The News-Sentinel, Fort Wayne, Ind., Health Sentinel Column: Sister Study Seeks Enrollment in Cancer Inquiry

By Jennifer L. Boen, The News-Sentinel, Fort Wayne, Ind.

Feb. 4–Ann Cirullo was just 38 when in 1995 she was diagnosed with breast cancer. Getting it at such a young age was a shock to the Fort Wayne woman, a claims examiner for K&K Insurance Group.

But the fact the cancer was in the breast was not such a surprise.

Cirullo’s maternal and paternal grandmothers, two aunts on both sides of the family and several cousins had already been diagnosed with breast cancer. Then, after Cirullo’s diagnosis, her mother was given the same news. As of yet, Cirullo’s three sisters are cancer-free — but Cirullo says, “We all know it could happen.”

Researchers know there is a genetic link to some kinds of breast cancer. For example, Cirullo has the gene that is known to be a linkage to a specific type of breast cancer. But what are the other links? Are they dietary, geographical, body metabolism or environmental?

These are some of the questions being addressed in the breast cancer Sister Study sponsored by the National Institute of Environmental Health Sciences, or NIEHS, which is a division of the National Institutes of Health

The Sister Study is in need of more enrollees, who must be women who have never had a diagnosis of breast cancer but who have at least one sister with a history of breast cancer. What is most needed are women age 50 and older; women of non-Caucasian race or minority women; and women who work in nontraditional occupations or occupations in which solvents, dyes, cleaners or other chemicals are used.

The Sister Study kicked off nationally in October 2004, “but we still like to think of it as new because we are still enrolling participants,” said Dr. Paula Scarborough Juras, one of the project officers and a NIEHS researcher.

“We’re making one last push to enroll women who are not well-represented.”

About 10,000 more women are needed, and Juras and her colleagues hope northeast Indiana women who meet the qualifications will consider participating.

By the end of this year, the goal is to have 50,000 women enrolled. Fort Wayne’s growing Hispanic community include women researchers would like to enroll.

In December, AARP partnered with the Sister Study researchers to get the word out about NIEHS’s call for older women, particularly those 65-74.

Several things set the Sister Study apart from other longitudinal studies of breast cancer causes or risk factors.

“We’re already starting with women at higher risk. Women who have a sister with breast cancer are at twice the risk of developing cancer as another woman in the United States,” Juras said.

In addition, “We are taking the most detailed look at the environment and how the environment may affect (the development of) cancer.”

For years, Asian women have had a lower incidence of breast cancer than Caucasians, but that is changing among families where the mother or grandmother grew up in her native country but has borne children in this country and raised them here.

“In just one or two generations, their risk of breast cancer increases. Information like that tells us something is going on in the environment,” Juras said.

A Western diet higher in fats, red meats and sugar than the typical Asian diet is likely the key, but other issues may also be at play.

“We know different occupations have different risks of breast cancer,” she said. For example, women who work in hair salons or who are frequently exposed to pesticides are more likely to develop cancer than comparable workers in other professions.

“We’re hoping to look at those types of work environments, and we hope to look at the home and community environment,” Juras said.

Periodically, a report is made that a certain community or parts of a city have much higher cancer rates than the surrounding areas. Aside from a Three Mile Island or Chernobyl catastrophe, where levels of chemicals or radiation are in the soil or air, are there less obvious reasons for clusters of cancer in a community or a family? Sometimes the obvious gets overlooked or taken for granted.

Juras, for example, says although she and her sister, who grew up in the same household, now live far apart, they share similar lifestyles and make many of the same choices.

“We use the same household products, cook the same way,” choices and habits that could have more significant bearing on the development of cancer than anyone has detected.

Although the primary focus of the Sister Study is on breast cancer risk, “the information we collect we will use in a whole spectrum of diseases,” including heart and autoimmune diseases, other cancers and asthma.

“That is the beauty of the way the study is designed, with the level of detail the women are providing,” she said.

It is too soon for researchers to discuss findings, “but we are starting to generate very early reports on the study design and looking at the relationship between some known or expected risk factors and how they relate to other things, such as obesity and stress,” Juras said.

In a few years, researchers should be able to “tease out” key indicators that could give hope of helping women reduce their risk of breast cancer or other diseases.

“The average person has never participated in a research study. That’s why we have tried very hard to make the study accessible to them,” Juras said, noting no participant has to travel. “It’s all done in their home.

One in eight U.S. women will develop invasive breast cancer in their lifetime, according to the National Cancer Institute.

“I don’t know anyone who hasn’t been touched by breast cancer. It affects families dramatically,” Juras said, noting testimonials on the Sister Study Web site www.sisterstudy.org from study participants give evidence of such. “That’s why they’re doing this,” Juras said. “They don’t want to see their daughters or nieces or granddaughters see this disease.”

Although Cirullo cannot participate, she thinks of her daughter and her sisters and says, “The more information we can learn, the better. If they can find that piece of the puzzle that goes with another piece, then I’m all for it.”

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