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The Sister Study

ARCHIVED FACEBOOK POSTS

The Sister Study is on Facebook!

We are excited to let you know that we have created a private Facebook group for the Sister Study to provide a forum for Sister Study participants, colleagues and friends of the study. This private group is by invitation only and not a public forum. We saw the need to have a more dynamic way of communicating with our Sister Study community than just the Sister Study website. We see the Facebook group as a real-time forum where we can post study updates, announcements, and new research findings or plans.

We know that Facebook has been in the news lately because of how they use their users' data. We want you to know that, as a research study funded by a government entity, we will abide by all NIEHS privacy policies.exit disclaimer We will not share your information with third parties. We ourselves will never post any personal and/or identifiable information on Facebook. If you decide to use your own real name, be mindful that you are responsible for that information. We will provide guidelines for what not to post, such as personal health information, treatment recommendations, and product endorsements or posts with an intent to sell. Our staff will monitor the group to make sure that policies are followed and remove inappropriate material.

We invite you to follow this direct link https://www.facebook.com/groups/niehssisterstudy/ exit disclaimer if you would like to join.

We hope you find this additional communication method helpful and that you enjoy connecting with other study participants, colleagues and friends of the study.

Facebook Posts


photo of Operations and Retention team

Introducing our Healthcare Providers Team! Bre Macon and Mercedes Anderson work with Sister Study participants and their healthcare providers to obtain medical records and other vital diagnosis information.

When you authorize the Sister Study to receive medical records about your cancer or other diagnoses, we are able to collect much more detailed information that improves our data and our investigator's analyses. This improved data increases our ability to identify connections between exposures and many chronic diseases.

Thank you to our participants for their continued support of the Sister Study and thank you to Bre and Mercedes for their diligence in furthering this essential research.

Thank you if you have already completed your 2022-2023 Annual Health Update! In October 2022 we began contacting all Sisters about completing your Annual Health Update. With so many of you, it takes us a number of months to reach the highest percentage possible. We have now reached 32.8%!

This Facebook post is to remind you to please check your emails or postal mail and complete your Annual Health Update as soon as you can.

We are deeply grateful for your continued participation! If you have not received your AHU or have any questions or issues, please contact our Help Desk toll-free at 877-4SISTER (877-474-7837) or email us at update@sisterstudy.org. We will gladly help you!

REMINDER

Enter our $500 Drawing upon Completing your Health Update:

  • To show our appreciation, when you complete your health update, you will be entered into a $500 gift card drawing. The earlier you complete your survey, the better your odds, as you will then be entered in each monthly drawing that follows in the 2022-2023 health update collection period.
  • Approximate odds of winning are 1 in 5,000 to 1 in 48,000 depending on when you complete your health update.
  • If you win but do not want the gift card, please feel free to decline.

Thank you in advance for continuing to complete these valuable questionnaires!

If you'd like to complete the questionnaire online, please click the link below:
The Sister Study Annual Health Update. exit disclaimer

image of a breast cancer ribbon that represents that 32.8% of participants have completed their annual health update

Researchers from the Sister Study have developed a new risk prediction score that may improve how we identify women at higher risk for developing breast cancer. The new risk score is based on measures of naturally occurring chemical modifications to DNA, known as DNA methylation, that can be assessed in the cells collected from a simple blood sample. In the Sister Study analysis, the investigators used blood samples that were provided at study enrollment and found that the new DNA methylation-based risk score helped predict whether or not a woman developed breast cancer during follow-up, especially when it was combined with existing information on other genetic or lifestyle factors. Though these results are novel and promising, further investigation and replication is needed to see if this will be useful in a clinical setting.

Learn more here:
Blood DNA methylation profiles improve breast cancer prediction. exit disclaimer

Outdoor air pollution is thought to be associated with many cardiovascular diseases, including hypertension. We conducted a cross-sectional analysis to explore the association between hypertension and predicted exposure to specific components of air pollution that are caused by combustion of fossil fuels or other energy sources. Estimates of combustion-related air pollution exposure at Sister Study participant's home residences were extracted from the from the 2005 National Air Toxics Assessment database. Women were considered to have hypertension if they had a high systolic (≥140 mm Hg) or diastolic (≥90 mm Hg) blood pressure or were taking antihypertensive medication. High exposure to diesel emissions, 1,3-butadiene, acetaldehyde, benzene, formaldehyde and NO2 were associated with higher prevalence of hypertension, as was higher exposure to all the measured pollutants together. Stronger associations were observed among women reporting races/ethnicities (Hispanic/Latina, non-Hispanic Black and other) other than non-Hispanic White.

Learn more here:
Fossil-fuel and combustion-related air pollution and hypertension in the Sister Study. exit disclaimer

Hypertension is an important public health issue because it is a risk factor for cardiovascular disease and affects most people over the age of 60. Characteristics of a person's immune system may be associated with their risk of developing hypertension. Using data from the Sister Study, we estimated the proportion of each type of white blood cell each participant had circulating in her body, finding that minor differences in those proportions were associated with later development of hypertension. Additionally, we found that having a history of hypertension was associated with a larger proportion of neutrophils, which are a type of white blood cells that cause inflammation. This study helps to clarify the immunological changes associated with hypertension and may be useful in the future for helping preventing the condition.

Learn more here:
Peripheral Immune Cell Composition is Altered in Women Before and After a Hypertension Diagnosis. exit disclaimer


photo of Operations and Retention team

Kalimah Fleming (not pictured), Erica Parker, Eva Bauer, and Sarah Watson are responsible for study management, day to day development and tracking of participant outreach, and other vital efforts that keep the Sister Study running smoothly. They are currently tracking and managing the newly launched 2022 Annual Health Update. Please help us recognize the hard work of the Sister Study Operations and Retention team!

In late August, NIEHS held an event to highlight current breast cancer research and efforts to evaluate how combined exposures can influence the disease. Sister Study Investigator Dr. Lexie White, head of the NIEHS Environment and Cancer Epidemiology Group, co-chaired the event.

During the workshop Dr. White shared some of her Sister Study research on air pollution and breast cancer and Sister Study PI, Dr. Dale Sandler gave an overview of the Sister Study and how studies like ours can answer questions about the effects of environmental exposures. Two of our Sister Study post-doctoral fellows also shared some of their ongoing research focused on how mixtures of industrial emissions and personal care products may be related to breast cancer risk.

The workshop focused on understanding exposure mixtures and their impact on breast cancer risk. "We know that single exposure analysis does not accurately reflect real-life exposure patterns because people are exposed to multiple chemicals simultaneously," said Dr. White. "Analyzing one chemical exposure at a time can result in an underestimation of risk.

Learn more here:
Role of complex exposures in breast cancer highlighted during workshop. exit disclaimer

In a paper published this morning in the Journal of the National Cancer Institute, Sister Study investigators Drs. Lexie White and Che-Jung Chang and their team found that women who used chemical hair straightening products were at higher risk for uterine cancer compared to women who did not report using these products.

"To our knowledge this is the first epidemiologic study that examined the relationship between straightener use and uterine cancer," said Dr. White. "More research is needed to confirm these findings in different populations, to determine if hair products contribute to health disparities in uterine cancer, and to identify the specific chemicals that may be increasing the risk of cancers in women."

The publication has been making headlines across media outlets for its important findings suggesting increased risk of uterine cancer.

Learn more here:
News Release: Hair straightening chemicals associated with higher uterine cancer risk. exit disclaimer

The New York Times: Hair Straighteners May Pose a Small Risk for Uterine Cancer, Study Finds. exit disclaimer

People: Hair-Straightening Chemicals Linked to Uterine Cancer in a New Study that Warns Black Women. exit disclaimer

Today: Chemical hair straighteners linked to higher risk of uterine cancer for Black women, study shows. exit disclaimer

The Washington Post: Chemical hair-straightening linked to uterine cancer, study warns Black women. exit disclaimer


photo of Fulfillment team

Introducing a few members of our Sister Study Fulfillment Team! Last year, our fulfillment team sent out nearly 90,000 pieces of mail! Ken, Sha-Mel, Mrs. Sharron, and the rest of the fulfillment team have outstanding attention to detail and efficiency with their work. They are currently gearing up for the 2022/2023 Annual Health Update. Please help us recognize the hard work of the Sister Study Fulfillment Team!

The age that menopause occurs is determined by the number of remaining ovarian follicles, often referred to as the ovarian reserve. Ovarian follicles are formed in very early life; the number of follicles is greatest at birth and decreases with age and menstruation, but environmental factors could also lead to decreased ovarian reserve. In a Sister Study investigation, we examined possible associations between prenatal and childhood exposure to the farm environment and Anti-Müllerian hormone (AMH), a blood-based biological marker of ovarian reserve, in women ages 35-54 years. We found that women whose mothers worked or resided on a farm while they were pregnant had lower AMH levels. The data also suggested that childhood contact with pesticide-treated livestock or buildings was also associated with lower AMH. These findings raise concern that aspects of prenatal farm exposure may result in reduced adult ovarian reserve.

Learn more here:
Early-life Farm Exposure and Ovarian Reserve in a US Cohort of Women. exit disclaimer

Nighttime light, either from inside your bedroom or outside your residence and shining in, is thought to increase the risk of breast cancer by disrupting the body's natural 24-hour (or circadian) rhythms, which serve a wide variety of biologic functions. To evaluate this in the Sister Study, we used questionnaire information on sources of indoor light exposure and estimated levels of outdoor light at night using satellite data. We then estimated how these light exposures were related to the risk of breast cancer. Sleeping with a television on or at least one light on in the bedroom was associated with a very small (9%) increase in breast cancer risk, although it is possible that this finding is due to chance. Living in an area with more outdoor light at night (e.g., from streetlamps or buildings) was not associated with an increased risk of breast cancer once we accounted for other co-occurring environmental exposures, such as air pollution and noise. So, while getting black-out curtains for your bedroom will likely help you sleep better, it is unlikely to reduce your risk of breast cancer.

Learn more here:
Light at night and the risk of breast cancer: Findings from the Sister study. exit disclaimer


photo of Noelle Rousseau

Meet our Sister Study Graphics Specialist, Noelle Rousseau! Noelle joined the Sister Study team in March of 2022, and is originally from Raleigh, NC. She works diligently to design the Sister Study flyers, newsletters, and website. Noelle is working hard to update the Sister Study website with our latest findings and publications. Please help us welcome Noelle!

Learn more here:
Check out the Sister Study website!. exit disclaimer

Telomeres are long sections of DNA at the end of chromosomes that protect our genes. Telomeres tend to get shorter over time, making telomere length an attractive marker of cellular aging. The rate of shortening may be faster in early life, making Sister Study researchers wonder if certain exposures early in life play a role in telomere shortening. Following up on earlier reports, the researchers looked at the association between telomere length, which was measured in blood samples collected from a sample of Sister Study participants at enrollment, and data on 20 different types of traumatic experiences (such as physical or sexual abuse, major accidents or illnesses, or losses from natural disasters). They found that that experience of high early life trauma was associated with shorter telomere length in adulthood. These associations were not explained by trauma that was reported in adulthood, which reinforces the important role of early life experiences in shaping lifetime health.

Learn more here:
Early life trauma and adult leucocyte telomere length. exit disclaimer

Sharonda is a PhD student in epidemiology at Boston University School of Public Health. She got started working with the Sister Study through the highly competitive NIH Summer Internship Program and has spent the last two summers studying important women's health issues. Her specific projects include examining the impact of gynecologic surgery (e.g. hysterectomies and oophorectomies) and hormone therapy use on breast cancer risk; and evaluating the extent to which experiencing trauma before age 18 may be related to pregnancy complications like gestational diabetes and hypertensive disorders. Both research topics highlight the importance of investigating how social and environmental factors influence health across the life course. In her future research, Sharonda hopes to further integrate her interests in cancer and trauma.

There are a few reasons why we might ask similar questions on multiple questionnaires from year to year. The main reason is that some things may change—you might lose or gain weight, start a new hobby, be prescribed a new medication, or develop a new medical condition, and we want to do our best to capture that information! Other times we realize that we did not originally ask the question in the best way and want you to provide additional or clarifying information. For example, we asked about your personal care product use (hair dyes, make-up, talc products, etc.) at enrollment, but focused specifically on use in your early adolescence and in the year before baseline. In later questionnaires, we asked about your recent (post-baseline) use and also tried to capture information about your lifetime use by asking about what products you used during each decade of your life.

August 7, 2022 is National Sisters Day: With the Sister Study, we are trying to understand how shared genetics and life experiences can affect the health of our participants whose sisters were diagnosed with breast cancer. But, we know these sisterly bonds are much stronger and deeper than anything our science can capture. Many of you joined our study to honor your sister who experienced breast cancer, and you have continued to convey your love for your sisters by remembering them and sharing their experiences here on our Facebook page. On National Sisters Day we pause to think of your sisterly bonds and express our appreciation for what it brings to cancer research and future generations. Thank you for your dedication to your sisters and our study!

Heart disease is the leading cause of death for women in the United States. Over the years, we have asked you questions about your cardiovascular health and disease history. In August, we began requesting medical records to confirm diagnoses and obtain needed details about reported heart conditions such as results of tests performed and disease subtypes. Our goal is to identify preventable environmental causes of cardiovascular disease. We have reached out to some of you for more information about your health history. If you were contacted and returned your authorization forms, we thank you! However, if you have not yet done so we encourage you to sign and mail your forms soon. We are excited to let you know that we are working with cardiovascular disease experts to study environmental contributors to stroke, heart attack, and congestive heart failure. Dr. Joseph Engeda will be using data collected from medical records to study these cardiovascular conditions. Thank you again for your contributions to the Sister Study. We could not do this research without your willingness to participate!

We would like to introduce you to Dr. Kemi Ogunsina, the Sister Study's newest post-doctoral fellow. Dr. Kemi Ogunsina recently earned her doctoral degree in Epidemiology from the University Of Miami Miller School Of Medicine, Miami Florida. She joined Dr. Dale Sandler's group as a post-doctoral fellow at the National Institute of Environmental Health Sciences. Dr. Ogunsina's research focus is on cancer prevention and control, including health disparities. For her first Sister Study research project she is studying health disparities in the association of between fibroids and use of genital talc or douche. She will also be assessing the interplay between reproductive factors, environmental exposure to endocrine disrupting chemicals, and risk of thyroid diseases.


photo of 16 members of the Sister Study team, posing outdoors

The Sister Study Team has staff across the nation, including in California, Ohio, Georgia, North Carolina, and Maryland! This photo only shows a small group of our staff that is local to North Carolina. Pictured are staff from our Advocate, Data Processing, Epidemiology, Help Desk, Fulfilment, and Operations Teams. As Sister Study participants, your primary contacts are our Help Desk Team and Advocates. Our Data Processing Team is busy processing your questionnaires as you return them to us. Our Epidemiology Team coordinates with researchers to support collaborations and publish papers. Our Fulfilment Team sends out over 100,000 pieces of mail each year to Sister Study participants. Our Operations Team supports the day to day of the Sister Study such as creating and updating the study website, answering participant questions, collecting medical records, and supporting participant retention. Together, we are here to serve you!

Experience of traumatic events—including sexual, physical, or emotional abuse, and financial hardships—is thought to influence breast cancer risk, but such events rarely occur in isolation, and little is known about how co-occurring traumas, particularly during early life, may impact breast cancer risk. Sister Study participants reported whether they experienced certain traumatic experiences during childhood and adolescence. Using that data, we identified six distinct patterns of early-life trauma in the cohort. About half of all Sister Study participants disclosed at least one traumatic experience before age 18. We reported that experiencing either sexual trauma and household dysfunction or medium levels of early-life trauma was suggestively associated with greater risk of developing breast cancer compared to experiencing low levels of early-life trauma. Furthermore, breast cancer risk due to early-life trauma appeared lower among participants who reported constant childhood social support. This research suggests that different types of early-life traumatic experiences may contribute to various levels of risk of breast cancer.

Learn more here:
Latent class models of early-life trauma and incident breast cancer. exit disclaimer

Every summer, the National Institute of Environmental Health Sciences proudly hosts early career researchers participating in the NIH Summer Internship program. This year, eight interns from colleges and graduate schools across the country will be working on Sister Study-related research projects, studying topics such as air pollution, early life trauma, uterine fibroids, and diabetes. We look forward to seeing what they find and reporting the results back to you!

Learn more here:
Summer Internship Program in Biomedical Research. exit disclaimer

Pregnancy is considered a "window of susceptibility" for breast cancer risk because changes to the breast during pregnancy may alter susceptibility to developing the disease later in life. Associations between pregnancy conditions and breast cancer risk may provide insight into how pregnancy relates to later cancer development. Some previous studies have found that women who experienced a gestational hypertensive disorder, including gestational hypertension, pre-eclampsia and eclampsia, have a reduced risk of breast cancer. In a recent analysis, Sister Study investigators examined whether history of a gestational hypertensive disorder was associated with breast cancer risk among women who have given birth at least once. They found that having a history of a gestational hypertensive disorder was not associated with breast cancer risk.

Learn more here:
Gestational hypertensive disorders and maternal breast cancer risk in a nationwide cohort of 40,720 parous women. exit disclaimer

Researchers have identified many genetic variants associated with breast cancer risk. The combined effects of these variants can be summarized using something called a polygenic risk score (PRS). The idea is that many genetic variants are individually associated with very small increases in risk, but their combined effects may be a powerful tool for identifying individuals at high risk of developing breast cancer. However, most PRSs were developed in women of European ancestry and are less accurate predictors in women of African ancestry. Using data from 9,235 women with breast cancer and 10,184 women without breast cancer, including many participants from the Sister Study and Two Sister Study, a team of researchers set out to develop a better PRS for women with African ancestry. The new PRS was better able to predict breast cancer occurrence among women of African ancestry, compared to previous PRS models, and may be useful in a clinical setting for identifying high-risk women who might benefit from more intensive screening.

Learn more here:
Polygenic Risk Scores for Prediction of Breast Cancer Risk in Women of African Ancestry: a Cross-Ancestry Approach. exit disclaimer

Meet Eva Bauer, the Sister Study's new Operations and Retention Manager. She leads the operationalization of all Sister Study efforts, including participant health update, data collection and special projects. In addition, she and her team work on tending to participant needs, answering questions, and reducing participant burden. Eva brings excellent health communication and project management skills, and works collaboratively across all of our study teams to keep us moving forward. She graduated from the University of North Carolina with her Master of Public Health. She is interested in chronic diseases, primarily cancer, women's health, public health and health services research, and health disparities. She joined the Sister Study in February 2021 and just recently took on this new role. Outside of work, Eva enjoys spending time with her family and friends as well as playing with her French Bulldogs Rascal and Rex. In her free time, you can find her doing Pilates, trying new restaurants and recipes, traveling or spending time outdoors. Some of Eva's favorite places she has traveled to include Istanbul, Gdansk and Whistler. Welcome, Eva, to the Sister Study team!

In addition to trying to better understand the causes of breast cancer, Sister Study researchers are interested in learning more about breast cancer survivors, including what factors might influence their health-related quality of life. In a recent study of 2,453 breast cancer survivors, we found that those with higher cancer stages, more concurrent conditions, surgical complications, or who were dissatisfied with their breast surgery or experienced breast cancer recurrences or new tumors had lower quality of life scores. Those with lower scores were more likely to die from their disease, even after controlling for disease stage and other factors. This research helps identify what areas are most important for improving care and survival rates of those diagnosed with breast cancer.

Learn more here:
Health-related quality of life outcomes among breast cancer survivors. exit disclaimer

Sister Study investigators and researchers from Duke University examined the association between poor sleep patterns and risk of developing hypertension (high blood pressure). They found that women with insomnia (difficulty falling or staying asleep) or insomnia plus short sleep (<7 hours per night) were more likely to develop hypertension. These associations were stronger among younger and premenopausal women but did not differ by race/ethnicity. This research demonstrates how poor sleep may impact other aspects of health.

Learn more here:
A prospective study of multiple sleep dimensions and hypertension risk among white, black and Hispanic/Latina women: findings from the Sister Study. exit disclaimer

Loss of sense of smell—or olfactory impairment—has been in the news because it is a common symptom of SARS CoV-2/COVID-19 infection. But olfactory impairment is important on its own—it increases with age and is a symptom of some neurodegenerative diseases, such as Parkinson's disease and Alzheimer's disease. Loss of sense of smell itself may have consequences, such as making food taste bad or not being able to smell smoke in a fire. Some Sister Study participants were invited to participate in further studies of sense of smell, including home "scratch and sniff" tests using a special booklet. An early report from that study found that women who were unable to accurately name the test scents usually under-reported how much difficulty that had smelling things. The olfactory impairment data are now being used to study environmental factors that might increase the likelihood of losing one's sense of smell. This work is being led by Sister Study collaborator, Dr. Honglei Chen at Michigan State University.

Learn more here:
Assessment of Self-reported Sense of Smell, Objective Testing, and Associated Factors in Middle-aged and Older Women. exit disclaimer

Radon, which occurs naturally in the environment, can breakdown into radioactive particles called isotopes. These isotopes can bind to particles in air pollution. This allows the radioactive isotopes to be inhaled, which may lead increased cancer risk in exposed tissues. Building on previous Sister Study work showing that living in areas of higher exposure to air pollution was related to a higher risk of breast cancer, a new Sister Study investigation evaluated whether exposure to airborne radioactive particles was also associated with breast cancer risk. Investigators found that living in areas with higher airborne particle radioactivity was associated with a higher risk of ER-negative breast cancer. These results suggest that exposure to radioactive particles may be one way in which air pollution contributes to breast cancer risk.

Learn more here:
Exposure to Particle Radioactivity and Breast Cancer Risk in the Sister Study: A U.S.-Wide Prospective Cohort. exit disclaimer

Some fruits and vegetables as well as vitamin supplements contain carotenoids, such as α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin, and lycopene, which may protect against chronic diseases including cancer. In a newly published Sister Study paper, we evaluated associations between carotenoids and biological markers of inflammation and oxidative stress, which is a measure of the balance between antioxidants and oxidative damage in human tissues. Some carotenoids measured in blood had an inverse association with oxidative stress measures, meaning that they may have antioxidant effects. Others were inversely associated with both inflammation and oxidative stress measures. β-carotene supplements, but not dietary carotenoid estimates, were associated with lower levels of inflammation and oxidative stress. This work helps to identify the role of individual nutrients in maintaining and promoting good health.

Learn more here:
Association of dietary and plasma carotenoids with urinary F2-isoprostanes. exit disclaimer

Gestational diabetes is a type of diabetes that develops during pregnancy. We used data from the Sister Study to better understand how the risk of developing type 2 diabetes is impacted by history of gestational diabetes. We observed that having had gestational diabetes was associated with an increased risk of developing type 2 diabetes, and that this risk remained elevated for more than 35 years after the affected pregnancy. We also observed that as the number of times a woman had gestational diabetes increased, the risk of developing type 2 diabetes also increased. Women with a history of gestational diabetes might want to discuss diabetes screening strategies with their physicians.

Learn more here:
Persistence of Risk for Type 2 Diabetes After Gestational Diabetes Mellitus. exit disclaimer

A large collaborative research project sought to answer the question: is the optimal approach to breast cancer screening for women with ATM, CHEK2, and PALB2 pathogenic variants? These are genes that are strongly linked with increased breast cancer risk, although the risks are not as great as they are for BRCA1/2. The researchers estimated that annual mammography from age 40 to 74 years reduced breast cancer mortality by 36% to 39% in women with these variants. Screening via annual magnetic resonance imaging (MRI) before age 40, followed by annual screening with both MRI and mammography after age 40 was estimated to reduce breast cancer mortality by 54%- 60%. However, the use of both annual MRIs and mammographies before age 40 did not meaningfully reduce mortality, and also increased the number of false-positive screenings. This modeling analysis, which includes data from Sister Study participants, suggests that starting MRI screening before age 40 may substantially reduce breast cancer mortality for women with moderate- to high-risk pathogenic variants for breast cancer.

Learn more here:
Good Housekeeping: Can Dying Your Hair Raise Your Risk for Breast Cancer? Experts Explain. exit disclaimer

Breast Cancer Screening Strategies for Women With ATM, CHEK2, and PALB2 Pathogenic Variants: A Comparative Modeling Analysis. exit disclaimer

In the US, Hispanic/Latina women are more likely to be diagnosed with a later stage of breast cancer than non-Hispanic White women. Efforts to increase screening and reduce this disparity could be more effective if we understood the factors that contribute to this disparity. We wondered if birthplace played a role. We asked about screening methods, including mammography, ultrasound, and magnetic resonance imaging (MRI) on the initial Sister Study questionnaire. We categorized women as recently screened (≤2 years ago), formerly screened (>2 years ago), or never screened, finding that compared to US-born non-Hispanic/Latina White women, US-born Hispanic/Latina women were more likely to be formerly screened for breast cancer and foreign-born Hispanic/Latina women were more likely to have never received breast cancer screening. The intersectional identity of foreign-born Hispanic/Latina women amounts to unique barriers to accessing preventive healthcare services in the US.

One consequence of climate change may be increased ultraviolet (UV) light exposure. UV exposure is an established risk factor for skin cancer, but as a major source of vitamin D it may also help protect against some cancers. Sister Study investigators used statistical models to estimate participants' UV exposure level based on their addresses at enrollment. Estimated UV exposure was not associated with breast cancer risk overall, but those with higher estimated UV levels were less likely to develop estrogen receptor negative disease. These results provide evidence that higher UV exposure may help prevent some types of breast cancer, possibly due to the link between UV and vitamin D.

Learn more here:
Residential ultraviolet radiation and breast cancer risk in a large prospective cohort. exit disclaimer

Women with a strong family history of breast cancer have a higher risk of getting breast cancer themselves, but it is unclear whether environmental risk factors for breast cancer have stronger associations within higher risk groups. Building on prior Sister Study research exit disclaimer showing there may be an association betweenair pollution and breast cancer risk exit disclaimer, newly published results indicate that nitrogen dioxide (NO2) concentrations are positively associated with breast cancer risk among those with very high family-based risk scores (>90th percentile), but not in those with lower estimated family risk scores. This research demonstrates that women with strong family histories of breast cancer may benefit more from interventions to reduce exposure to NO2.

Learn more here:
Air Pollution and Breast Cancer: An Examination of Modification By Underlying Familial Breast Cancer Risk. exit disclaimer

Anti-Müllerian hormone (AMH) is a blood-based measure of ovarian reserve that is indicative of a woman's reproductive life-span. In a recently published study, Sister Study investigators examined whether various measures of outdoor air pollution were associated with AMH concentrations among 883 Sister Study participants who were premenopausal at enrollment. They did not observe a consistent link between any of the air pollution measures and AMH, an indication that air pollution may not directly affect ovarian reserve.

Learn more here:
Outdoor air pollution and anti-Müllerian hormone concentrations in the Sister Study. exit disclaimer

The Sister Study contributed to a large, pooled analysis looking at how some of the more commonly studied genetic mutations (or "variants") may be related to the risk of specific breast cancer subtypes. In a sample of more than 200,000 women, 10 of the 173 variants examined were associated with all of the subtypes, but many others were associated with either estrogen receptor positive breast cancer or triple-negative breast cancer, but not both. This work helps to deepen our understanding of the role of genetics in determining the risk of specific breast cancer subtypes.

Learn more here:
Common variants in breast cancer risk loci predispose to distinct tumor subtypes. exit disclaimer

Thelarche is a term for the start of breast development during puberty. Thelarche often begins up to 2 years before the onset of menses. A previous Sister Study report showed that earlier age at thelarche is associated with increased breast cancer risk, but little is known about factors that influence the timing of thelarche. In a recent analysis, Sister Study investigators identified early-life factors associated with early thelarche, which they defined as age 10 or younger. They found that multiple prenatal factors were associated with early thelarche, including maternal gestational hypertensive disorder, diethylstilbestrol (DES) use, smoking during pregnancy, being firstborn, and being born to a teenage mother. This work helps us better understand how the early-life environment influences the timing of puberty and may also affect adult breast cancer risk.

Learn more here:
Early-life exposures and age at thelarche in the Sister Study cohort. exit disclaimer

In addition to the known breast cancer genes, BRCA1 and BRCA2, other inherited genes are also important in breast cancer. Some are considered pathogenic, meaning they are predictive of an elevated breast cancer risk. In a very large study that included Sister Study participants, investigators found that the frequencies of inherited genetic mutations in 12 known pathogenic breast cancer genes did not vary by race (5.65% in Black women versus 5.06% in non-Hispanic white women). The biggest racial difference was seen for CHEK2, which was more common in non-Hispanic white women with breast cancer (1.29%) than Black women with breast cancer (0.38%). BRCA2 and PALB2 mutations were slightly more common in Black cases. The findings suggest that policy changes related to genetic testing should not be based on race and that all efforts should be made to ensure equal access and uptake to genetic testing.

Learn more here:
Comparison of the Prevalence of Pathogenic Variants in Cancer Susceptibility Genes in Black Women and Non-Hispanic White Women With Breast Cancer in the United States. exit disclaimer

The prevalence of hypertension (high blood pressure) varies by race/ethnicity. Many studies have shown that lower individual socioeconomic status is associated with higher risk of hypertension, but less is known about the association between neighborhood level socioeconomic factors and hypertension. Using an established measure that summarizes across many different census variables we found that women living in more disadvantaged neighborhoods had a higher prevalence of hypertension. Compared with non-Hispanic White women in the least disadvantaged neighborhoods, self-identified non-Hispanic Black woman with higher neighborhood disadvantage had the highest prevalence of hypertension. Physical activity tended to moderate some of the hypertension risk associated with neighborhood factors.

Learn more here:
Association between neighbourhood deprivation and hypertension in a US-wide Cohort. exit disclaimer

Vitamin D may help prevent some cancers and other chronic diseases, but its relationship with breast cancer is not established. Vitamin D supplement use was common in the Sister Study. At the time of enrollment, 64% of participants reported regularly taking f a vitamin D-containing supplement We found that recent use of vitamin D-containing supplements (within the last 2-3 years) was associated with a reduced risk of breast cancer. Supplement use was less common among Black women (56%) and Latinas (50%) than non-Hispanic White women (66%), but we did not see clear differences in the relationship between vitamin D supplement use and breast cancer by race/ethnicity. Our findings are consistent with the hypothesis that vitamin D is inversely associated with breast cancer risk across all racial/ethnic groups.

Learn more here:
Vitamin D Supplement Use and Risk of Breast Cancer by Race-Ethnicity. exit disclaimer

Most of what we know about the role of genes that confer high risk of breast cancer (BRCA1, BRCA2, CDH1, CHEK2, ATM, and PALB2) is based on their association with invasive ductal carcinoma, the most common form of breast cancer. Less is known about their role in invasive lobular carcinoma (ILC), which makes up about 10% of all breast cancers exit disclaimer. In a recent collaborative study that includes some Sister Study participants, investigators showed that 5-6% of women with ILC have at least one mutation, or "pathogenic variant" in one of these known breast cancer risk genes. More specifically, pathogenic variants in CDH1, BRCA2, CHEK2, ATM, and PALB2 were associated with increased risk of ILC, but variants in BRCA1 were not. These results show that multigene panel testing is appropriate for women with ILC and to identify women at risk of ILC.

Learn more here:
Germline Pathogenic Variants in Cancer Predisposition Genes Among Women With Invasive Lobular Carcinoma of the Breast. exit disclaimer

Ovarian cancer is a rare cancer, with a lifetime risk of approximately 1% in US women. This makes it a very difficult disease to study and the Ovarian Cancer Cohort Consortium (OC3) was established to allow researchers to pool together data from 23 large cohorts from all over the world, including the Sister Study. The consortium currently includes 1.3 million women, among whom 7,314 developed ovarian cancer since joining one of the studies. Sister Study investigators previously led OC3 projects examining associations between genital powder use and ovarian exit disclaimer and uterine exit disclaimer cancer, and have contributed to many other published and ongoing projects. You can read more about OC3 here exit disclaimer.

Learn more here:
Cohort Profile: The Ovarian Cancer Cohort Consortium (OC3). exit disclaimer

Sister Study investigators and researchers from Duke University examined the association between poor sleep patterns and risk of developing hypertension (high blood pressure). They found that women with insomnia (difficulty falling or staying asleep) or insomnia plus short sleep (<7 hours per night) were more likely to develop hypertension. These associations were stronger among younger and premenopausal women but did not differ by race/ethnicity. This research demonstrates how poor sleep may impact other aspects of health.

Learn more here:
A prospective study of multiple sleep dimensions and hypertension risk among white, black and Hispanic/Latina women: findings from the Sister Study. exit disclaimer

The main reason is that some things may change—you might lose or gain weight, start a new hobby, be prescribed a new medication, or develop a new medical condition, and we want to do our best to capture that information! Other times we realize that we did not originally ask the question in the best way and want you to provide additional or clarifying information. For example, we asked about your personal care product use (hair dyes, make-up, talc products, etc.) at enrollment, but focused specifically on use in your early adolescence and in the year before you joined. In later questionnaires, we asked about your recent use (after you joined) and also tried to capture information about your lifetime use by asking about what products you used during each decade of your life.

Periodontal (gum) disease and tooth loss are common public health concerns and may be an indicator of more significant health problems. Researchers at the National Cancer Institute recently led an investigation of the associations of periodontal disease and tooth loss with mortality among Sister Study participants. They observed that women with periodontal disease, tooth loss, or both had higher overall mortality rates than women without those conditions. In terms of specific causes of death, having periodontal disease was associated with increased likelihood of dying from an infectious or parasitic disease, and having tooth loss was associated with increased risk of dying from cardiovascular, endocrine-related, or respiratory system diseases. This study supports the importance of maintaining good oral health.

Learn more here:
Associations of periodontal disease and tooth loss with all-cause and cause-specific mortality in the Sister Study. exit disclaimer

Thanks to the health updates and other information you share year after year with the Sister Study, our researchers are able to publish papers such as this one. Please read about how a healthy diet may lower women's risk of age-related diseases and mortality.

Learn more here:
Diet holds key to slowing biological aging, researchers say. exit disclaimer

Please welcome new Sister Study researcher Dr. Che-Jung Chang! Dr. Chang recently received her PhD in Environmental Health Science from Rollins School of Public Health, Emory University. She joined Dr. Alexandra White's group in September 2021 as a post-doctoral research fellow at the National Institute of Environmental Health Sciences. Her research will focus on how exposure to environmental pollutants play a role in developing and progressing reproductive cancers in women. For her first Sister Study research project, Dr. Chang will examine how personal care products, which may contain endocrine-disrupting chemicals, are related to female reproductive cancers.

Heart disease is the leading cause of death for women in the United States. Over the years, we have asked you questions about your cardiovascular health and disease history. In August, we began requesting medical records to confirm diagnoses and obtain needed details about reported heart conditions such as results of tests performed and disease subtypes. Our goal is to identify preventable environmental causes of cardiovascular disease. We have reached out to some of you for more information about your health history. If you were contacted and returned your authorization forms, we thank you! But if you haven't yet done so we encourage you to sign and mail your forms soon. We are excited to let you know that we are working with cardiovascular disease experts to study environmental contributors to stroke, heart attack, and congestive heart failure. Dr. Joseph Engeda, who recently joined the Sister Study team as an Epidemiologist, will be using data collected from medical records to study these cardiovascular conditions. Thank you again for your contributions to the Sister Study. We couldn't do this research without your willingness to participate!

While human papillomavirus (HPV) is the primary cause of cervical cancer, other factors may influence susceptibility and response to the virus. Using data from the Sister Study, we looked at whether genital talc use or douching were associated with the occurrence of cervical cancer. We observed a possible positive association between douching during adolescence and cervical cancer, but no association between adolescent talc use and cervical cancer. Recent (in the year before study enrollment) douching and to a lesser extent genital talc use were positively associated with incident cervical cancer, but the number of new cases was small. This research helps us understand some of the possible causes of cervical cancer and could help guide preventative strategies, particularly in areas with low HPV vaccination rates.

Learn more here:
The association between douching, genital talc use, and the risk of prevalent and incident cervical cancer. exit disclaimer

Do you remember clipping your toenails and having them collected by our examiners when you enrolled in the Sister Study? We measured concentrations of 15 metals in the toenails from a subset of Sister Study women and studied whether those levels were associated with future breast cancer risk. We did not observe a relationship between most of the metals and breast cancer risk, either individually or as a combined metal exposure. One possible exception was that molybdenum, an essential element found in legumes, leafy vegetables, and milk, was associated with a reduced risk of breast cancer, particularly estrogen receptor negative breast cancer.

Learn more here:
Metals and Breast Cancer Risk: A Prospective Study Using Toenail Biomarkers. exit disclaimer

On October 27, 2021, the FDA took several new actions to strengthen breast implant risk communication and help those who are considering breast implants make informed decisions. If you are considering breast implant or have received them in the past, we encourage you to talk to your personal doctor about these new recommendations.

Learn more here:
FDA Strengthens Breast Implant Safety Requirements and Updates Study Results. exit disclaimer

This large collaborative study that included more than 26,000 women aimed to evaluate the importance of screening for known breast cancer genes in women over age 65. The study looked at the frequency of so called "pathogenic variants" (PVs), which are mutations in known breast cancer risk genes, including the most widely known BRCA1 and BRCA2 genes. PVs in BRCA1, BRCA2, and PALB2 were found in 3.4% of women diagnosed with estrogen receptor ER-negative, 1.0% with ER-positive, and 3.0% with triple-negative breast cancer. As expected, PVs in CHEK2, PALB2, BRCA1, and BRCA2 were associated with increased risks of breast cancer: remaining lifetime risks of breast cancer were ≥ 15% for those with PVs in BRCA1, BRCA2, and PALB2. While this remaining lifetime risk is not as great as it is for younger women, this study suggests that all women diagnosed with triple-negative breast cancer or ER-negative breast cancer should receive genetic testing and that women over age 65 years with BRCA1 and BRCA2 PVs and perhaps PALB2 and CHEK2 PVs should be considered for more advanced breast cancer screening such as with magnetic resonance imaging.

Learn more here:
Risk of Late-Onset Breast Cancer in Genetically Predisposed Women. exit disclaimer

The age that menopause occurs is determined by the number of remaining ovarian follicles, often referred to as the ovarian reserve. Ovarian follicles are formed in very early life; the number of follicles is greatest at birth and decreases with age and menstruation, but environmental factors could also lead to decreased ovarian reserve. In a new Sister Study investigation, we examined possible associations between prenatal and childhood exposure to the farm environment and Anti-Müllerian hormone (AMH), a blood-based biological marker of ovarian reserve, in women ages 35-54 years. We found that women whose mothers worked or resided on a farm while they were pregnant had lower AMH levels. The data also suggested that childhood contact with pesticide-treated livestock or buildings was also associated with lower AMH. These findings raise concern that aspects of prenatal farm exposure may result in reduced adult ovarian reserve.

Learn more here:
Early-life Farm Exposure and Ovarian Reserve in a US Cohort of Women. exit disclaimer

Researchers from the Sister Study have developed a new risk prediction score that may improve how we identify women at higher risk for developing breast cancer. The new risk score is based on measures of naturally occurring chemical modifications to DNA, known as DNA methylation, that can be assessed in the cells collected from a simple blood sample. In the Sister Study analysis, the investigators used blood samples that were provided at study enrollment and found that the new DNA methylation-based risk score helped predict whether or not a woman developed breast cancer during follow-up, especially when it was combined with existing information on other genetic or lifestyle factors. Though these results are novel and promising, further investigation and replication is needed to see if this will be useful in a clinical setting.

Learn more here:
Blood DNA methylation profiles improve breast cancer prediction. exit disclaimer

Sister Study investigators teamed up with collaborators from Boston University and elsewhere to evaluate the potential association between gestational diabetes and young-onset breast cancer. For the analysis, we pooled data from 5 large cohort studies, including nearly 260,000 women, 6,842 of whom developed breast cancer before age 55. Women who had one or more children had a reduced risk of young-onset breast cancer, compared to women who never gave birth. Among women who gave birth, gestational diabetes was not associated with an increased risk of young-onset breast cancer.

Learn more here:
Gestational diabetes and risk of breast cancer before age 55 years. exit disclaimer

October is Breast Cancer Awareness Month and we at the Sister Study would like to join our participants and friends of the study to remember those affected by breast cancer. With our ongoing research, we honor those we have lost and those who continue to fight against breast cancer. We are grateful to those of you who participate in research like the Sister Study so we can work together toward solutions. Thank you.

We would like to introduce you to Dr. Jennifer Ish, who recently earned her PhD in Epidemiology from the University of Texas Health Science Center School of Public Health and joined Dr. Alexandra White's group as a post-doctoral fellow at the National Institute of Environmental Health Sciences. Dr. Ish is interested in investigating the interplay between environmental, social, and psychosocial stressors and the mechanisms by which these factors influence the risk of adverse health outcomes in women and children. In her first project at NIEHS, she will be using data from the Sister Study to examine the effect of exposure to industrial air pollution on breast cancer risk. She will also investigate whether stress-related factors, such as race and neighborhood segregation, enhance susceptibility to toxic air emissions, potentially informing how air pollution contributes to disparities in breast cancer outcomes.

The Women's Health Awareness: Virtual Series "Real Talk With the Experts" is over, but you can learn more about the initiative here:

Women's Health Awareness. exit disclaimer

Almost 39,000 (76.6%) Sister Study participants have completed the special COVID-19 survey. Many of you have also completed either your Annual Health Update (85.6%) or your Detailed Health Update (84.0%). You are truly a dedicated and remarkable group! We thought it would interest you if we shared a bit on what we have learned thus far from the COVID-19 surveys:

  • About 7.5% of responders have had COVID-19.
  • Of those who have had COVID, approximately 5.6% tell us they were hospitalized as a result. Of those hospitalized, about 15.3% required rehab.

Thank you for helping our researchers learn how COVID-19 is impacting our Sister Study participants!

Overall dietary patterns may be stronger predictors of health than any individual food item or nutrients. Using the diet data you provided when you joined the Sister Study we studied three well-established healthy diets—the Dietary Approaches to Stop Hypertension (DASH) diet exit disclaimer, the Mediterranean Diet exit disclaimer and the Alternative Healthy Eating Index exit disclaimer. We found that high adherence to the DASH diet scoring well on the Alternative Healthy Eating Index was associated with a reduced risk of breast cancer. There are common features of these healthy diets including eating lots of fruits and vegetables and limiting red meat.

Learn more here:
Dietary index scores and invasive breast cancer risk among women with a family history of breast cancer. exit disclaimer

In late July, the Sister Study summer interns presented their preliminary findings at the NIEHS virtual poster session. There were many fabulous projects, and several of our students won awards! We'd like to congratulate Yilda Macias ("COVID-19 and Vitamin D Supplement use by Race/Ethnicity in the Sister Study Cohort") and Rachel Thompson ("Associations between Serum Iron Biomarkers and Breast Cancer Tumor Size") for their 2nd place finishes. Sharonda Lovett ("Gynecologic Surgery, Hormone Therapy, and Incident Breast Cancer in the Sister Study") and Claire Ashley ("Use of Wood-Burning Stoves and Fireplaces and Select Cardiovascular Outcomes among Sister Study Participants") received honorable mentions. Stay tuned for more details on their findings - these students and their mentors are continuing to work on getting the results written up and submitted for publication.

We have shared a few recent articles using Sister Study data to analyze genes linked to breast cancer risk, including PALB2. Thanks to all the Sister Study participants whose data allows us to continue our research!

  1. The Sister Study contributed to a landmark study exit disclaimer that examined how some of the genes with known links to cancer impact breast cancer risk in the general population. Most of the current information we have on risk associated with these genes comes from clinical studies of high risk patients and their families, not women in the general population. Variations in the BRCA1 and BRCA2 genes were associated with the highest risk of breast cancer, followed by variations in PALB2. Variations in the genes BARD1, RAD51C, and RAD51D were associated with increased risk of estrogen receptor negative and triple-negative breast cancer. This work helps us understand the overall impact of these rare mutations on women's risks of developing breast cancer.
  2. The breast cancer risk associated with cancer predisposition genes in African Americans is not well known, in part because few studies have been large enough to address this question. For that reason, researchers at Boston University and the Mayo Clinic collaborated with the Sister Study to analyze DNA from 5,054 African-American women with breast cancer and 4,993 African-American women without breast cancer. Their research focused on 23 cancer predisposition genes, including BRCA1, BRCA2, and PALB2. They found that the genes that greatly increase the risk of breast cancer in U.S. white women also greatly increase breast cancer risk among African-American women. Currently, rates of breast cancer genetic testing are substantially lower in African-American women with breast cancer than in white patients of the same ages. The authors cite differences in recommendations given to African American women as one of the drivers of this disparity.
  3. This large collaborative study exit disclaimer that included more than 26,000 women aimed to evaluate the importance of screening for known breast cancer genes in women over age 65. The study looked at the frequency of so called pathogenic variants (PVs), which are mutations in known breast cancer risk genes, including the most widely known BRCA1 and BRCA2 genes. PVs in BRCA1, BRCA2, and PALB2 were found in 3.4% of women diagnosed with estrogen receptor ER-negative, 1.0% with ER-positive, and 3.0% with triple-negative breast cancer. As expected, PVs in CHEK2, PALB2, BRCA1, and BRCA2 were associated with increased risks of breast cancer: remaining lifetime risks of breast cancer were ≥ 15% for those with PVs in BRCA1, BRCA2, and PALB2. While this remaining lifetime risk is not as great as it is for younger women, this study suggests that all women diagnosed with triple-negative breast cancer or ER-negative breast cancer should receive genetic testing and that women over age 65 years with BRCA1 and BRCA2 PVs and perhaps PALB2 and CHEK2 PVs should be considered for more advanced breast cancer screening such as with magnetic resonance imaging.

One major area of interest for Sister Study researchers is the potential long-term health effects of personal care products, particularly those containing potentially harmful chemicals exit disclaimer. We previously showed exit disclaimer that using permanent hair dye, straighteners, or perms exit disclaimer may be associated with an increased risk of breast cancer. In a recent examination of the association between hair products and ovarian cancer risk, we found that frequent use of hair straighteners/relaxers (>4 times/year) was associated with twice the risk of ovarian cancer compared to never users. This finding is particularly relevant for Black/African American women, who are more likely to use straighteners/relaxers.

Learn more here:
Use of hair products in relation to ovarian cancer risk. exit disclaimer

With the Sister Study, we are trying to understand how shared genetics and life experiences can affect the health of our participants whose sisters were diagnosed with breast cancer. But, we know these sisterly bonds are much stronger and deeper than anything our science can capture. Many of you joined our study to honor your sister who experienced breast cancer, and you have continued to convey your love for your sisters by remembering them and sharing their experiences here on our Facebook page. Today, on National Sisters Day we pause to think of your sisterly bonds and express our appreciation for what it brings to cancer research and future generations. Thank you for your dedication to your sisters and our study!

In one of the follow-up questionnaires, we asked Sister Study participants about their experiences with discrimination. We defined 'everyday' discrimination as being treated unfairly receiving while receiving a service, being treated as less intelligent or worthy, or experiencing people acting as if they were afraid of you. We defined 'major' discrimination as being specific to a particular event (e.g., being treated unfairly when renting or buying a house; being treated unfairly by the police; being treated unfairly at work). Non-Hispanic Black Sister Study participants were more likely to report having experienced everyday (75%) or major (51%) discrimination because of their race/ethnicity, relative to Non-Hispanic White (4% everyday, 2% major) or Hispanic/Latina participants (32% everyday, 16% major). While everyday discrimination was not associated with the risk of developing type 2 diabetes during follow-up, experiencing major discrimination was associated with an increased risk. This work provides evidence that anti-discrimination efforts may help mitigate racial/ethnic disparities in the risk of type 2 diabetes.

Learn more here:
Experiences With Everyday and Major Forms of Racial/Ethnic Discrimination and Type 2 Diabetes Risk Among White, Black, and Hispanic/Latina Women: Findings From the Sister Study. exit disclaimer

In a sample of Sister Study and Two Sister Study participants with breast cancer, we looked at measures of financial hardship after diagnosis. Among the 1628 breast cancer survivors who were employed at diagnosis, 27% reported employment disruption (15% stopped working; 12% had reduced hours), and 21% experienced financial hardship (16% had difficulty paying for care; 13% borrowed money or incurred debt; 2% filed for bankruptcy). These results demonstrate how women experiencing employment disruptions after breast cancer may be vulnerable to financial hardship and highlight the need to identify risk factors for employment disruption and ways to help mitigate financial consequences after cancer.

Learn more here:
Breast Cancer-Related Employment Disruption and Financial Hardship in the Sister Study. exit disclaimer

With collaborators at the Environmental Protection Agency, we studied whether measures of neighborhood greenery were associated with body size among Sister Study participants living in or near certain US cities for which detailed land-use and greenery measures were available. We found that more tree cover was associated with a decreased odds of being overweight or obese. Herbaceous cover (including grasses, shrubs, and other plants) was also associated with lower odds of being overweight or obese in arid climates (Western states, excluding the Pacific coast), but with higher odds in temperature climates (Southern states). These findings add to a growing body of evidence that greenery design in urban planning can support public health.

Learn more here:
Types and spatial contexts of neighborhood greenery matter in associations with weight status in women across 28 U.S. communities. exit disclaimer

Building off Sister Study research that showed various measures of body composition and physical activity exit disclaimer were associated with a woman's "biological age", we wanted to see if alcohol intake also potentially contributed to aging. We did not find strong evidence that recent or lifetime alcohol use was associated with biological age. As a possible exception, women averaging approximately 1 drink/day for each year they drank alcohol had a biological age measure that was consistent with being about 9 months to one year older than their chronological age would suggest.

Learn more here:
Alcohol Consumption and Methylation-Based Measures of Biological Age. exit disclaimer

Over 31,000 (61.4%) Sister Study participants have completed the special COVID-19 survey. Many of you have also completed either your Annual Health Update (82.4%) or your Detailed Health Update (74.5%). You are truly a dedicated and remarkable group! We thought it would interest you if we shared a bit on what we have learned thus far from the COVID-19 surveys:

  • About 6.7% of responders have had COVID-19.
  • Of those who have had COVID, approximately 5.2% tell us they were hospitalized as a result. Of those hospitalized, about 9.7% required rehab.

Thank you for helping our researchers learn how COVID-19 is impacting our Sister Study participants!

NIEHS post-doctoral fellow, Dr. Kaitlyn Lawrence, recently won an award for her research on the link between higher neighborhood deprivation and accelerated biological aging measures in the Sister Study. Congrats to Kaitlyn!

Learn more here:
Scientific Journeys: From summer intern to award-winning researcher. exit disclaimer

The Sister Study contributed to a landmark study that examined how some of the genes with known links to cancer impact breast cancer risk in the general population. Most of the current information we have on risk associated with these genes comes from clinical studies of high risk patients and their families, not women in the general population. Variations in the BRCA1 and BRCA2 genes were associated with the highest risk of breast cancer, followed by variations in PALB2. Variations in the genes BARD1, RAD51C, and RAD51D were associated with increased risk of estrogen receptor negative and triple-negative breast cancer. This work helps us understand the overall impact of these rare mutations on women's risks of developing breast cancer.

Learn more here:
A Population-Based Study of Genes Previously Implicated in Breast Cancer. exit disclaimer

We recently published a study exit disclaimer that looked at the association between type 2 diabetes, metformin use, and breast cancer risk. This newly published commentary further discusses these findings, which showed that while type 2 diabetes may increase the risk of developing breast cancer, the widespread use of metformin appears to counteract the hazards of long-term metabolic changes associated with type 2 diabetes.

Read the cpmmentary here:
Making sense of associations between type 2 diabetes, metformin, and breast cancer risk. exit disclaimer

This summer, the Sister Study will be welcoming 8 students into our (virtual) summer internship program. These undergraduate and graduate level students live all over the country and will be working with NIEHS investigators for 8-12 weeks, focusing on specific research questions that can be studied using Sister Study data. Students will be exploring how the following factors are related to breast cancer risk: thyroid diseases and treatment with radioactive iodine, history of gynecologic surgery (hysterectomy and oophorectomy), sedentary behavior (time spent sitting), and redlining (residential racial segregation due to lending and mortgage discrimination). Other students will consider how vitamin D supplement use is related to COVID-19 infections and severity; how wood smoke is related to lung cancer and cardiovascular disease; how blood iron levels are related to breast tumor size among women with breast cancer; and how sleep is related to insulin resistance measures. Please stay tuned for updates on their research.

Collaborators at the University of Wisconsin - Milwaukee examined the association between measures of childhood socioeconomic status and depression in adulthood. Approximately 17% of Sister Study participants reported being diagnosed with depression between age 30 and when they enrolled in the study. Those who perceived their families as relatively disadvantaged during their childhood were more likely to have reported depression. The relationship was less clear when the researchers considered the relationship between parents' education levels (more objective measures of socioeconomic status) and depression, noting that the relationship may vary across birth year and time.

Learn more here:
Objective and subjective childhood socioeconomic disadvantage and incident depression in adulthood: a longitudinal analysis in the Sister Study. exit disclaimer

Inflammation and oxidative stress may promote breast and other cancers. The role of diet is still uncertain, however. In this study, Sister Study authors examined how the Dietary Inflammatory Index (DII) exit disclaimer and dietary oxidative-balance scores (D-OBS) exit disclaimer may be related to breast cancer. They found that diet may indeed be associated with an increased risk of both overall and especially triple-negative breast cancer. The greatest risk was seen in diets with the poorest pro-inflammatory and pro-oxidative scores combined. These results suggest that modifying dietary lifestyle factors may help reduce the risk of breast cancer.

Learn more here:
Dietary inflammatory potential, oxidative balance score, and risk of breast cancer: Findings from the Sister Study. exit disclaimer

Some African-American/ Black Sister Study participants were included in a large, collaborative study of genetic risk factors for breast cancer among women with African ancestry. The lead investigators were interested in understanding how summary measures of genetic risk, called polygenic risk scores, would be associated with breast cancer in Black women. They found that the scores were strongly associated with breast cancer risk in women of African descent, though they were better predictors of risk in women of European, Asian or Latino descent. These results demonstrate that while there are many genetic similarities across these populations, more research is needed to identify variants that better predict risk among women of African ancestry.

Learn more here:
Evaluating Polygenic Risk Scores for Breast Cancer in Women of African Ancestry. exit disclaimer

With the Sister Study, we are trying to understand how shared genetics and life experiences can affect the health of our participants whose sisters were diagnosed with breast cancer. But, we know these sisterly bonds are much stronger and deeper than anything our science can capture. Many of you joined our study to honor your sister who experienced breast cancer, and you have continued to convey your love for your sisters by remembering them and sharing their experiences here on our Facebook page. Today, on National Siblings Day we pause to think of your sisterly bonds and express our appreciation for what it brings to cancer research and future generations. Thank you for your dedication to your sisters and our study!

Past research exit disclaimer from the Sister Study showed that women with a higher "biological age", as measured by changes to certain genetic markers, appeared to be at increased risk for breast cancer. This finding made us wonder: what factors are associated with biological aging? In a recent analysis, Sister Study researchers found that women with a higher body mass index, waist-to-hip ratio, or waist circumference had higher biological ages. Fortunately, researchers also found that increasing physical activity was associated with lower biological age, especially among women with larger body sizes. These findings are exciting because they help us understand what factors might contribute to how our bodies age and how that may relate to breast cancer risk.

Learn more here:
Associations of Body Composition and Physical Activity Level With Multiple Measures of Epigenetic Age Acceleration. exit disclaimer

Puberty is a period of rapid hormonal changes and breast development. Earlier age at menarche (a woman's first menstrual period) is known to be associated with increased breast cancer risk. In a recent analysis, Sister Study investigators examined whether early onset of breast development, also known as thelarche, is also associated with breast cancer risk. They found that earlier age at thelarche and earlier age at menarche were each associated with increased breast cancer risk, and that experiencing both early menarche (before age 12) and early thelarche (before age 10) together was associated with a greater increase in risk than either factor on its own. This work helps us better understand how early life factors may influence adult breast cancer risk.

Learn more here:
Pubertal timing and breast cancer risk in the Sister Study cohort. exit disclaimer

We previously posted that the Environmental Protection Agency routinely measures potentially toxic chemicals in the air exit disclaimer across the United States. This includes metals, including arsenic, cadmium, chromium, cobalt, lead, manganese, mercury, nickel, selenium, and antimony. In a recent Sister Study analysis, we looked at whether these metals are associated with hypertension (high blood pressure). We observed that those whose residential addresses were located in areas of high estimated arsenic, lead, chromium, cobalt, or manganese were more likely to have hypertension, but that those potentially exposed to high levels of airborne selenium were less likely to have hypertension. This study adds to the evidence that environment you live in can affect health.

Learn more here:
Airborne metals exposure and risk of hypertension in the Sister Study. exit disclaimer

We hope you and your family are staying healthy in these challenging times. We are so relieved that COVID-19 rates are decreasing and that the vaccine is available for many of you. Whether you have had COVID-19 or not, we encourage you to take a few minutes each day to log your health status in the COVID-19 symptom tracker. Your data is useful, even if you have been vaccinated, as it may help us understand how effective the different vaccines are in protecting us against infections or in preventing serious disease. Thank you if you are already tracking! The secure app is free to download and many large studies, including the Sister Study, are asking participants to use the app so that researchers and public health officials can get good information on the spread of this disease and its symptoms. If you enroll as a member of a cohort study and select The Sister Study, we will later be able to link the data you enter in the tracker with data you already gave us to identify factors that affected the likelihood of developing COVID-19 and learn if the virus has any long-term health impacts. The tracker collects data that complements what we are collecting with our own COVID questionnaire and because some people report daily, the APP provides data that can be used to track the spread of COVID in your community. Your friends and family can download the app and participate too, even if they are not involved in the Sister Study.

Learn more here:
COVID Symptom Study. exit disclaimer

Over 20,000 (40%) Sister Study participants have completed the special COVID-19 survey. Many of you have also completed either your Annual Health Update (57%) or your Detailed Health Update (50%). You are truly a dedicated and remarkable group! We thought it would interest you if we shared a bit on what we have learned thus far from the COVID-19 surveys:

  • Roughly 6% of responders have had COVID-19.
  • Of those who have had COVID, approximately 5% tell us they were hospitalized as a result. Of those hospitalized, about 10% required rehab.

Thank you for helping our researchers learn how COVID-19 is impacting our Sister Study participants!

Since we began analyzing the data provided by our generous Sister Study sisters, our researchers have published over 200 scientific papers! These findings contribute to improvements in our understanding of the environmental and genetic causes of breast cancer and other important issues in women's health. We are proud of what we have accomplished together with our study sisters! Thank you for sticking with us!

To view Sister Study findings:
Research Articles. exit disclaimer

Previous research exit disclaimer by Sister Study researcher Dr. Alexandra White demonstrated that air pollution may be associated with breast cancer, but that the association may vary by geographic region. This variability is attributed to differences in the types of airborne particles (called "particulate matter") more common in each region. Dr. White pursued this research further with a second study of air pollution and breast cancer, this time in the Black Women's Health Study, a large cohort of Black women living throughout the US. In this newly published work, air pollution was associated with breast cancer in the Midwest, where the particulate matter was composed of chemicals associated with industrial processes. Taken together with our findings in Sister Study, this work underscores the importance of considering air pollution composition when evaluating health effects.

Learn more here:
Air pollution and breast cancer risk in the Black Women's Health Study. exit disclaimer

Women may apply powder to the genital area to help manage excess moisture and odor. However, powders often contain talc and other substances that potentially irritate and inflame tissues and promote carcinogenesis in female reproductive organs. We previously published a study of powder use and ovarian cancer exit disclaimer with inconclusive findings. In a new publication, Sister Study investigated possible associations between powder use and uterine cancer using data on more than 209,000 women in four prospective cohorts, including the Sister Study. Analyses show that overall, 37 percent of women reported ever using genital powder, and 3272 invasive uterine cancers were documented across the study cohorts. Uterine cancer risk was not associated with genital powder use, with the possible exception of a slightly elevated risk among long-term users.

Learn more here:
Genital powder use and risk of uterine cancer: A pooled analysis of prospective studies. exit disclaimer

A few years ago, as part of a special survey of cancer survivors, we asked women who had been diagnosed with breast cancer to answer questions about their breast cancer and their current health and quality of life. Among the 1675 women who were employed at the time of their diagnosis, the 17% who were not employed at the time the special survey was administered were older and more likely to have peripheral neuropathy, lack sick leave, have later stage at diagnosis, have a recurrence or a new cancer, have problems with memory or attention, or have poor general health. These findings exit disclaimer highlight some of the challenges cancer survivors face if they try to remain in the workforce after their diagnosis.

Learn more here:
Employment After Breast Cancer Diagnosis and Treatment Among Women in the Sister and the Two Sister Studies. exit disclaimer

A study of 44,541 women has found that there appears to be no association between type 2 diabetes and developing breast cancer overall. This may be because most women in the study with type 2 diabetes were taking metformin, a medication widely used to treat type 2 diabetes, whose actions may help to reduce the risk of developing estrogen receptor positive breast cancer. While type 2 diabetes was not associated with increased risk of estrogen receptor positive breast cancer in this study, it was associated with a small increase in risk for estrogen receptor negative and triple negative breast cancer.

Press release:
Metformin may affect risk of breast cancer in women with type 2 diabetes. exit disclaimer

Article:
A prospective study of type 2 diabetes, metformin use, and risk of breast cancer. exit disclaimer

The Sister Study contributed to a landmark study that examined how some of the genes with known links to cancer impact breast cancer risk in the general population. Most of the current information we have on risk associated with these genes comes from clinical studies of high risk patients and their families, not women in the general population. Variations in the BRCA1 and BRCA2 genes were associated with the highest risk of breast cancer, followed by variations in PALB2. Variations in the genes BARD1, RAD51C, and RAD51D were associated with increased risk of estrogen receptor negative and triple-negative breast cancer. This work helps us understand the overall impact of these rare mutations on women's risks of developing breast cancer.

Learn more here:
A Population-Based Study of Genes Previously Implicated in Breast Cancer. exit disclaimer

Iron is essential to life, but also potentially toxic at higher levels. In the Sister Study, we looked at the association between breast cancer risk and levels of iron in the blood. We found little evidence to support an association between higher blood iron levels and breast cancer risk.

Learn more here:
Association Between Serum Iron Biomarkers and Breast Cancer. exit disclaimer

In addition to trying to better understand the causes of breast cancer, Sister Study researchers are interested in learning more about breast cancer survivors, including what factors might influence their health-related quality of life. In a recent study exit disclaimer of 2,453 breast cancer survivors, we found that those with higher cancer stages, more concurrent conditions, surgical complications, or who were dissatisfied with their breast surgery or experienced breast cancer recurrences or new tumors had lower quality of life scores. Those with lower scores were more likely to die from their disease, even after controlling for disease stage and other factors. This research helps identify what areas are most important for improving care and survival rates of those diagnosed with breast cancer.

Learn more here:
Health-related quality of life outcomes among breast cancer survivors. exit disclaimer

Puberty is a period of rapid hormonal changes and breast development. Earlier age at menarche (a woman's first menstrual period) is known to be associated with increased breast cancer risk. In a recent analysis, Sister Study investigators examined whether early onset of breast development, also known as thelarche, is also associated with breast cancer risk. They found that earlier age at thelarche and earlier age at menarche were each associated with increased breast cancer risk, and that experiencing both early menarche (before age 12) and early thelarche (before age 10) together was associated with a greater increase in risk than either factor on its own. This work helps us better understand how early life factors may influence adult breast cancer risk.

Learn more here:
Pubertal timing and breast cancer risk in the Sister Study cohort. exit disclaimer

Ann Von Holle is a postdoctoral fellow in the Biostatistics and Computational Biology Branch at NIEHS and member of the Sister Study team. She completed her doctorate in epidemiology at UNC Chapel Hill in 2018. Since coming to NIEHS, she has been studying factors related to breast cancer incidence, including a study looking at whether sisters with breast cancer were diagnosed at similar ages, and a study considering how BMI, age and menopausal status act together to affect breast cancer risk. In other work, Ann is studying how blood iron levels may be related to breast cancer risk.

Learn more here:
More about Dr. Von Holle's research. exit disclaimer

We introduced you to Dr. Ann Von Holle (here), a postdoctoral fellow in the Biostatistics and Computational Biology Branch at NIEHS and member of the Sister Study team. Dr. Von Holle is lead author on a recently published paper pointing to evidence for familial clustering in breast cancer age of onset. If sisters with breast cancer tend to get diagnosed around the same age, there could be important implications for both personalized screening and understanding the causes of breast cancer. With data from the Sister Study, we explored whether breast cancer risk was higher around the age at which an older sister was diagnosed and found evidence to support this hypothesis. If confirmed in additional studies, personalized screening for those who have a sister previously affected by the disease could account for how close they are to the age at which their sister was diagnosed.

Learn more here:
Evidence for Familial Clustering in Breast Cancer Age of Onset. exit disclaimer

Some of you may have heard about California's decision to ban certain chemicals from personal care products. We thought you'd like to know that a Sister Study paper on hair products and increased risk of breast cancer is often cited as one of the reasons for creating this law!

Learn more:

California Ban - New California law banning toxic chemicals in cosmetics will transform industry exit disclaimer

Sister Study Paper - Hair dye and chemical straightener use and breast cancer risk in a large US population of black and white women exit disclaimer

Because they are so rare, researchers often include peritoneal (from the abdominal cavity membrane) and fallopian tube cancers in studies of ovarian cancer. The Sister Study contributed to a large collaborative effort to tease apart potential differences in risk factors by tumor site. The results of this study showed that most associations did not vary by location, exit disclaimer providing evidence that these three types of cancer likely have similar causes.

Learn more:
Ovarian Cancer Risk Factor Associations by Primary Anatomic Site: The Ovarian Cancer Cohort Consortium exit disclaimer

Earlier age at menopause is thought to be associated with a lower risk of breast, endometrial and ovarian cancer but increased risk of other chronic diseases such as heart disease. In a recent analysis, Sister Study investigators examined whether exposure to certain metals, as measured in toenail specimens collected from participants at enrollment, was associated with age at menopause. They found that while no individual metal was strongly associated with onset of menopause, lower overall metal levels, particularly essential metals such selenium, zinc, and manganese, were associated with earlier age at menopause.

Learn more here:
Toenail metal concentrations and age at menopause, A prospective study. exit disclaimer

At enrollment, 22% of Sister Study participants reported a history of periodontal disease, or chronic infection and inflammation of the gums. Periodontal disease is thought to be associated with oral, lung and gastrointestinal cancers, possibly because these tissues have an inflammatory response to bacteria spreading from the gums. The association with breast cancer is not known. In a recent collaboration with investigators from the National Cancer Institute, we did not see a clear association between periodontal disease and overall breast cancer risk, though there was some suggestion that periodontal disease is associated with lower risk of ductal carcinoma in situ but a higher risk of invasive disease. More research is needed to understand this discrepancy.

Learn more here:
The Association Between Periodontal Disease and Breast Cancer in a Prospective Cohort Study. exit disclaimer

Dr. Jacob Kresovich is a Sister Study researcher and post-doctoral fellow in the Epidemiology Branch at NIEHS. His research explores how a naturally occurring chemical modifications to DNA, called DNA methylation, are related to aging and disease risk. He previously showed that a higher "biological age", as measured changes to DNA methylation, was associated with increased likelihood of developing breast cancer. Currently, he is studying how biological aging is affected by modifiable lifestyle factors such as physical activity and alcohol use.

There are likely some differences in the underlying causes of breast cancer diagnosed before or after menopause. The "Two Sister Study" was an initiative led by Dr. Clarice Weinberg in which we collected information from some of your sisters who had young-onset disease, thereby giving us the opportunity to study risk factors for breast cancer diagnosed before age 50. We recently used data from this companion study to look at whether features of your mother's pregnancy with you and your birth might affect risk of developing breast cancer at a young age. We observed that having a mother with pre-eclampsia (a serious form of pregnancy-related high blood pressure) was associated with increased risk of developing young-onset disease. We also observed a positive association between higher birth weight and young-onset breast cancer.

Learn more here:
Perinatal and postnatal exposures and risk of young-onset breast cancer exit disclaimer

We have known for a long time that there are many different types of breast cancer and that each subtype likely has some unique risk factors. However, because hormone receptor positive breast cancer is the most common, it has been much easier to identify factors associated with that subtype. In a recently published international collaboration, researchers pooled data to examine genetic risk factors for each subtype separately. They identified 32 previously unknown markers! This information will be useful for understanding the genetic origins of some of the rarer subtypes, including triple-negative disease, and for developing genetic risk scores to predict what individuals are at the highest risk of developing one or more breast cancer subtypes.

Learn more here:
Genome-wide association study identifies 32 novel breast cancer susceptibility loci from overall and subtype-specific analyses. exit disclaimer

Researchers from Dartmouth recently conducted exit disclaimer a study comparing mercury levels in toenail samples from select Sister Study participants to those taken from individuals with amyotrophic lateral sclerosis (ALS). They observed that ALS patients were more likely to have very high mercury concentrations (above the 90th percentile) than our participants. The Sister Study toenail measurements were from an earlier study exit disclaimer where we showed that toenail metal concentrations were not associated with young-onset breast cancer. Thank you for all you have shared with the Sister Study so researchers can continue to make an impact.

Learn more here:
Keratinous biomarker of mercury exposure associated with amyotrophic lateral sclerosis risk in a nationwide U.S. study. exit disclaimer

Toenail-Based Metal Concentrations and Young-Onset Breast Cancer. exit disclaimer

As many of you know, we are asking our participants to report any symptoms (or lack thereof) through the COVID-19 symptom study and app exit disclaimer. Thank you for continuing to use the symptom tracker and for encouraging others to also use it!

A few things that we really like about the app are:

  • It can help identify emerging outbreaks by capturing data quickly and in real-time. You and millions of others are contributing to this research just by logging in and reporting your symptoms every day.
  • It helped identify anosmia (loss of sense of smell) as a good predictor of having a coronavirus infection.
  • We have already collected a lot of information about your existing health conditions, medication use, and genetics. With the data collected from the app, we will be able to look out how these factors might be related to whether or not you get infected or how serious your symptoms are.
  • We are able to do all of this while still protecting your privacy. The app developers and other scientists involved will have access to the data that you enter into the app, but we will not share any of the data that we collected specifically for the Sister Study.

If you'd like a more scientific look at how this app can contribute to public health, we recommend checking out these recently published articles:

Your friends and family can download the app and participate too, even if they are not involved in the Sister Study.

Please visit https://covid.joinzoe.com/us exit disclaimer for more information.

Congratulations to Sister Study researcher Dr. Chandra Jackson who received an award jointly funded by the National Institutes of Environmental Health Sciences and National Institute of Aging. With this award, Dr. Jackson will study how neighborhood environments and sleep health are related to cardiometabolic function. This work builds on her published research on sleep and metabolic disorders, including a study showing that not getting enough sleep or having insomnia may be associated with certain metabolic disorders in the Sister Study.

Learn more:

Multiple poor sleep characteristics and metabolic abnormalities consistent with metabolic syndrome among white, black, and Hispanic/Latina women: modification by menopausal status exit disclaimer

Dr. Jennifer Woo is the first graduate of the PhD in Epidemiology program at the University of Wisconsin-Milwaukee, Joseph J. Zilber School of Public Health. Using data from the Sister Study, her dissertation focused on how early life trauma may affect adult health, including breast cancer risk and biological markers of stress and aging. Dr. Woo is joining Dr. Dale Sandler's group as a post-doctoral fellow at the National Institute of Environmental Health Sciences and will be continuing to do research using data from the Sister Study. She hopes to learn more about how trauma and other early life experiences affect the body and influence individuals' risks of developing autoimmune or other chronic diseases.

Dr. Mary V. Díaz Santana received her Master's degree in Epidemiology from the University of Puerto Rico, Medical Science Campus and later completed a PhD in Epidemiology at the University of Massachusetts-Amherst. Her doctoral work focused on the role of acculturation in cancer screening among Hispanic women as well as the role of phthalate (a family of chemicals that are used in cosmetics as solvents and to make PVC plastic more flexible) exposure in breast cancer risk and weight change. As a postdoctoral fellow and Sister Study researcher, Dr. Díaz Santana is currently studying prenatal risk factors for breast cancer and diabetes. Dr. Díaz Santana is most interested in lessening the burden of chronic diseases among Hispanics, and plans to examine risk factors for breast cancer subtypes in Hispanic women participating in the Sister Study.

We hope you and your family are staying healthy in these challenging times. As you may know, COVID-19 has proven difficult to track. Whether you have COVID-19 or not, we encourage you to take a few minutes each day to log your health status in the new COVID-19 symptom tracker exit disclaimer. The secure app is free to download and many large studies, including the Sister Study, are asking participants to use the app so that researchers and public health officials can get good information on the spread of this disease and its symptoms. If you enroll as a member of a cohort study and select The Sister Study, we will later be able to link the data you enter in the tracker with data you already gave us to identify factors that affected the likelihood of developing COVID-19 and learn if the virus has any long-term health impacts. Your friends and family can download the app and participate too, even if they are not involved in the Sister Study.

Please visit https://covid.joinzoe.com/us exit disclaimer for more information.

In a pooled analysis lead by Sister Study researchers, we observed a small, positive, but not statistically significant association between self-reported use of powder on the genital area and risk of ovarian cancer. Altogether, the study included 252,745 women from 4 large observational studies, 2168 of whom developed ovarian cancer. The observed positive association may be limited to women with intact reproductive tracts (i.e., women who have not had a hysterectomy or tubal ligation). We did not observe an association between duration or frequency of genital powder use and ovarian cancer risk. Though the results are not definitive, this is the largest study of the topic to date. It also improves upon some of the design limitations of earlier studies, which had previously suggested there is a modest, positive association between genital powder use and ovarian cancer risk.

Learn more here:
Association of Powder Use in the Genital Area With Risk of Ovarian Cancer exit disclaimer

More than 3,000 papers were published by National Institute of Environmental Health Sciences researchers or grantees in 2019. The institute's leaders selected 26 for special recognition as Papers of the Year, including 3 Sister Study papers: "DNA methylation changes occur years before breast cancer develops", "Artificial light while sleeping may lead to obesity in women" and "Study finds eating processed meat increases colorectal cancer risk in women". Thanks to all of our longtime participants for your continued commitment to the Sister Study!

A recent study, exit disclaimer looked at whether living in an area with higher levels of a type of air pollution - fine particulate matter (PM2.5) - was associated with genetic changes in certain inflammation-related genes. The researchers looked at two inflammation-related pathways [tumor necrosis factor-alpha (TNFa) and toll-like receptor-2 (TLR-2)], While PM2.5 was not associated with changes to the TLR-2 gene, high levels may be associated with chemical changes (i.e. "methylation") of the TNFa gene. These changes could affect how that gene is expressed in the body. This work is very preliminary, but could help us understand how air pollution affects the risk of inflammation-related chronic diseases, such as cardiovascular disease and cancer.

Learn more here:
Long-term ambient fine particulate matter and DNA methylation in inflammation pathways: results from the Sister Study exit disclaimer

Previous research has suggested that poor sleep may be a risk factor for type 2 diabetes. Sister Study researchers found evidence to support this hypothesis, showing that women who reported frequent napping and other markers of poor sleep were more likely to develop diabetes in the future. Because women in racial or ethnic minority groups were more likely to experience both poor sleep and type 2 diabetes than Non-Hispanic white women, these findings underscore the importance of understanding how early life factors contribute to overall health and health disparities.

In a sample of participants from the Sister Study, we measured biologic age, a DNA-based estimate of a woman's age. We were interested in studying the association between biologic age and number of live births, as having children is thought to be protective against breast cancer risk. Our study showed for every live birth a woman reported, her biologic age increased by about 3 months. In other words, childbearing may lead to very slight increases in biologic age.

Learn more here:
Reproduction, DNA methylation and biological age exit disclaimer

Air pollution has been linked to a number of diseases, including cardiovascular disease and death, but less is known about air pollution's role in breast cancer. We evaluated whether air pollution concentrations at the residential level were associated with breast cancer risk. Because the make-up of air pollution varies, we also considered geography and looked at patterns of air pollution composition. We found that among women in the western US and with certain patterns of particulate matter composition, greater exposure to air pollution was associated with higher risk of breast cancer. This research helps to emphasize the importance of continuing to reduce air pollution levels nationwide.

Processed meat has been classified as a cause of colorectal cancer, exit disclaimer and red meat is also thought to be a risk factor for the disease. In a recent Sister Study analysis, researchers sought to further investigate the influence of specific meat products and meat cooking practices on colorectal cancer incidence. Over an average of 9 years of follow-up, 216 women developed colorectal cancer. As expected, we observed a positive association between overall consumption of processed meats and colorectal cancer, with high intake of breakfast sausages and bacon associated with the largest increases in risk. There was also some evidence of a positive association between colorectal cancer and consumption of barbecued or grilled red meat.

Learn more here:
A Prospective Analysis of Red and Processed Meat Consumption and Risk of Colorectal Cancer in Women exit disclaimer

Please take a look at the newly published Sister Study findings on hair dyes and straighteners. As always, for individualized application of study results, please consult your health care provider.

Read more about it here:
Permanent hair dye and straighteners may increase breast cancer risk. exit disclaimer

We examined the association between having experienced childhood trauma and multiple measures of sleep quality. 55% of women in the Sister Study reported experiencing some type of childhood trauma, including a natural disaster, major accident, household dysfunction, sexual trauma, physical trauma, and/or psychological/emotional trauma. We found that women who experienced childhood trauma reported getting less sleep at night, taking longer to fall asleep, waking up more often at night, and taking more naps.

Read more about it here:
Traumatic childhood experiences and multiple dimensions of poor sleep among adult women. exit disclaimer

Sister Study staff scientist, Dr. Katie O'Brien, recently received a grant from the Office of Dietary Supplements to study the association between vitamin D supplement use, blood levels of vitamin D, and breast cancer risk among African-American women enrolled in the Sister Study. The link between vitamin D and breast cancer is not well understood, though findings from some studies suggest that regular supplement use and high blood levels are associated with small reductions in risk. However, these studies have included few African-American women, despite the fact that African-Americans are less likely than other racial/ethnic groups to take vitamin D supplements and more likely to have low vitamin D blood levels. Dr. O'Brien will also investigate how some genetic factors may influence vitamin D blood levels in African-American women.

We would like to introduce you to Dr. Mandy Goldberg, a new post-doctoral fellow and Sister Study researcher. Dr. Goldberg recently received her PhD in Epidemiology from Columbia University, where she studied how early-life experiences may affect age at onset of puberty, breast density and benign breast disease. In her new position, Dr. Goldberg is looking forward to studying early-life risk factors for breast cancer in the Sister Study, including how environmental exposures during your mother's pregnancy and your childhood and adolescence may affect both the timing of puberty and breast cancer risk. Dr. Goldberg is also interested in understanding how family history of breast cancer may influence these relationships.

Working with a summer student from Columbia University, Sister Study researchers found that increasing consumption of red meat was associated with increased risk of invasive breast cancer. Women who consumed the highest amount of red meat had a 23% higher risk compared with women who consumed the lowest amount. Conversely, increasing consumption of poultry was associated with decreased invasive breast cancer risk: women with the highest consumption had a 15% lower risk than those with the lowest consumption. Importantly, the analysis suggested that breast cancer incidence could be reduced if women who eat meat substitute poultry for red meat.

Learn more here:
Study finds a possible link between Meat Consumption and Risk of Breast Cancer exit disclaimer

For the investigation in the link below, we collected information from young breast cancer survivors (diagnosis age less than 45) about their experiences with fertility counseling and treatment. Although 20% of those surveyed said that they were interested in future fertility at the time of their diagnosis, most did not discuss fertility treatment options with their doctor and far fewer actually pursued treatment (only 10% of those who reported interest in future fertility). It is our hope this research will help facilitate communication between oncologists and young patients who may be interested in discussing fertility treatments.

Learn more here:
Fertility-related experiences after breast cancer diagnosis in the Sister and Two Sister Studies exit disclaimer

Meet our Sister Study Operations and Retention team! This group tends to the day-to-day operations of the study. They specialize in operationalizing data collection efforts such as the yearly health update questionnaire, among many other efforts to retrieve information from participants. The team also tends to participants' individual needs and work to reduce burden so participants continue to remain in the study.

In addition to breast and other cancers, Sister Study researchers are interested in studying risk factors for cardiovascular disease. We recently published a study showing that while higher leisure-time physical activity levels are associated with reduced risk of stroke and transient ischemic attacks, higher levels of occupational physical activity may be associated with an increased risk of experiencing these events.

Read more about it here:
Occupational and leisure-time physical activity differentially predict 6-year incidence of stroke and transient ischemic attack in women. exit disclaimer

The human microbiome, the many microbes that live within our body, is thought to play a role in health and disease. Taking antibiotics for a long period of time could change our microbiome. We looked to see whether taking an oral antibiotic at least three times a week for three months or longer was associated with weight change, finding that chronic penicillin use may be associated with increased risk of obesity. The association between other types of antibiotics and weight was less clear. Though this work suggests that antibiotic use could have long-lasting impacts on weight, we consider it very preliminary and hope that future research will be better able to account for the reason antibiotics were prescribed. Please see the link below for more on these findings thanks to our dedicated Sister Study participants. As always, please check with your health care provider for guidance on how these findings may apply to you.

Read more about it here:
Chronic antibiotic use during adulthood and weight change in the Sister Study. exit disclaimer

While the main goal of the Sister Study is to research environmental and genetic causes of breast cancer, we have the opportunity to study other cancers that are important to women. We recently examined two possible risk factors for uterine/endometrial cancer: douching and use of talcum powder in the genital area. Though we did not observe an association between douching and uterine cancer, we saw some evidence that genital talcum powder use may be associated with an increased risk. We consider this work preliminary and are planning to do additional research using data from other large cohorts. As always, please contact your health care provider for help with applying these findings to yourself.

Read more about it here:
Perineal Talc Use, Douching, and the Risk of Uterine Cancer. exit disclaimer

Many Sister Study participants reported exposure to artificial light while sleeping, including having a small nightlight or light from clock radios on in the room (40%), light from outside the room (31%) or a light or television on inside the room (12%). Exposure to any of these was associated with being overweight or obese upon study enrollment, with stronger associations seen for those reporting lights or television on in the room while sleeping. Women who had exposure to artificial light while sleeping were also more likely to gain weight after baseline. Though we cannot confirm that the relationship is causal, our findings provide evidence that lowering exposure to light while sleeping may be a useful intervention for obesity prevention.

Learn more here:
Sleeping with lights on and weight gain in women linked in new study. exit disclaimer

Sleeping with Artificial Light at Night Associated with Weight Gain in Women. exit disclaimer

Association of Exposure to Artificial Light at Night While Sleeping With Risk of Obesity in Women. exit disclaimer

We previously posted about our findings that higher 'biological age', which is determined by measuring molecular changes to the genome (genetic material), was associated with increased breast cancer risk. In an effort to understand what factors might influence biological age, Sister Study investigators looked for differences in biological age between those who reported doing shift work (7% of participants) versus those who did not. Those who reported doing shift work tended to have a biological age that was older than their age in calendar years, especially if they worked night shifts. On average, those who worked for more than 10 years in a job that included night shifts were 3 years "older" than their chronological age. This research helps us understand some of the chemical processes that may explain previously observed associations between shift work and chronic diseases like breast cancer.

For those interested in learning more about the association between shift work and breast cancer, the National Toxicology Program recently released a report stating that "There is strong, but not sufficient, evidence from cancer epidemiology studies that persistent night shift work (e.g., frequent and long-term, or working a large number of night shifts over a lifetime, especially in early adulthood) causes breast cancer in women."

Read more about it here:
Shift work, DNA methylation and epigenetic age. exit disclaimer

We would like to introduce you to Dr. Nicole "Nikki" Niehoff, a new post-doctoral fellow and Sister Study researcher. Dr. Niehoff has already made major contributions to the Sister Study through her work as a doctoral student in Epidemiology at the University of North Carolina, studying air pollutants, pesticides, and physical activity in relation to breast cancer risk. In her post-doctoral position, Dr. Niehoff will continue to study environmental risk factors for breast cancer, including how obesity and other metabolic factors affect the relationship between the environment and cancer, and how multiple pollutants together influence risk.

When we talk about genetic risk factors for breast cancer, we are usually referring to how the genes we are born with can influence our risk of getting breast cancer. However, breast cancer may also be affected by change to our genes that occur after birth. Epigenetics is a term that refers to biologic changes that can affect DNA, including "DNA methylation", which can affect which genes can be "read" and turned into proteins. In a recent publication, Sister Study authors discuss how they examined more than 400,000 known DNA methylation markers, measured in DNA from blood samples given at study enrollment. The researchers identified several thousand methylation markers associated with breast cancer. Since the associations were stronger for breast cancer diagnosed shortly after study enrollment, they hypothesize that many of these markers may be indicators of early disease. These results could help develop tools for detecting invasive breast cancer at an early stage.

Read more about it here:
Blood DNA methylation and breast cancer: A prospective case-cohort analysis in the Sister Study. exit disclaimer

As previously discussed, even though the DNA you inherit from your parents is generally not modifiable, biological changes within cells over time can affect how the body reads and processes your genetic information. Sister Study investigators are very interested in learning about what environmental and lifestyle factors might affect DNA methylation, a type of genetic alteration that serves as an indicator of which genes are turned "on" or "off". In a recent study, we identified many such markers that may be associated with high alcohol consumption, which is a known risk factor for breast cancer and other diseases. These results may help explain how alcohol affects the body and increases disease susceptibility.

Read more about it here:
Alcohol and DNA Methylation: An Epigenome-Wide Association Study in Blood and Normal Breast Tissue. exit disclaimer

In a recently published study, Sister Study researchers found that women who ate breakfast every morning were less likely to be or become obese, compared to women who irregularly ate breakfast (3-4 days a week). On the other hand, women who never ate breakfast were also less likely to be obese than those who irregularly ate breakfast. We interpret this to mean that a regular breakfast consumption habit, whether it be eating breakfast every day or never eating breakfast, may be important for maintaining a healthy weight.

Read more about it here:
Day-to-day regularity in breakfast consumption is associated with weight status in a prospective cohort of women. exit disclaimer

The DNA you inherit from your parents is largely fixed and unchangeable. However, outside factors can alter how your body reads and uses the information coded in the genes. One such example is DNA methylation, where the presence of certain molecules (a "methyl" group) on the strand of DNA can affect whether the gene is turned "on" (i.e. it can be read) or "off". We recently found that Sister Study participants who were born to older mothers had different DNA methylation patterns than those with younger mothers. We do not yet know what this means in terms of health or breast cancer risk, specifically, but it could be a clue as to why some conditions or diseases are more common in individuals born to older mothers.

Read more about it here:
Persistent epigenetic changes in adult daughters of older mothers. exit disclaimer

In a recently published study led by Sister Study investigators Symielle Gaston and Chandra Jackson, women who averaged less than 7 hours of sleep per night and who had difficulty falling or staying asleep were more likely to have metabolic disorders like high blood pressure and obesity. These associations were usually stronger in premenopausal women than postmenopausal women. Because sleep and metabolic disorders were measured at the same time, we could not assess which occurred first. However, this work helps us to understand the biological relationship between sleep and metabolic disorders and to identify possible approaches to prevent metabolic disorders in women. As always, please consult your health care provider to tailor these findings individually.

All paper surveys and other forms you complete and return to the Sister Study are handled by this team. Your responses are securely processed into our system in preparation for their eventual analysis by our researchers. We are grateful for your diligence in completing your health update surveys! Those responses directly inform the research findings we share with you in this Facebook group. Thanks to what you share with us, researchers have published over 100 articles.

Please visit our website to view these articles:
Sister Study articles

Thanks to our Sister Study participants' continued dedication to the study, researchers are able to publish such important findings as the ones described in this news release. We encourage you to read about "if a woman's biologic age is older than her chronologic age, she has an increased risk of developing breast cancer."

Read more about it here:
Older biologic age linked to elevated breast cancer risk. exit disclaimer

Anti-Müllerian hormone (AMH), like estrogen, is a marker of ovarian function. Levels decrease as women approach menopause. AMH levels are thought to correspond with how many egg cells remain in the ovaries, so the measure has implications for fertility. Like estrogen, higher levels may be associated with breast cancer risk. But unlike estrogen, AMH has the advantage that levels do not change across the menstrual cycle, making it easier to use in research studies. Sister Study investigators measured AMH in blood samples collected at enrollment from a subgroup of participants who had not yet gone through menopause, and looked at how dietary factors might be related to levels. The results indicated that dietary fat intake may be associated with lower AMH, but that other factors, including protein and alcohol intake were not related to AMH levels. Please check with your health care provider about applying these results individually.

Read more about it here:
Dietary factors and serum Anti-Müllerian hormone concentrations in late premenopausal women. exit disclaimer

You may find this article on testing for BRCA1 and BRCA2 interesting and helpful. As always, please consult your health care provider to interpret and apply specifics to your own health.

Read more about it here: Taking the Uncertainty Out of Interpreting BRCA Variants. exit disclaimer

Fruits and vegetables contain nutrients called antioxidants, which may counteract cell damage caused by harmful substances. Green and black tea contain some types of antioxidants, but their specific health benefits are not fully understood. In a small study that included 889 Sister Study participants, we looked at whether consumption of black or green tea was associated with biologic measures of oxidative stress, a measure of the balance between the body's potentially harmful (oxidative) and potentially beneficial (antioxidant) chemicals. We found that while black tea may be associated with lower levels of oxidative stress, green tea was not. Related research is looking at whether tea consumption is related to breast cancer risk.

Read more about it here:
Tea consumption and oxidative stress: a cross-sectional analysis of 889 premenopausal women from the Sister Study. exit disclaimer

Did you know that the average age of women in the Sister Study is now 67 years of age? Our youngest Sister participant is just 44 years young and our "wisest" participant is going strong at 89!

Research has shown that engaging regularly in exercise reduces breast cancer risk generally, but it was not clear whether the benefit would also apply to women with a family history of breast cancer. Our research in the Sister Study, where all women have a family history of breast cancer, showed that being more physically active was associated with a reduction in postmenopausal breast cancer, but not premenopausal breast cancer. Please check with your health care provider about applying these results individually.

Read more about the research here:
Adult Physical Activity and Breast Cancer Risk in Women with a Family History of Breast Cancer. exit disclaimer

Heart disease is the leading cause of death for women in the United States. Over the years, we have asked you questions about your cardiovascular health and disease history. We are excited to let you know that we are working with cardiovascular disease experts to study environmental contributors to stroke, heart attack, and congestive heart failure. As part of that effort, in October we started requesting medical records to confirm diagnoses and obtain needed details about reported heart conditions such as results of tests performed and disease subtypes. Our goal is to identify preventable environmental causes of cardiovascular disease. We have reached out to some of you for more information about your health history. If you were contacted and returned your authorization forms, we thank you! But if you haven't yet done so we encourage you to sign and mail your forms soon. Thank you again for your contributions to the Sister Study. We couldn't do this research without your willingness to participate!

We would like to introduce you to Dr. Symielle Gaston, a post-doctoral research fellow working with the Sister Study. Dr. Gaston is interested in studying how the physical and social environments contribute to racial/ethnic and socioeconomic disparities in cardiovascular health. For instance, how living in neighborhoods with social and physical disorder may negatively affect cardiovascular health. She recently received a grant to support this research. In the Sister Study, she has several ongoing projects, including a study of the association between racial/ethnic discrimination and poor sleep, an understudied contributor to cardiovascular health and other health conditions.

Read more here:
Postdoc awards reflect strong research potential exit disclaimer

We would like to announce that Dr. Alexandra White joined the Sister Study as a Stadtman Tenure-Track Investigator. exit disclaimer Dr. White's research will focus on identifying environment and lifestyle risk factors for cancer and understanding the biologic mechanisms that allow cancer to develop. She has already worked for three years as a post-doctoral fellow on the Sister Study, publishing research on factors that may influence breast cancer risk, such as alcohol consumption, smoking, physical activity, and obesity. She is particularly excited to expand her research to examine the effects of exposure to toxic metals and air pollution on breast density and breast cancer risk.

In the first study to make use of the data from the "Sisters Changing Lives" sub-study, we measured the concentrations of 16 trace elements in each of two sets of toenail samples; the first collected at enrollment and the second in 2013-2014. We found that concentrations of most of the elements decreased over time, with the biggest decreases seen for lead, cadmium and chromium. This was true for women who were diagnosed with breast cancer between enrollment and 2013 and women who were not. This work was led by Drs. Katie O'Brien and Clarice Weinberg, both NIEHS investigators.

Read more about it here:
Do Post-breast Cancer Diagnosis Toenail Trace Element Concentrations Reflect Prediagnostic Concentrations? exit disclaimer


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