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  1. Article: Risk of Subsequent Breast Cancer in Women with Early Stage HER2-Positive Breast Cancer in a Large Community Health Plan.

    Haque, Reina / Chen, Lie Hong / Oestreicher, Nina / Lalla, Deepa / Chlebowski, Rowan T

    Breast cancer (Dove Medical Press)

    2023  Volume 15, Page(s) 637–645

    Abstract: Purpose: Clinical outcomes have improved for women with early stage, HER2-positive breast cancer following the FDA approval of adjuvant trastuzumab use in 2006. However, only limited information exists on such patients' outcomes in real-world settings ... ...

    Abstract Purpose: Clinical outcomes have improved for women with early stage, HER2-positive breast cancer following the FDA approval of adjuvant trastuzumab use in 2006. However, only limited information exists on such patients' outcomes in real-world settings outside of clinical trials. We examined the risk of subsequent breast cancer in women with HER-2 positive disease, and the impact of trastuzumab use, in a large California community-based health plan.
    Patients and methods: A cohort of 3550 women with HER2-positive breast cancer (stages I-III) from 2009-2017 were followed through December 2018. We calculated subsequent breast cancer (SBC) rates overall and by trastuzumab use. Multivariable Cox proportional hazards modeling was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for SBC by trastuzumab use.
    Results: Within the cohort diagnosed with HER2-positive disease, 81% received adjuvant trastuzumab. After 4.1 mean years follow-up (maximum 10 years), the risk of SBC was 22% lower with adjuvant trastuzumab use (hazard ratio [HR] = 0.78, 95% confidence interval [CI]: 0.66-0.92) compared with non-use. The cumulative incidence of SBC precipitously rose two years after diagnosis and by the 10th year, the cumulative incidence was 31% among those who had trastuzumab therapy versus 34% without this therapy.
    Conclusion: In community practice settings, the cumulative incidence of SBC in patients with early stage HER2-positive BC was 31% at 10 years in a cohort treated with adjuvant trastuzumab. Trastuzumab use was associated with a 22% reduced risk of developing SBC. This residual disease burden suggests breast cancer outcomes may be improved with further treatment given the advent of next-generation HER2-targeted therapies.
    Language English
    Publishing date 2023-08-16
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2520722-2
    ISSN 1179-1314
    ISSN 1179-1314
    DOI 10.2147/BCTT.S420061
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  2. Article ; Online: Sleep medication use and risk of fractures in breast cancer survivors.

    Haque, Reina / Chlebowski, Rowan T / Chen, LieHong

    Breast cancer research and treatment

    2021  Volume 190, Issue 3, Page(s) 541–548

    Abstract: Purpose: Sleep problems are more common in breast cancer survivors than those without a cancer history. Our goal was to examine the risk of fractures among breast cancers survivors who used prescription sleep aids.: Methods: We conducted a ... ...

    Abstract Purpose: Sleep problems are more common in breast cancer survivors than those without a cancer history. Our goal was to examine the risk of fractures among breast cancers survivors who used prescription sleep aids.
    Methods: We conducted a retrospective cohort study of 21,346 adult women diagnosed with stage 0-III breast cancer between 2009 and 2016 and followed them through 2017. We examined person-year rates of fractures by sleep medication use and calculated adjusted hazard ratios (HR) and 95% confidence intervals (CI) with Cox proportional hazards models using time-dependent variables for sleep medications and covariate medications (antidepressants, anti-anxiety medications, and bisphosphonates) adjusted for demographics, comorbidities, and tumor characteristics and cancer treatments.
    Results: The sleep medication use was common (40%) in breast cancer survivors and was associated with a 33% increased risk of fractures (adjusted HR = 1.33, 95% CI: 1.20-1.49). Further, in a sensitivity analysis based on new use of sleep medication, the fracture risk was even stronger (adjusted HR = 1.44, 95% CI: 1.26-1.64).
    Conclusion: Given the high use of sleep medications and the high risk of fractures in breast cancer survivors, this study suggests that non-pharmacologic management of sleep problems might be considered as alternative therapy.
    MeSH term(s) Breast Neoplasms/complications ; Breast Neoplasms/drug therapy ; Breast Neoplasms/epidemiology ; Cancer Survivors ; Female ; Humans ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Sleep ; Survivors
    Language English
    Publishing date 2021-09-29
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 604563-7
    ISSN 1573-7217 ; 0167-6806
    ISSN (online) 1573-7217
    ISSN 0167-6806
    DOI 10.1007/s10549-021-06392-4
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  3. Article ; Online: Validating a model for predicting breast cancer and nonbreast cancer death in women aged 55 years and older.

    Wolfson, Emily A / Schonberg, Mara A / Eliassen, A Heather / Bertrand, Kimberly A / Shvetsov, Yurii B / Rosner, Bernard A / Palmer, Julie R / LaCroix, Andrea Z / Chlebowski, Rowan T / Nelson, Rebecca A / Ngo, Long H

    Journal of the National Cancer Institute

    2023  Volume 116, Issue 1, Page(s) 81–96

    Abstract: Background: To support mammography screening decision making, we developed a competing-risk model to estimate 5-year breast cancer risk and 10-year nonbreast cancer death for women aged 55 years and older using Nurses' Health Study data and examined ... ...

    Abstract Background: To support mammography screening decision making, we developed a competing-risk model to estimate 5-year breast cancer risk and 10-year nonbreast cancer death for women aged 55 years and older using Nurses' Health Study data and examined model performance in the Black Women's Health Study (BWHS). Here, we examine model performance in predicting 10-year outcomes in the BWHS, Women's Health Initiative-Extension Study (WHI-ES), and Multiethnic Cohort (MEC) and compare model performance to existing breast cancer prediction models.
    Methods: We used competing-risk regression and Royston and Altman methods for validating survival models to calculate our model's calibration and discrimination (C index) in BWHS (n = 17 380), WHI-ES (n = 106 894), and MEC (n = 49 668). The Nurses' Health Study development cohort (n = 48 102) regression coefficients were applied to the validation cohorts. We compared our model's performance with breast cancer risk assessment tool (Gail) and International Breast Cancer Intervention Study (IBIS) models by computing breast cancer risk estimates and C statistics.
    Results: When predicting 10-year breast cancer risk, our model's C index was 0.569 in BWHS, 0.572 in WHI-ES, and 0.576 in MEC. The Gail model's C statistic was 0.554 in BWHS, 0.564 in WHI-ES, and 0.551 in MEC; IBIS's C statistic was 0.547 in BWHS, 0.552 in WHI-ES, and 0.562 in MEC. The Gail model underpredicted breast cancer risk in WHI-ES; IBIS underpredicted breast cancer risk in WHI-ES and in MEC but overpredicted breast cancer risk in BWHS. Our model calibrated well. Our model's C index for predicting 10-year nonbreast cancer death was 0.760 in WHI-ES and 0.763 in MEC.
    Conclusions: Our competing-risk model performs as well as existing breast cancer prediction models in diverse cohorts and predicts nonbreast cancer death. We are developing a website to disseminate our model.
    MeSH term(s) Female ; Humans ; Breast Neoplasms/diagnosis ; Risk Factors ; Risk Assessment/methods ; Women's Health ; Mammography
    Language English
    Publishing date 2023-10-24
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2992-0
    ISSN 1460-2105 ; 0027-8874 ; 0198-0157
    ISSN (online) 1460-2105
    ISSN 0027-8874 ; 0198-0157
    DOI 10.1093/jnci/djad188
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  4. Article ; Online: The relationship between optimism, MCI, and dementia among postmenopausal women.

    Sachs, Bonnie C / Gaussoin, Sarah A / Brenes, Gretchen A / Casanova, Ramon / Chlebowski, Rowan T / Chen, Jiu-Chiuan / Luo, Juhua / Rapp, Stephen R / Shadyab, Aladdin H / Shumaker, Sally / Wactawski-Wende, Jean / Wells, Gretchen L / Hayden, Kathleen M

    Aging & mental health

    2022  Volume 27, Issue 6, Page(s) 1208–1216

    Abstract: ... Revised (LOT-R) total score, and optimism and pessimism subscales. A panel of experts adjudicated ... to examine the association of LOT-R total score and optimism and pessimism sub-scores with MCI/dementia ... We also examined the relationship between vascular disease, LOT-R total score, optimism and pessimism, and ...

    Abstract Objectives: The relationship between optimism and cognitive functioning is not fully understood. We examined the association of optimism with risk of mild cognitive impairment (MCI) and dementia in the Women's Health Initiative Memory Study (WHIMS).
    Methods: Optimism was measured by the Life Orientation Test-Revised (LOT-R) total score, and optimism and pessimism subscales. A panel of experts adjudicated cognitive endpoints based on annual cognitive assessments. We used cox proportional hazard regression models to examine the association of LOT-R total score and optimism and pessimism sub-scores with MCI/dementia. We also examined the relationship between vascular disease, LOT-R total score, optimism and pessimism, and cognition.
    Results: Mean age was 70.5 (SD = 3.9) years. The sample (
    Conclusion: These data suggest that less pessimism, but not more optimism, was associated with a lower risk of MCI and dementia.
    MeSH term(s) Humans ; Female ; Aged ; Postmenopause ; Cognitive Dysfunction/epidemiology ; Cognition Disorders ; Optimism ; Dementia/epidemiology ; Vascular Diseases
    Language English
    Publishing date 2022-06-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 1474804-6
    ISSN 1364-6915 ; 1360-7863
    ISSN (online) 1364-6915
    ISSN 1360-7863
    DOI 10.1080/13607863.2022.2084710
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  5. Article ; Online: Association between menopausal hormone therapy and incidence of psoriasis: a secondary analysis from the Women's Health Initiative randomized clinical trials.

    Chan, A A / Noguti, J / Yang, C T / Feldman, S R / Wallace, R B / Shadyab, A H / Manson, J E / Aragaki, A K / Chlebowski, R T / Lee, D J

    The British journal of dermatology

    2021  Volume 185, Issue 3, Page(s) 669–671

    Language English
    Publishing date 2021-06-14
    Publishing country England
    Document type Letter
    ZDB-ID 80076-4
    ISSN 1365-2133 ; 0007-0963
    ISSN (online) 1365-2133
    ISSN 0007-0963
    DOI 10.1111/bjd.20410
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  6. Article ; Online: Chronic Oxidative Stress as a Marker of Long-term Radiation-Induced Cardiovascular Outcomes in Breast Cancer.

    Vasbinder, Alexi / Cheng, Richard K / Heckbert, Susan R / Thompson, Hilaire / Zaslavksy, Oleg / Chlebowski, Rowan T / Shadyab, Aladdin H / Johnson, Lisa / Wactawski-Wende, Jean / Wells, Gretchen / Yung, Rachel / Martin, Lisa Warsinger / Paskett, Electra D / Reding, Kerryn

    Journal of cardiovascular translational research

    2022  Volume 16, Issue 2, Page(s) 403–413

    Abstract: While biomarkers have been proposed to identify individuals at risk for radiation-induced cardiovascular disease (RICVD), little is known about long-term associations with cardiac events. We examined associations of biomarkers of oxidative stress ( ... ...

    Abstract While biomarkers have been proposed to identify individuals at risk for radiation-induced cardiovascular disease (RICVD), little is known about long-term associations with cardiac events. We examined associations of biomarkers of oxidative stress (myeloperoxidase, growth differentiation factor-15, 8-hydroxy-2'-deoxyguanosine [8-OH-dG], placental growth factor), cardiac injury (troponin I, cystatin-C), inflammation (interleukin-6, C-reactive protein), and myocardial fibrosis (transforming growth factor-ß) with long-term RICVD in breast cancer (BC) survivors. We conducted a nested case-control study within the Women's Health Initiative of postmenopausal women with incident BC stages I-III, who received radiation and had pre- and post-BC diagnosis serum samples. Cases (n = 55) were defined as developing incident, physician-adjudicated myocardial infarction, coronary heart disease death, other CVD death, heart failure, or stroke after BC. Cases were matched to three controls (n = 158). After adjustment, a higher 8-OH-dG ratio was significantly associated with an elevated long-term risk of RICVD, suggesting oxidative DNA damage may be a putative pathway for RICVD.
    MeSH term(s) Female ; Humans ; Risk Factors ; Breast Neoplasms ; 8-Hydroxy-2'-Deoxyguanosine ; Case-Control Studies ; Placenta Growth Factor ; Cardiovascular Diseases ; Myocardial Infarction/complications ; Biomarkers ; Oxidative Stress
    Chemical Substances 8-Hydroxy-2'-Deoxyguanosine (88847-89-6) ; Placenta Growth Factor (144589-93-5) ; Biomarkers
    Language English
    Publishing date 2022-09-30
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 2422411-X
    ISSN 1937-5395 ; 1937-5387
    ISSN (online) 1937-5395
    ISSN 1937-5387
    DOI 10.1007/s12265-022-10320-2
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  7. Article ; Online: Changes in physical function in older women with endometrial cancer with or without adjuvant therapy.

    Quick, Allison M / McLaughlin, Eric / Krok Schoen, Jessica L / Felix, Ashley S / Presley, Carolyn J / Cespedes Feliciano, Elizabeth M / Shadyab, Aladdin H / Jung, Su Yon / Luo, Juhua / King, Jennifer J / Rapp, Stephen R / Werts, Samantha / Chlebowski, Rowan T / Naughton, Michelle / Paskett, Electra

    Journal of cancer survivorship : research and practice

    2023  

    Abstract: Objective: To evaluate changes in physical function (PF) for older women with endometrial cancer (EC) + / - adjuvant therapy in the Women's Health Initiative Life and Longevity after Cancer cohort.: Materials and methods: This study examined women ≥ ... ...

    Abstract Objective: To evaluate changes in physical function (PF) for older women with endometrial cancer (EC) + / - adjuvant therapy in the Women's Health Initiative Life and Longevity after Cancer cohort.
    Materials and methods: This study examined women ≥ 70 years of age with EC with available treatment records. Change in PF was measured using the RAND-36 and compared between groups using Wilcoxon rank-sum tests. Multivariable median regression was used to compare the changes in scores while adjusting for confounding variables.
    Results: Included in the study were 287 women, 150 (52.3%) women who did not receive adjuvant therapy and 137 (47.7%) who received adjuvant therapy. When comparing PF scores, there was a statistically significant difference in the median percent change in functional decline, with a greater decline in those who received adjuvant therapy (- 5.9% [- 23.5 to 0%]) compared to those who did not (0 [- 18.8 to + 6.7%]), p = 0.02). Results were not statistically significant after multivariable adjustment, but women who underwent chemotherapy had a greater percent change (median ∆ - 13.8% [- 35.5 to 0%]) compared to those who received radiation alone (median ∆ - 5.9% [- 31.3 to 0%]) or chemotherapy and radiation (median ∆ - 6.5% [- 25.8 to + 5.7%].
    Conclusions: Older women with EC who received adjuvant therapy experienced greater change in PF than those who did not receive adjuvant therapy, particularly women who received chemotherapy. These results were not statistically significant on multivariate analysis.
    Implications for cancer survivors: EC survivors may experience changes in PF because of chemotherapy and/or radiation therapy. Additional supportive care may need to be provided to older women to mitigate functional decline.
    Language English
    Publishing date 2023-09-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2388888-X
    ISSN 1932-2267 ; 1932-2259
    ISSN (online) 1932-2267
    ISSN 1932-2259
    DOI 10.1007/s11764-023-01460-8
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  8. Article ; Online: Inflammatory, Oxidative Stress, and Cardiac Damage Biomarkers and Radiation-Induced Fatigue in Breast Cancer Survivors.

    Vasbinder, Alexi / Thompson, Hilaire / Zaslavksy, Oleg / Heckbert, Susan R / Saquib, Nazmus / Shadyab, Aladdin H / Chlebowski, Rowan T / Warsinger Martin, Lisa / Paskett, Electra D / Reding, Kerryn W

    Biological research for nursing

    2022  Volume 24, Issue 4, Page(s) 472–483

    Abstract: Purpose: Studies examining biomarkers associated with fatigue in breast cancer survivors treated with radiation are limited. Therefore, we examined the longitudinal association between serum biomarkers and post-breast cancer fatigue in survivors treated ...

    Abstract Purpose: Studies examining biomarkers associated with fatigue in breast cancer survivors treated with radiation are limited. Therefore, we examined the longitudinal association between serum biomarkers and post-breast cancer fatigue in survivors treated with radiation: [oxidative stress] 8-hydroxyguanosine, myeloperoxidase; [inflammation] interleukin-6 (IL-6), c-reactive protein, growth differentiation factor-15 (GDF-15), placental growth factor, transforming growth factor-beta, [cardiac damage] cystatin-C, troponin-I.
    Methods: In a secondary analysis, we included participants from the Women's Health Initiative if they had: a previous breast cancer diagnosis (stages I-III), no prior cardiovascular diseases, pre-and post-breast cancer serum samples drawn approximately 3 years apart, and fatigue measured using the Short-Form 36 vitality subscale at both serum collections. Biomarkers were measured using ELISA or RT-qPCR and modeled as the log
    Results: Overall, 180 women with a mean (SD) age of 67.0 (5.5) years were included. The mean (SD) vitality scores were 66.2 (17.2) and 59.7 (19.7) pre- and post-breast cancer, respectively. Using multivariable weighted linear regression, higher biomarker ratios of cystatin-C, IL-6, and GDF-15 were associated with a lower vitality score (i.e., higher fatigue). For example, for each 2-fold difference in cystatin-C biomarker ratio, the vitality score was lower by 7.31 points (95% CI: -14.2, -0.45).
    Conclusion: Inflammatory and cardiac damage biomarkers are associated with fatigue in breast cancer survivors treated with radiation; however, these findings should be replicated in a larger sample. Biomarkers could be measured in clinical practice or assessed in risk prediction models to help identify patients at high risk for fatigue.
    MeSH term(s) Aged ; Biomarkers ; Breast Neoplasms/complications ; Breast Neoplasms/radiotherapy ; Cancer Survivors ; Cystatins ; Fatigue/etiology ; Female ; Growth Differentiation Factor 15 ; Humans ; Interleukin-6 ; Middle Aged ; Oxidative Stress ; Placenta Growth Factor ; Survivors
    Chemical Substances Biomarkers ; Cystatins ; Growth Differentiation Factor 15 ; Interleukin-6 ; Placenta Growth Factor (144589-93-5)
    Language English
    Publishing date 2022-05-07
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 2145107-2
    ISSN 1552-4175 ; 1099-8004
    ISSN (online) 1552-4175
    ISSN 1099-8004
    DOI 10.1177/10998004221098113
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    Zs.A 5946: Show issues Location:
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  9. Article ; Online: Toward optimal health: advances in breast cancer detection and management. Interview by Jodi R. Godfrey.

    Chlebowski, Rowan T

    Journal of women's health (2002)

    2008  Volume 17, Issue 7, Page(s) 1067–1070

    MeSH term(s) Antineoplastic Agents, Hormonal/therapeutic use ; Breast Neoplasms/diagnosis ; Breast Neoplasms/drug therapy ; Breast Neoplasms/genetics ; Breast Neoplasms/prevention & control ; Female ; Humans ; Mammography/methods ; Raloxifene Hydrochloride/therapeutic use ; Risk Assessment/methods ; Risk Factors ; Selective Estrogen Receptor Modulators/therapeutic use ; Tamoxifen/therapeutic use ; United States
    Chemical Substances Antineoplastic Agents, Hormonal ; Selective Estrogen Receptor Modulators ; Tamoxifen (094ZI81Y45) ; Raloxifene Hydrochloride (4F86W47BR6)
    Language English
    Publishing date 2008-09
    Publishing country United States
    Document type Interview
    ZDB-ID 1139774-3
    ISSN 1931-843X ; 1059-7115 ; 1540-9996
    ISSN (online) 1931-843X
    ISSN 1059-7115 ; 1540-9996
    DOI 10.1089/jwh.2008.1011
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  10. Article ; Online: Reply to the siren's song of anonymous web-based sampling.

    Weiss, Marisa C / Hibbs, Julianne E / Buckley, Meghan E / Danese, Sherry R / Leitenberger, Adam / Bollmann-Jenkins, Melissa / Meske, Sam / Aliano-Ruiz, Katherine E / McHugh, Theresa W / Larson, Sharon L / Le, Elaine H / Green, Nancye L / Gilman, Paul B / Kaklamani, Virginia G / Chlebowski, Rowan T / Martinez, Diana M

    Cancer

    2022  Volume 128, Issue 9, Page(s) 1873–1874

    Language English
    Publishing date 2022-02-23
    Publishing country United States
    Document type Letter ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 1429-1
    ISSN 1097-0142 ; 0008-543X ; 1934-662X
    ISSN (online) 1097-0142
    ISSN 0008-543X ; 1934-662X
    DOI 10.1002/cncr.34099
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