September 2, 2014
Donate
Print This Page

Did you know?

  • We envision a world free from cancer.

    Our research scientists and their teams collaborate with colleagues around the world to conduct cutting-edge research using large data-sets to:
    • understand the causes of cancer
    • find ways to prevent it or detect it early
    • improve outcomes for cancer survivors 
  • Our mission began more than 40 years ago.

    Established in 1974 as the Northern California Cancer Program, the organization later became known as the Northern California Cancer Center. The name was changed again in 2010 when it became the Cancer Prevention Institute of California (CPIC), which reflects the organization's broader scope and demonstrates its large scale impact of preventing cancer before it starts.
  • We are an independent research institute and a valued partner to many.

    Through its collaborative approach, CPIC also serves as an asset to the nation’s leading cancer fighting organizations, including the National Cancer Institute, and to scientists worldwide, educators, patients, and clinicians, and is affiliated with the Stanford Cancer Institute.
  • We work hard to understand who gets cancer and why.

    Our scientists are frequent contributors to major scientific journals, and often present their findings at important cancer-related conferences. CPIC research has been covered by numerous local, national and international media outlets, such as The New York Times and The Washington Post.
  • Every case of cancer counts…and is counted.

    CPIC operates the Greater Bay Area Cancer Registry as part of the National Cancer Institute's Surveillance, Epidemiology and End Results program and the California Cancer Registry. As required by law, the registry gathers data from hospitals and doctors on all cancers diagnosed and treated in nine Bay Area counties. This information is used to produce cancer statistics and as a platform for research to understand cancer occurrences and survival. Our registry regularly earns Gold Standard Certification by the North American Association of Central Cancer Registries.
  • Our educational efforts reach people of all ethnicities and backgrounds.

    Our Community Education team provides important information to cancer survivors, health professionals and others through conferences and publications on many cancer-related topics including employment, patient advocacy, care giving, specific cancers, and treatments.

  • Breast cancer rates decline when hormone therapy is stopped.

    CPIC was first to report on the alarmingly high and increasing rates of breast cancer in the Bay Area and Marin County in the 1990s. In subsequent studies, CPIC found that when women stopped taking hormone replacement therapy, breast cancer rates declined immediately and dramatically. This showed that hormone therapy was a major contributor to the high rates previously reported and identified one clear path to breast cancer prevention.
  • Our work to associate tanning beds and melanoma prompted legislation.

    CPIC described increased occurrence of melanoma in young women in California, particularly in high socioeconomic areas, implicating use of tanning beds as one cause. This finding led to passage of the first statewide legislation to ban minors from using tanning beds, which should ultimately reduce occurrences of deadly melanoma in young persons.
  • Physical activity lowers your risk of Breast Cancer

    CPIC found that risk of breast cancer was lower for women engaging in more physical activity, such as walking and biking, doing household chores and yard work, and being active on the job. This shows a simple and practical way women can help prevent breast cancer from occurring.
  • Second-hand smoke increases the risk of lung and breast cancer.

    CPIC studies have shown that women exposed to second-hand tobacco smoke have a higher risk of lung cancer even if they don't smoke, and that exposure to household smoke increases their risk of breast cancer over and above the risk they incur from smoking themselves. These findings have been important in leading to anti-smoking legislation.
  • Vitamin D may reduce the risk of prostate cancer.

    CPIC assessed whether sun exposure, which is the main source of vitamin D, is related to prostate cancer risk. Using the difference in skin color measured on the forehead and upper underarm as an indicator of sun exposure, the study found that prostate cancer risk was reduced by 50% in men with a high sun exposure index, with an even higher reduction in risk noted in men with certain alterations in the vitamin D receptor gene.
  • Survival outcomes differ among Asian women of different ethnic backgrounds.

    CPIC was the first to show that breast cancer survival is not uniform across women of different Asian ethnicities, irrespective of how advanced the cancer was when diagnosed. In California, Korean, South Asian and Vietnamese women had the poorest survival after breast cancer, pointing to the need in these communities for better screening and/or breast cancer treatment.
  • Melanoma is on the rise throughout California.

    CPIC demonstrated that the rates of both early and more advanced melanomas were rising in all populations in California. This disturbing finding signals a true and alarming epidemic of this deadly cancer, and it has been cited over 245 times in the medical literature since 2009 because it identifies a major public health problem.
  • Survival disparities occur across many cancer types.

    CPIC showed that survival after follicular lymphoma, a common form of this cancer, is lower in poorer communities than in more affluent communities. This demonstrates population disparities in cancer treatment and shows a need in poorer communities for more access to skilled lymphoma care, including access to new successful drug treatments.
  • Our nail salon studies have widespread positive impact.

    CPIC found that California nail salons had higher than expected levels of carcinogens and other banned substances in the air, identifying the need for better standards and the importance of clarifying whether such exposures lead to cancer and other undesirable health outcomes.
  • Tailored approaches to healthcare are needed to address cultural differences.

    CPIC used two approaches to learn how best to help Vietnamese communities in California receive lifesaving colorectal cancer screening: one approach involved lay health workers directly educating the community on the importance of screening, and the other involved advertising about colorectal cancer screening. CPIC found that the use of lay health workers worked best to improve the screening rate, proving that organized community involvement improves colorectal screening practices among Vietnamese-Americans in California.
  • Lung cancer afflicts nonsmoking women more than men.

    CPIC was the first to show definitively that among nonsmokers, women were more likely than men to have lung cancer. Until this paper, there were no hard data about the incidence of lung cancer in nonsmokers. This study has been cited extensively as motivation for other research to understand the reasons why.
  • Genetic screening is especially important for African American and Hispanic women.

    CPIC was the first to study the level of BRCA1 mutations (genetic changes responsible for increased risk of breast cancer) in nonwhite women. This work found that young African American and Hispanic women with breast cancer had a particularly high prevalence of BRCA1 mutations, and signaled the importance to these communities and their doctors of screening for this mutation when indicated.

Press Releases

Breast cancer patients with bilateral mastectomy don’t have better survival rates, researchers find

This news release was issued jointly by the Stanford University School of Medicine and the Cancer Prevention Institute of California. It was written by Krista Conger, Office of Communications and Public Affairs, Stanford University School of Medicine.


Surprise finding about mastectomy


FREMONT, CA and PALO ALTO, CA (Sept. 2, 2014) -- Breast cancer patients treated with lumpectomy followed by radiation therapy survived as long as patients who had bilateral mastectomy, according to a large study conducted by researchers at the Stanford University School of Medicine and the Cancer Prevention Institute of California.

The comprehensive analysis of nearly 190,000 California women with the disease is the first to directly compare survival rates following the three most common surgical interventions: bilateral mastectomy (the removal of both breasts), unilateral mastectomy (the removal of the affected breast), and lumpectomy (the selective removal of cancerous tissue within the breast) plus radiation. Women in the study were diagnosed between 1998 and 2011 with cancer in one breast.

The study was published in the Journal of the American Medical Association.

Dispelling uncertainty

The researchers sought to understand why increasing numbers of women are choosing bilateral mastectomies after a diagnosis of cancer in just one breast. The study found that, in 2011, as many as 12 percent of newly diagnosed breast cancer patients opted for a bilateral mastectomy, despite uncertainty as to whether this approach was better than the alternatives. This study dispels much of that uncertainty.

“We can now say that the average breast cancer patient who has bilateral mastectomy will have no better survival than the average patient who has lumpectomy plus radiation,” said Allison Kurian, MD, an assistant professor of medicine and of health research and policy at Stanford. “Furthermore, a mastectomy is a major procedure that can require significant recovery time and may entail breast reconstruction, whereas a lumpectomy is much less invasive with a shorter recovery period.”

The study did find, however, a slightly lower survival rate among women who underwent a unilateral mastectomy.

Kurian is the lead author of the study. Scarlett Gomez, PhD, a research scientist at CPIC, is the senior author.

“Given the recent attention around bilateral mastectomies, we wanted to know whether there are particular types of patients likely to receive a bilateral mastectomy,” Gomez said. “And, secondly, are there relative differences in mortality among the three procedures? We were able to address these questions using data from the California Cancer Registry, which covers nearly all women diagnosed with breast cancer in the state. The registry is enhanced with information on factors that may influence a treatment decision, including their socioeconomic status, health insurance and where they received their care.”

Recent increases in double mastectomies

The researchers found that of the 189,734 women in the study, 55 percent received a lumpectomy with follow-up radiation, 38.8 received a unilateral mastectomy and 6.2 percent received a bilateral mastectomy. Overall, the proportion of women receiving unilateral mastectomies declined during the study period, while the proportion of women receiving bilateral mastectomies increased. Racial and ethnic minorities, as well as women of lower socioeconomic status, were more likely than others to receive a unilateral mastectomy. In contrast, women who received a bilateral mastectomy were more likely to be middle- or upper-class, younger than 50 or non-Hispanic whites, or some combination of these.

The difference in the long-term survival rates between women who underwent a bilateral mastectomy and women who received a lumpectomy plus radiation was not statistically significant.

The slightly lower survival rate among women who underwent a unilateral mastectomy could be due to the fact that these patients tended to be members of racial or ethnic minorities or have a lower socioeconomic status than other patient groups, or both, the researchers said. Gomez and Kurian speculate that these patients may have been more likely to have other health problems, such as diabetes, that could have affected or limited the course or effectiveness of their cancer treatment. They may also have had difficulty securing transportation to radiation appointments or had other barriers in access to care, according to Gomez and Kurian.

Physicians in California are legally required to report all cancer cases in the state to the Cancer Registry. The researchers used this data to assess the outcomes of women diagnosed with stages 0 to 3 unilateral breast cancer — that is, cancer affecting only one breast — in the state from 1998 to 2011.

Getting a bigger picture

The registry is unique because it includes information about nearly every cancer case in the state. It captures important information, such as the stage of the disease, the surgical outcome chosen by the patient and her physician, and whether the patient eventually died from her disease. It also includes information about the patient’s racial or ethnic background and where she lived.

“The registry allows us to do a population-based study to gain a real-world picture of cancer cases in California,” said Kurian. “We can ask and answer questions that couldn’t be answered in a randomized clinical trial.” For example, Kurian and Gomez point out that it would not be ethical to assign a woman randomly to one of the three common surgical options. But using the registry, they can simply track who received which intervention.

Despite the fact that women who removed both breasts did not have better survival rates, the study found that rapidly increasing numbers of women are opting for the complex surgery, which requires a long recovery period and possibly reconstructive surgery.

Racial, socioeconomic differences

The bilateral mastectomy procedure is particularly prevalent among non-Hispanic white women younger than 40 who have private insurance and receive care at a National Cancer Institute-designated cancer center. In fact, 33 percent of women under age 40 received bilateral mastectomies in 2011, compared with 3.6 percent in 1998. (The prevalence of bilateral mastectomy among all patients in the study increased from 2 to 12.3 percent during the same time period.)

In contrast, racial or ethnic minorities and women with public insurance, such as Medicaid, were more likely to receive a unilateral mastectomy.

Kurian and Gomez emphasize that the study’s findings don’t mean that a woman with a BRCA1, BRCA2 or other gene mutation known to significantly increase the risk of developing breast cancer, or with a strong family history of breast cancer, should not get a bilateral mastectomy. A genetic predisposition may mean that removing both breasts is an effective option.

There are also other reasons why a woman might choose a bilateral mastectomy. Some newer breast-reconstruction methods achieve better symmetry when both breasts are reconstructed simultaneously. Removal of both breasts may also alleviate a woman’s fear and worry that a second cancer will occur in her remaining breast, the researchers said.

“We’re hopeful that this study will open a dialogue between a patient and her physician to discuss these kinds of questions,” said Gomez. “It’s an important piece of evidence that can guide their decision-making process.”

Other co-authors of the study are affiliated with the Cancer Prevention Institute of California.

The study was supported by the Suzanne Pride Bryan Fund for Breast Cancer Research, the Jan Weimer Junior Faculty Chair in Breast Oncology at the Stanford Cancer Institute, the National Cancer Institute, the California Department of Health Services and the U.S. Centers for Disease Control and Prevention.

More information about Stanford’s Department of Medicine and Department of Health Research and Policy, which also supported the work, can be found at http://hrp.stanford.edu and http://medicine.stanford.edu.

# # #

About the Cancer Prevention Institute of California
The Cancer Prevention Institute of California is the nation’s premier organization dedicated to preventing cancer and to reducing its burden where it cannot yet be prevented. CPIC tracks patterns of cancer throughout the entire population and identifies those at risk for developing cancer. Its research scientists are leaders in investigating the causes of cancer in large populations to advance the development of prevention-focused interventions. CPIC’s innovative cancer prevention research and education programs, together with the work of the Stanford Cancer Institute, deliver a comprehensive arsenal for defeating cancer. For more information, visit www.cpic.org.

About the Stanford University School of Medicine
The Stanford University School of Medicine consistently ranks among the nation’s top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Health Care and Lucile Packard Children’s Hospital Stanford. For information about all three, please visit http://med.stanford.edu.

# # #

Media Contact: Jana Cuiper, 510-608-5160 | jana.cuiper@cpic.org