Profiles of Two CBCRP Postdoctroal Fellows

Lauren John

Karyn L. Angell, Ph.D.

Breast cancer strikes many women at a time in their lives when they are busy caring for others. Some women are responsible for teenagers, some are caring for aging parents, and some are caring for both older and younger family members. With all of these responsibilities, are women paying enough attention to their own health care?

That was one of the questions explored in clinical psychologist Karyn Angell's CBCRP funded study entitled, “Effects of Stress and Support on Delay in Cancer Treatment.”

“Knowledge about the influences of stress and care seeking behavior will provide important information for interventions aimed at getting women into treatment sooner, possibly leading to better prognoses and potentially lowering breast cancer mortality rates,” she wrote in her award application to CBCRP.

In her study, Dr. Angell interviewed 34 women recently diagnosed with primary breast cancer and asked them what else was going on in their lives in the year before diagnosis—and how soon they sought treatment.

She found that women who experienced severe life events such as the death of a parent or close family member during the year before breast cancer diagnosis were seven times more likely to delay treatment for breast cancer. What's more, women whose social network included people who were critical or demanding were found to be two and a half times more likely to delay treatment for their breast cancer.

When Dr. Angell applied for a grant in 1994, she had just received her Ph.D. in psychology from University of Oregon and was four months into an appointment at the lab of psychiatrist David Spiegel at Stanford University. Dr. Spiegel is a leading researcher on the effects of stress and social support on breast cancer survival, and he has studied how and why support groups benefit women with metastatic disease.

“My experience at Stanford taught me how important it was to interview women living with breast cancer and hear firsthand what they were experiencing, rather than giving them questionnaires to fill out to report on stress levels,” Angell says.

“The CBCRP grant, which was my first funded work in breast cancer research, enabled me to receive training on the use of interview-based stress measures from George Brown, Ph.D., one of the leaders in the field of stress assessment,” she says. “Combined with David's clinical training and encouragement, it was a tremendous opportunity.”

Catherine Carpenter, Ph.D.

Can women reduce their risk of breast cancer by exercising regularly? These days, with activists calling for more focus on preventative medicine, a number of breast cancer researchers are exploring this issue. But back in 1995, when CBCRP funded University of Southern California (USC) researcher Catherine Carpenter's work in this area, it was a relatively new idea.

“There was a lot of evidence from population studies that suggested that women who engage in strenuous physical activity are at reduced risk of breast cancer . and identification of physical activity as a possible protective factor among postmenopausal women could provide an intervention tool to reduce breast cancer among women in California,” Dr. Carpenter wrote back in 1994 in her grant application for a postdoctoral fellowship.

In her final report in 1998, she concluded, “results indicate that exercise and maintenance of a stable weight during adulthood are important ways that women can reduce their chances of developing breast cancer after menopause.”

“Today most of the exercise papers coming out have cited our paper,” Carpenter says. “In fact, the CBCRP grant was essential to everything that I am doing now,” she adds. Today, Dr. Carpenter continues to do breast cancer research at the University of California at Irvine, where she is now a faculty member. Her personal exercise routine includes work with weights and aerobics.

A decade ago Dr. Carpenter's dissertation focused on lung cancer research. But she decided to apply for a CBCRP grant after being inspired by research done by University of Southern California School of Medicine breast cancer researcher Dr. Leslie Bernstein. Dr. Bernstein's hypothesis was and is that physical activity offers a modifiable lifestyle choice with the potential to substantially reduce a woman's lifetime risk of breast cancer. In 1994 Dr. Bernstein published a study in the Journal of the National Cancer Institute, indicating a link between physical exercise and reduced risk of breast cancer in younger women.

Drs. Carpenter and Bernstein decided to study an older population, and CBCRP's threeyear fellowship, which was granted for 1995- 1998, enabled Carpenter to do that.

“Leslie Bernstein became my mentor thanks to the fellowship grant,” she says. Today the two continue to collaborate on studies linking lifetime physical exercise, obesity, and body mass index to breast cancer risk.

A 1999 study, done by a team including Carpenter and Bernstein, published in the British Journal of Cancer entitled, “Lifetime exercise activity and breast cancer risk among postmenopausal women,” showed that strenuous exercise appears to reduce breast cancer risk among postmenopausal women who do not gain sizable amounts of weight during adulthood.

Overall, what have we learned about the role that exercise plays in breast cancer prevention? “The evidence is becoming more consistent about the risk-lowering benefits of exercise in postmenopausal women,” Carpenter says. “However, exercise is still not listed as a protective risk factor in guidance provided to women by medically-related information sources,” she adds. More evidence needs to be gathered first, she says, adding that with continued research in exercise and breast cancer, we could potentially factor in women's exercise patterns with other known risk factors for breast cancer, like those measured, for instance,in the Gail model.

To date, the Gail model is a checklist that takes into consideration a patient's age and the number of first-degree relatives who have been diagnosed with breast cancer. It also factors in whether a woman has had children and, if so, her age at her first delivery. It also counts the number and types of breast biopsies she has had and how old she was at her first menstrual period.

“I'd like to be able to see exercise listed as a way that women can lower their risk,” Carpenter says.