also be honored at the Group Health Community Foundation’s fifth annual
Gift of Health Gala on the evening of October 21, where he will receive the Foundation’s Health Care
Achievement Award.
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Research Highlights
Physicians vary widely in how they would disclose errors to patients, with less than half of those
surveyed reporting they would explicitly state that an error had occurred. This is according to research led by
Thomas H. Gallagher, MD, associate professor at the UW School of Medicine. CHS Executive Director
Eric B. Larson, MD, MPH,
is a co-author of the
study, which was published in the August 15, 2006 issue of Archives of Internal Medicine.
The research is based on a survey of 2,637 physicians from Washington, Missouri, and Canada. Participants received one of four
scenarios depicting serious errors that varied by specialty and how obvious the errors would be to the patient if not disclosed.
Five questions measured what respondents would disclose using scripted statements. Some 56 percent chose statements that mentioned
the adverse event but not the error, while 42 percent would explicitly state that an error occurred.
Disclosure was affected
by the nature of the error and physician specialty. “The medical profession should address the barriers to transparency
within the culture of medical and surgical specialties,” concluded Gallagher.
Principles for developing better health literacy are presented in a commentary
co-authored by CHS Senior Investigator Ed Wagner, MD, MPH, and Research Associate Sarah Greene, MPH, in the August 2006 issue of the
Journal of General Internal Medicine. Describing how the Institute of Medicine has identified health literacy as a national
priority for transforming health care quality, the article shifts the focus of the problem from the patient to the health care system.
It presents three overarching principles to: 1) promote productive interactions; 2) address the organization of health care; and
3) embrace a community-level, ecological perspective. Michael K. Paasche-Orlow, MD, MA, MPH, of Boston University School of Medicine is
the lead author of the article.
While the number of people using complementary and alternative medicine (CAM) providers in 2002 was substantial, the effect
on insurance expenditures was modest, according to a University of Washington (UW)/Group Health
study published in the July 2006 issue of the American Journal of Managed Care. The study examined CAM
utilization and expenditures among enrollees of three large insurers, including Group Health, following the 1996 implementation of a
state law requiring insurers to cover CAM services. CHS Senior Investigator
Dan Cherkin, PhD, and Associate Investigator
Karen Sherman, PhD,
are co-authors of the article. The lead author is UW’s William E. Lafferty, MD.
Radiologists within three U.S. mammography registries tended to overestimate their true frequency of recommending further
evaluation after screening mammography, according to a study conducted at Group Health and two other
organizations that are part of the Breast Cancer Surveillance Consortium. The same radiologists tended to underestimate the positive
predictive value of their recommendations for biopsy, the researchers found. Their study, published in the July 2006 issue of the
American Journal of Roentgenology, is based on 1998-2001 data. CHS Biostatistician
Linn Abraham, MS, Senior Investigator
William Barlow, PhD, and Affiliate Investigator Joann G. Elmore, MD, MPH, are co-authors. The lead author is Joshua J. Fenton, MD, MPH, of
the University of California at Davis.
Online smoking cessation support interventions can be as appealing to smokers as other forms of treatment according to
results of the “Project Quit” study published in August 2006 in the Journal of Medical Internet Research. CHS Associate
Investigator Jennifer McClure, PhD, is lead author of the
study conducted among members of Group Health and the Henry Ford Health
System. Offering access to an online program developed at the University Michigan Center for Health Communications
Research, the researchers found that uptake rates for the “Project Quit” intervention were comparable to those seen
when smokers are advised to quit and referred to other forms of smoking cessation treatment. Proactive mailings worked better than study
advertisements. Other CHS researchers on the study were Research Associate
Sarah M. Greene, MPH, Survey Manager
Cheryl Wiese, MA, and Project Manager Karin E. Johnson, PhD.
Children exposed to intimate partner violence have a higher likelihood of internalizing behaviors (anxiety and depression) and
physical aggression, according to a UW
study co-authored by CHS Associate Investigator
Paula Lozano, MD, MPH, and
Affiliate Investigator Fred Rivara, MD, MPH. Nerissa S. Bauer, MD, MPH, of the UW Department of Pediatrics, is the lead author of an
article about the study, which appeared in the August 2006 issue of the journal Pediatrics. The research was based
on data from 112 children, aged 6 to 13, and their parents.
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