MMC—Cancer

Cancer

LEADERSHIP

Dr. Nananda Col has expertise on women’s health issues, particularly breast cancer. She sits on the Breast Cancer Technology Assessment Working Group of the American Society of Clinical Oncology (ASCO) and helped updated the ASCO guidelines for reducing the risk of breast cancer. Dr. Col worked served on the National Cancer Institute study section about behavior research and cancer and has developed decision aids to address breast cancer risk and preventative treatment. Dr. Susan Miesfeldt is a clinical oncologist specializing in high risk populations and is the Director of the Cancer Risk and Prevention Program at Maine Medical Center. She has worked with the Maine state government on several task forces dedicated to breast and cervical cancer detection and prevention. She works with cancer organizations throughout the state including the Maine Cancer Consortium, the Maine Center for Cancer Medicine and MaineHealth. In addition to her work on the state level, Dr. Miesfeldt is involved with the National Institutes of Health Cancer Genetics Studies Consortium and the American Society of Clinical Oncology. Dr. Kathleen Fairfield was a fellow in Cancer Prevention at the Harvard School of Public Health. Her major area of research is ovarian cancer epidemiology.

PROJECTS (Current and completed within the past 3 years)

Ovarian Cancer and Geographic Variation:

CORE Investigator Dr. Kathleen Fairfield is working with Dr. Lee Lucas to analyze ovarian cancer data available through the SEER registry. The Surveillance Epidemiology and End Results (SEER) Program is a National Cancer Institute registry of cancer incidence and survival rates in the United States, and is the only comprehensive source for population-based cancer data in the United States. The SEER Program is recognized among cancer registries worldwide for the quality and completeness of its data. The analysis examines geographic variation in stage at diagnosis of ovarian cancer, and geographic variation in treatment outcomes for ovarian cancer, including survival and complications. This study is funded by the Maine Medical Center Research Strategic Plan for Clinician-Scientists.

Cancer Screening for High-Risk Women:

CORE investigator Dr. Susan Miesfeldt has been involved in numerous projects addressing breast, ovarian and colon cancer screening among high risk women. One project, entitled, "Screening and Prevention Practices Among Women At-Risk for Hereditary Breast and Ovarian Cancer Following Genetic Counseling in the Community Setting" examined the post-counseling care of at-risk women with a focus on barriers or facilitators of care. Currently, data collection is complete and is being prepared for publication. This study was funded by Maine Cancer Foundation.

Another, the "Southern Maine Colon Cancer Screening Study," addresses the lack of low cost or no cost screening services for under or uninsured Maine residents. Working with collaborators at DHHS/Maine CDC and the Maine Cancer Consortium, we developed a pilot study that offered no-cost FOBT screening to women enrolled in the Southern Maine Breast and Cervical Health Program. This study was designed to serve as a pilot for the remainder of the state. The hope is that through the development of a statewide program like this, Maine would be in position to apply for CDC funds to develop a comprehensive (colonoscopy-based) statewide screening program. The project was partially funded through a CDC seed grant.

A third study, "Cancer Screening and Prevention Practices Following Cancer Genetic Risk Assessment among Those At Risk for Hereditary Breast Cancer," evaluated adherence to recommended screening and prevention interventions. It also examined barriers to care among those who have undergone genetic counseling for hereditary breast cancer risk. This project was funded by the Maine Cancer Foundation.

LiveWell: Improving Life after Cancer Treatment

Dr. Susan Miesfeldt, an investigator at CORE, is an advisor to the LiveWell Program. LiveWell is a collaboration between the Maine Cancer Consortium and MaineHealth to develop a survivorship program that advances the physical and emotional strength of those who have completed primary therapy for colorectal cancer. Aims of LiveWell are to improve diet and fitness by setting realistic and manageable goals, cope with medications and changes to daily life including cognitive symptom management and access support resources available in the community.

Hereditary Colorectal Cancer Assessment

CORE Investigator Dr. Susan Miesfeldt is Co-PI is developing an educational and risk assessment toolkit for Maine clinicians who care for patients at risk for hereditary non-polyposis colorectal cancer (HPCC) in collaboration with the Institute for Preventive Medicine and Medical Screening. The aims of the toolkit are to identify carriers of the mutation and insure proper follow-up and care is offered to these individuals and their families. This year-long grant is in progress and researchers have already completed an extensive literature review and held multiple stakeholder meetings. Data from the stakeholder meetings will be used to draft the Families with Color Cancer Toolkit. This toolkit will be used by clinicians as well as administrators to assess HPCC risk at routine screenings. A pilot test is expected to begin in early 2008 in which the impact of the toolkit will be assessed and reviewed. This study is funded by the Maine Cancer Foundation, a non-profit organization dedicated to improving the health and well-being of people in Maine through grants cancer research, education and support programs.

Maine Cancer Plan

Cancer is the leading cause of death in Maine, with over 3,000 deaths each year. Cancer is important as a public health issue, impacting many aspects of life in the community. The Maine Cancer Consortium recently undertook the task of reviewing and updating the Maine Cancer Plan to reflect new data and issues in cancer prevention and care. The Plan is divided into sections addressing goals for specific types of cancer and stages of cancer prevention. CORE Investigator and Clinical Oncologist Dr. Susan Miesfeldt is a member of the Colon Cancer Task Force. The Maine Cancer Plan is a framework outlining what can and should be done on the state and local level in cancer prevention, detection, education and care. It is an evolving plan meant to guide and coordinate action by the government, private businesses, non-profits and members of the community.

SELECTED PUBLICATIONS (since 2000)

Col NF, Chlebowski RC. Managing the risk of breast cancer in postmenopausal women. Menopause 2008; In press.
Cohn W, Jones S, Miesfeldt S. “Are You at Risk for Hereditary Breast Cancer?” Development of a Personal Risk Assessment Tool for Hereditary Breast and Ovarian Cancer. J Genet Couns 2008; 17: 64-78.
Plumer A, Duan H, Subramanaiam S, Lucas FL, Miesfeldt S, Ng A, Liaw L. Development of fragment-specific osteopontin antibidies and ELISA for quantification in human metastatic breast cancer. BMC Cancer 2008; 8: 38.
Matloff ET, Shannon KM, Moyer A, Col NF. Should menopausal women at increased risk for breast cancer use tamoxifen, raloxifene, or hormone therapy? A framework for personalized risk assessment and counseling. J Cancer Edu 2007; 22: 10-14.
Fairfield KM, Stampfer M. Vitamin and mineral supplements for cancer prevention: issues and evidence. Am J Clin Nutr 2007; 289S-292S.
Tworoger SS, Fairfield KM, Colditz GA, Rosner BA, Hankinson SE. Association of oral contraceptive use, other contraceptive methods, and infertility with ovarian cancer risk. Am J Epidemiol 2007; 166: 894-901.
Zbuk K, Patocs A, Shealy A, Sylvester H, Miesfeldt S, Eng C. Germline mutations in both the PTEN tumor suppressor gene and the SDHC mitochondrial complex II gene in a young woman with epithelial thyroid cancer and carotid paraganglioma: implications for cancer risk assessment and management. Nature Clinical Practice Oncology 2007; 4: 608-612.
Lindor L, Peterson G, Hadley D, Kinney A, Miesfeldt S, Lu K, Lynch P, Burke W, Press N. Recommendations for care of individuals with an inherited predisposition to Lynch Syndrome. JAMA 2006; 296: 1507-17.
Matloff ET, Moyer A, Shannon KM, Niendorf, KB, Col NF. Healthy women with a family history of breast cancer: impact of a tailored genetic counseling intervention on risk perception, knowledge, and menopausal therapy decision-making. J Women’s Health 2006; 15:843-56.
Barry MJ, DeLorenzo MA, Walker-Corkery ES, Lucas FL, Wennberg DE. The rising prevalence of androgen deprivation among older American men since the advent of prostate-specific antigen testing: a population-based cohort study. BJU International 2006; 98: 973-8.
Col NF, Kim JA, Chlebowski RT. Menopausal hormone therapy after breast cancer: A meta-analysis and critical appraisal of the evidence. Breast Cancer Research 2005; 7:R535-40.
Col NF, Duffy C, Landau C. Commentary-Surgical decisions after breast cancer: Can patients be too involved in decision making? Health Services Research 2005; 40: 769-80.
Fairfield KM, Hunter DJ, Colditz GA, Fuchs CS, Cramer DW, Speizer FE, Willett WC, Hankinson SE. A prospective study of dietary lactose and ovarian cancer. Int J Cancer 2004; 110: 271-277.
Fairfield KM, Chen WY, Colditz GA, Emmons KM, Fletcher SW. Colon cancer risk counseling by healthcare providers: perceived barriers and response to an internet-based cancer risk appraisal instrument. J Cancer Educ 2004; 19:95-97.
Miesfeldt S, Cohn W, Jones S, Ropka W, Weinstein J. Breast cancer survivors’ attitudes about communication of breast cancer risk to their children. AJMG 2003; 119C: 45-50.
Cohn W, Ropka M, Jones S, Fraser G, Miesfeldt S. Information needs about hereditary breast cancer reported by women with early-onset breast cancer. Cancer Det and Prev 2003; 27: 345-352.
Braithwaite S, Chlebowski R, Lau J, Col NF. Meta-analysis of vascular and neoplastic events associated with tamoxifen. J Gen Intern Med 2003; 18:937-47.
Chlebowski RC, Kim JA, Col NF. Estrogen deficiency symptom management in breast cancer survivors in the changing context of menopausal hormone therapy. Seminars in Oncology 2003; 30:776-88.
Fairfield KM, Hunter DJ, Fuchs CS, Colditz GA, Hankinson SE. Aspirin, other NSAIDS, and ovarian cancer risk (United States). Cancer Causes and Control 2002; 13:535-542.
Fairfield KM, Willett WC, Rosner BA, Manson JE, Speizer FE, Hankinson SE. Obesity, weight gain, and ovarian cancer. Obstet Gynecol 2002; 100: 288-96.
Fairfield KM, Emmons K, Rigotti N, Colditz, GA. Use of a computerized risk-appraisal instrument for cancer prevention education of medical students. J Cancer Educ 2002; 17: 183-185.
Paschold C, Miesfeldt S. Hereditary breast cancer: an update. The Female Patient 2002; 27: 15-24.
Miesfeldt S, Jones S, Cohn W, Ropka M. Knowledge about breast cancer risk factors and hereditary breast cancer among women with early-onset breast cancer. Familial Cancer 2002; 1: 35-141.
Bond B, Hirota L, Fortin J, Col NF. Women like me: Reflections on health and hormones from women treated for breast cancer. J Psychosoc Onc 2002; 20:39-56.
Chlebowski R, Col NF, Winer EP, Collyar DE, Cummings SR, Vogel VG 3rd, Burstein HJ, Eisen A, Lipkus I, Pfister DG. American Society of Clinical Oncology technology assessment of pharmacologic interventions for breast cancer risk reduction including tamoxifen, raloxifene, and aromatase inhibition. J Clin Onc 2002; 20: 3328-43.
Col NF, Goldberg RJ, Orr RK, Erban JK, Fortin JM, Chlebowski RT. Survival impact of tamoxifen for breast cancer risk reduction: Projections from a patient-specific markov model. Med Decis Making 2002; 22: 386-93.
Geer K, Cohn W, Ropka M, Jones S, Miesfeldt S. Attitudes related to patients’ decisions to decline cancer genetics counseling services. J Genetic Counseling 2001; 10: 25-40.
Col NF, Hirota LK, Orr RK, Erban JK, Wong JB, Lau J. Hormone replacement therapy after breast cancer: A systematic review and quantitative assessment of risk. J Clin Oncol 2001; 19:2357-2363.
Fairfield KM, Hankinson SE, Rosner BA, Hunter DJ, Colditz GA, Willett WC. Risk of ovarian cancer and consumption of vitamins A, C, E and specific carotenoids: a prospective analysis. Cancer 2001; 92: 2318-2326.
Miesfeldt S, Jones S, Cohn W. Informed consent for BRCA 1 and BRCA 2 testing: what clinicians should know about the process and content. JAMA 2000; 55: 275-279.