Special studies within the BWHS and collaborations involving the BWHS

The belief that a study result is “real” is increased when similar results are found in other studies—that is, when a finding is confirmed or “replicated”. The BWHS has served as a replication site for many findings from studies of genetic risk factors for disease. Please see the BWHS publication list for descriptions of the various results.

Breast cancer is not a single disease. There are different subtypes, some of which are more aggressive and difficult to treat than others. Because Black women are more often diagnosed with the more aggressive subtypes such as “estrogen receptor negative” (ER-) and “triple negative” breast cancer, it is very important for the BWHS to help identify risk factors for these subtypes. Because no study alone includes enough women with these subtypes to provide informative results, collaborations are needed. Led by Dr. Julie Palmer, BWHS investigators are working with other studies of breast cancer in Black women learn about risk factors for subtypes of breast cancer; the collaboration is called the AMBER Consortium (African- American  Breast Cancer Epidemiology and Risk). Besides the BWHS, the consortium involves the Women’s Circle of Health Study (Roswell Park Cancer Institute, Buffalo, NY), the Carolina Breast Cancer Study (Lineberger Cancer Center, University of North Carolina, Chapel Hill), and the Multiethnic Cohort Study (Cancer Research Center of Hawaii, University of Hawaii, Honolulu). The first analyses will involve subtypes such as estrogen receptor negative and triple negative breast cancer based on information available from pathology reports. However, there are new ways of defining subtypes that involve doing tests on the tumor tissue. For example, a subtype defined in this way, “basal  like” breast cancer, is a subset of estrogen receptor negative breast cancer. Hospitals that treat women with breast cancer generally store breast tumor tissue from the women in their pathology labs. As part of the AMBER Consortium, the BWHS is obtaining tumor tissue from these labs if the woman with breast cancer has given permission to do so and then conducting the tests that allow for these new classifications of the cancer. Visit the AMBER Consortium website here.

Many substances that can be measured in blood are predictors of disease (for example, cholesterol levels). In 2005-2006, a study was led by Dr. Michelle Albert and Dr. Yvette Cozier to determine whether it was possible to collect blood samples from a large number of BWHS participants, given that BWHS participants live in many different areas of the United States. Quest Diagnostics is a national company that draws blood samples and conducts assays of substances in blood samples for doctors and hospitals across the country. Randomly selected participants who lived in greater New York, Chicago, and Atlanta were invited to go to a Quest Patient Service Center located near their home or work at any time during which the Center was open to have a blood sample drawn (3 tablespoons of blood). 550 women provided samples, which were processed and sent to the BWHS collaborating laboratory for storage. The women were reimbursed for their time and effort. This study showed that blood sample collection in the BWHS is feasible. Collection from as many BWHS participants as wish to take part will be conducted during 2013-2018.

Saliva-mouthwash samples are a convenient source of DNA. During 2003-2008, in an effort led by Dr. Julie Palmer, BWHS participants were invited to provide a saliva-mouthwash sample by swishing with mouthwash, spitting it into a small container, and mailing it to the BWHS laboratory at Howard University. A total of 26,700 participants provided a sample. These samples have contributed to analyses of genetic risk factors for breast cancer, lupus, uterine fibroids, lupus, and other outcomes. (Cozier YC, Palmer JR, Rosenberg L. Comparison of methods for collection of DNA samples by mail in the Black Women’s Health Study. Ann Epidemiol 2004;14(2):117-22.)

In 2001-2002, 115 participants from the Washington D.C. area participated in a study conducted by Dr. Lucile Adams-Campbell at Howard University. For a week during their waking hours, the women wore “actigraphs”, which measure movement; a higher number of counts indicates more movement. In a comparison of the exercise women reported on their BWHS questionnaire with the counts, there were significant correlations, especially for vigorous exercise. In addition, a technician measured the woman’s weight, height, waist circumference, and hip circumference. The women’s reports were highly correlated with the measurements made by the technician. (Carter-Nolan PL, Adams-Campbell LL, Makambi K, Lewis S, Palmer JR, Rosenberg L.  Validation of physical activity instruments: Black Women’s Health Study.  Ethn Dis 2006;16:943-7.)

In 1996-1998, 400 BWHS participants participated in a validation study conducted by Dr. Shiriki Kumanyika. They provided recalls of the past day’s diet in telephone interviews and also kept a 3-day written food diary during the course of a year. The agreement of these reports with dietary intake data provided on the 1995 BWHS baseline questionnaire was found to be sufficiently good for meaningful analyses of diet-health associations. (Kumanyika SK, Mauger D, Mitchell DC, Phillips B, Wright H, Palmer JR. Relative validity of food frequency questionnaire nutrient estimates in the Black Women’s Health Study. Ann Epidemiol 2003;13:111-8.)