I am a molecular epidemiologist with broad research interests in cancer control in human populations, from prevention to survival. The focus of my research is the intersection of molecular epidemiology and health disparities. Specifically, I am interested in examining genetic and molecular factors in female cancers that impact disease occurrence or prognosis in underserved populations. The ultimate goal of this work is to disseminate these findings so that interventions can be developed that will help us achieve health equity.
Over the last 17 years, I have built a national reputation as a leader in endometrial cancer disparities, by developing a multifaceted approach to untangling the contributions of the factors driving this disparity. My current R01 focuses on characterizing molecular differences in ~370 high grade endometrial tumors from black and white women that potentially affect survival. In addition to tumor biology contributing to survival disparities, I have attempted to better characterize the role of comorbidities and treatment in endometrial cancer survival. I use various epidemiologic approaches, from mining large federal databases (SEER-Medicare) to analyzing single institution data in order to address these questions. In short, our data suggest that even after adjusting for comorbid conditions, prognosis is worse for black women (Fucinari et al., Gyn Onc 2021). We have sought to determine if the risk factors (both genetic and behavioral) associated with endometrial cancer development differ by race, and it appears they do not, but these studies are severely limited by the sparse data available for black women. Given that black women are more likely to be diagnosed with aggressive endometrial tumors, and to die from their disease, this continues to be an area of high research interest.
My second area of expertise is in defining the role benign breast disease (BBD) has in the development of subsequent breast cancers. A previous breast biopsy is known to increase risk of breast cancer, and this variable is included in most clinical models used to estimate a woman’s individual risk of breast cancer. What is still unknown is whether more detailed pathological characterization can stratify different types of BBD into various levels of risk. This work has extended into examining gene expression profiles to determine whether certain markers can predict time to breast cancer, or the subtype of breast cancer. Sponsored by an Investigator Initiated Scientific Grant from Komen for the Cure, we identified 3,800 black women with a benign breast biopsy that was assessed by WSU pathologists from 1997-2010. All 3,800 of these cases were completely re-reviewed to assess 12 different pathological features, and were then followed through the Metropolitan Detroit Cancer Surveillance System to identify a subsequent breast cancer. We have identified 235 tumors thus far, and have leveraged institutional funding and subawards from collaborators at the Mayo Clinic (both Rochester and Jacksonville) to identify women with breast cancer and a prior benign biopsy through 2019. There are 3 other BBD institutional cohorts across the United States, but these are primarily comprised of white women, and are also decades older. As black women suffer from earlier onset, more aggressive breast cancers, and reproductive histories have changed drastically over the last several decades, it is imperative that we continue to develop contemporary, diverse cohorts.
As I look forward to my next decade of scientific research, I will continue to build upon my collaborations as I explore new avenues of study. Specific to the KTB, the integration of imaging and ‘omics will be enhanced as emerging technologies such as digital pathology become standardized. Continued follow up of current participants and expansion of the KTB into new, diverse populations is also key as demand for the resource will continue to grow. The KTB is a singular resource that can provide key information regarding the physiology and function of the normal breast throughout the life course, as well as the transition to invasive cancer.
Ph.D. - University of Michigan, Ann Arbor, MI 4/2004
M.P.H. - University of Alabama, Birmingham, AL 12/1996