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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.

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Presentation on theme: "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."— Presentation transcript:


2 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?

3 Why Was it Initiated?

4 Breast Cancer Incidence Trends in Marin County* (2001-02) * White non-Hispanic women, invasive cancers only


6 The Breast Cancer Incidence Rates Comparison – 2004-05 Mortality Phipps A, Clark C, Ereman R; Breast Cancer Research, June 7, 2005 Marin SFBA CA US Rates in the1990’sRe-calculated based on new Census

7 MANY Questions WHY Marin’s Breast Cancer Rates High 2001-2005

8 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

9 Left with the question  Do the women in Marin who get breast cancer have more of the risk factors that are more prevalent here?  We needed risk factor information from women getting cancer, so we could answer this crucial question.

10 2004 - What Next?  Research suggests that lifestyle risk factors play a role in Marin  We need to gather individual risk factors and breast health information from each Marin woman  The County/Community IS where research needs to be – Community is determined and cares deeply  All women do not respond to risk factors in the same way, We need to to look at gene-environment interactions  Can we pave a way for investigating environmental toxins. THE MARIN WOMEN’S STUDY WAS BORN

11 HISTORY  Funded by the CDC in July 2005  Multiple stakeholder planning meetings during 2005-2006  Data Collection Launched November 2006  First Research Results January 2008

12 Marin Women’s Study GOALS   Investigate how reproductive, lifestyle, demographic and biologic factors affect breast cancer risk in Marin Alcohol, Hormone Therapy, Reproductive Factors, Socio-economic Status, Stress, Environmental Exposures.Alcohol, Hormone Therapy, Reproductive Factors, Socio-economic Status, Stress, Environmental Exposures.  Understand why breast cancer risk factors do not affect all women in the same way.

13 MWS COMPONENTS Breast Cancer Breast Density

14 Who is Involved?



17 COMMUNITY INVOLVEMENT GROUP  Marin General Hospital  Meals of Marin  Marin Family Action  Marin Friends of Women  Kaiser Permanente  Marin Center for Independent Living  Zero Breast Cancer 15 Individuals & Community Groups  Marin Breast Cancer Council  Breast Cancer Resource Center  American Cancer Society  Tina Action Programs  Fair Housing of Marin


19 What Is Happening Now?

20 STUDY SUCCESSES – Oct. 2009 QUESTIONNAIRE  Almost 14,000 Questionnaires received! BIOSPECIMEN  Saliva Collection 6,000 Samples!  AVON funding received July 2007, Sept 2009 CAMPAIGN  Campaign – Banners, Movie Theatres, Grocers…  80% of women surveyed knows about MWS

21 Hormone Therapy Study In Review

22 Hormone Therapy Use, 2001 Women, ages 50+  Marin: 40.7%, California: 39.3% - used any type of prescription hormone therapy.  % of women >50 yrs. with a Hysterectomy: Marin 29.4% Marin 29.4% California- 38.1% California- 38.1% Kings County – 53.7% Kings County – 53.7% E + P

23 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%

24 Alternative Hormone Use n=1,748#% Use (2006-07) 152 8.7% 8.7% Soy Products Soy Products45 2.6% 2.6% Black Cohosh Black Cohosh39 2.2% 2.2% Combination Herbal Combination Herbal20 1.1% 1.1% Phytoestrogens Phytoestrogens11 0.6% 0.6% Other Other43 1.5% 1.5% Current E+P Use 6%

25 QUITTING BEHAVIOR Why Quit: (E+P) users who quit in past… 5 yrs>10 yrs ago Side Effects 11.5% 32.3% Dr. Recommended31.9 25.8 Health Effects38.1 19.4 News Reports46.9 12.9 Switched types6.2 6.5 Health or News Reports59.3 25.8 Multiple reasons allowed

26 Number of Breast Cancer Cases In each two year period 1998-992001-022003-042005-06 Total Cases 424434351373 61-83 fewer cases Women’s Health Initiative Results Published NOTE: Mammography Screening did not decrease during this time

27 What’s Next?

28 MWS Next Steps  Complete cleaning and scanning data into database.  Complete analysis of first saliva study  Embark on second ‘spit study’!  Conduct analyses on key research questions.  Track Hormone Therapy use - ‘re-starting’, replacement regimens, - Are emerging CAMS safe?

29 Selected Risk Factors in Women 50-80 in DRAFT Marin n=5438 DRAFT CASESNon-CasesSignificance Age at first birth 27.427.5 No Difference Menarche12.712.7 Number of Children 1.71.6SIG Months Breastfed 8.49.0 No Difference Former Smoker 56.1%45.9%SIG Ashkenazi Jewish Heritage 13.6%11.1% No Difference HRT Combination Therapy (current use) No Obs for age group Alcohol in High School 29.4%25.1% No Difference

30 Cancer Root Flower  Growth similar to cancer in humans  To remind us that the cure is in the earth.

31 CONTACT INFO  Web Site:  Contact Epidemiology Program for materials or information: 507-4077  Rochelle Ereman, Study Director 499-3056  Kathy Koblick, Outreach and Campaign 507-2578  Mark Powell, MD, MPH, Biospecimen 499-6969


33 Percentage of Women with Hysterectomies, selected CA counties  San Francisco, Santa Cruz and Marin – counties with lowest hysterectomy rates. (24.5-30.6%)  Kings, Madera and Kern counties – highest hysterectomy rates (55-62%)  Average 41.5% CA 31% 62% NOT MORE WOMEN ON HRT: Current use of HRT 35% in 2001 CA, Marin

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