The School of Public Health (SPH) recently marked its 50th year at the the University of Washington, and in celebration has named “50 Changemakers of Public Health,” a distinction bestowed upon 50 SPH alumni whose work has left an indelible mark on the field. The SPH notes that these alumni represent “leaders, trailblazers, educators, innovators, influencers, and health equity heroes that represent just a slice of the School’s community of more than 10,000 alumni worldwide who are addressing some of the most pressing population health issues of our time.”
Among the alumni named was Dr. Garnet Anderson, principal investigator of the WHI Clinical Coordinating Center and Senior Vice President and Division Director of Public Health Sciences at the Fred Hutchinson Cancer Research Center in Seattle, Washington. Dr. Anderson graduated from the SPH in 1989 with a Ph.D. in biostatistics, and has served in the leadership of the landmark WHI study since 1994. In naming Dr. Anderson, the SPH specifically cites her co-leadership of the initiative’s trial of estrogen and progestin therapy, along with the development of WHI’s vast epidemiological data resources and biorepository, which continue to aid researchers in conducting studies into chronic disease risk factors and prevention.
Age-related physiologic and social changes to eating has been shown to affect diet and nutrition-related diseases, but it is not known whether these changes also affect physical function. A team of WHI researchers led by Dr. Marian Neuhouser examined the relationship of eating barriers on physical function in a subset of 5,910 WHI participants. Eating barriers were both psychosocial-related (i.e., eating alone, poor eating frequency, or financial burdens to obtaining food) and physical (i.e., dentition problems or physical difficulties with cooking or shopping) and were collected by a questionnaire developed by the Nutrition and Energy Balance Scientific Interest Group. Physical function was collected during an in-person clinic visit and included grip strength and components of the Short Physical Performance Battery – a balance test, timed walking speed, and a chair stand test.
Their results showed that all the barriers to eating, with the exception of eating alone, were associated with lower physical functioning. Furthermore, as the number of eating barriers a participant had increased, her level of physical functioning decreased. Since poor physical function is highly predictive of future health events and mortality, these findings emphasize the importance of addressing health and nutrition concerns related to eating and physical functioning in older women.
These findings were published in Preventative Medicine in October 2020.
Updated WHI Investigator Datasets are now available! The data release includes Outcomes and Extension Study follow-up data through February 28, 2020, as well as updated Specimen Results datasets. Additionally, Form 159 data is now available, including a repeat of the sleep disturbance construct, new variables related to symptoms, medications for hypertension and cholesterol, current weight, and age-related macular degeneration.
Dr. Garnet Anderson, principal investigator of the WHI Clinical Coordinating Center and Senior Vice President and Division Director of Public Health Sciences at the Fred Hutchinson Cancer Research Center in Seattle, Washington, was named as a 2020 Fellow of the American Statistical Association (ASA). Fellowship with the ASA is bestowed only upon a very small percentage of the ASA membership on the basis of the candidate’s established reputation and ongoing outstanding contributions to statistical science.
A recent analysis led by Dr. Victor Eng examined nearly 90,000 WHI Observational Study participants to determine the association between smoking history and cancer screening use. Among the women in the study, 53% never smoked, 41% were former smokers, and 6% were current smokers. They discovered that over a mean 8.8 years of follow-up, active smokers were less likely to have obtained a breast, cervical, and colorectal cancer screening relative to women who never smoked. As a consequence of having lower cancer screening usage, women who were active smokers were diagnosed with a higher stages for breast and colorectal cancers. Women who were former smokers were found to have higher usage of breast and cervical cancer screening services compared to those who never smoked. The authors recommend that clinicians emphasize both the use of cancer screening services and smoking cessation for this high-risk group.
This manuscript was published in BMJ Open in August 2020.
WHI researcher, Dr. Marian Neuhouser, has been appointed to the Food and Nutrition Board. The Food and Nutrition Board was established in 1940 within the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine. It researches issues related to the U.S. food supply, aids in the development of healthy nutrition guidelines, and evaluates the relationships between consumption, nutrition, and health maintenance and disease prevention. Dr. Neuhouser’s appointment is for a 3-year term, beginning July 1, 2020.
For women aged 65 and older, the US Preventive Services Task Force recommends a bone mineral density, or BMD, measurement to screen for osteoporosis. For younger women, a BMD measurement is recommended for those at higher risk for osteoporosis. There are however no recommendations about the frequency of BMD testing owing to lack of research.
To address this, a team of WHI investigators led by Carolyn Crandall examined the added contribution of repeating a BMD test 3-years after a baseline BMD measurement was collected. In their analysis of nearly 7,500 WHI participants, they found that a follow-up BMD measurement did not improve fracture risk discrimination beyond the baseline BMD assessment. Recognizing that BMD scans uses resources, they concluded that follow-up BMD testing should not be routinely performed in postmenopausal women.
Dr. Crandall’s manuscript was published in JAMA Internal Medicine in July 2020.
Earlier findings published by WHI investigators identified an increased risk of developing breast cancer among clinical trial participants without prior hysterectomy who had received treatment with combination estrogen-plus-progestin hormone replacement therapy over a median of 5.6 years. Conversely, trial participants with prior hysterectomy who underwent estrogen-only therapy for a median of 7.2 years experienced a reduced risk for developing breast cancer. Prior analyses, conducted in 2013 and 2015, noted that these effects endured over a median cumulative follow-up period of 13 years for both therapies.
A recent follow-up analysis, led by WHI investigator Rowan Chlebowski, found that after more than 20 years of median follow-up, the protective effects of estrogen-alone therapy continued to endure, as did the increased risks for developing breast cancer attributed to estrogen-plus-progestin therapy. Despite many years having passed since withdrawal of hormone treatment, the investigators attributed the lasting impacts of each therapy to altered cellular processes in breast tissue affecting cell death (apoptosis). While estrogen-alone therapy is presently not indicated as a prophylaxis for breast cancer due to prior findings suggesting increased risk of stroke and potential influences on hormone-targeted drugs, the authors indicate that other factors may be involved and recommend further work in this arena.
Decisions pertaining to the use and selection of hormone-replacement therapy should be undertaken in partnership with a qualified medical professional and should take into account the numerous personal and health history factors that may influence the benefit/risk calculation of utilizing a particular treatment course.
These findings were published in JAMA in July 2020.
In early July 2020, the National Institute on Aging announced findings linking vision impairment to enhanced risk of developing dementia or mild cognitive impairment (MCI). The study enlisted the participation and study data from 1,061 participants enrolled in the WHI Sight Examination and WHI Memory Study cohorts, and was conducted over the course of the past 20 years.
The study found that risk of cognitive impairment could be correlated with worsening of visual impairment, with the highest risk found among women whose (n = 183) objectively measured vision acuity threshold was 20/100 or worse, followed by 20/80 or worse, then 20/40 or worse. The study also included 206 women who self-reported visual impairment, but it was found that self-reported impairment was not associated with an increased risk for dementia. The investigators note that further research is necessary to identify how specific ophthalmic interventions may influence risk for developing dementia or MCI.
These findings were published in JAMA Ophthalmology in April 2020.
COVID-19 presents an evolving world-wide health and economic crisis. Many WHI participants are in a high-risk group for experiencing the serious health consequences of this novel coronavirus pandemic if infected. In keeping with the WHI mission to address the major health concerns of older women, the WHI Steering Committee determined that it is critical to assess the impact of this pandemic in the WHI population. Information from these well-characterized older women could significantly add to the science broadly on the epidemiology of the SARS-CoV-2 infection and adverse outcomes, knowledge and practice of preventive measures, and the impact of social distancing on quality of life. Recognizing that this is a fast moving and complex situation, the WHI Steering Committee approved the development and implementation of a survey instrument to be administered online for WHI participants with email access, and mailed surveys otherwise, augmented with telephone-based interviews for a selected subset of participants, in the June-August 2020. The survey is meant to stimulate rapid reports on the impact of SARS-CoV-2 and support new ancillary studies within our cohort of women currently 70 years and older. The RFPs for manuscript proposals or ancillary studies for COVID-19 related research provide additional details. Investigators with interest in these data who missed the June 24 deadline for manuscript proposals may consider applying for access through the usual P&P approval process. Finally, the WHI will be sponsoring a Scientific Interest Group (SIG), open to all interested researchers, that will seek to catalyze discussion and formation of new study and paper proposals around COVID-19-related research topics.
Dr. Wactawski-Wende is the PI of one of the original 16 vangard WHI clinics since 1993.
“Dr. Wactawski-Wende has made seminal contributions that have significantly impacted health care practice and disease prevention for women in the U.S. and around the world,” University of Buffalo President Satish K. Tripathi
An article summarizing this recently published paper by Kerryn W. Reding PhD, MPH, RN et al. appeared in OncologyNurseAdvisor.com
The Steering Committee has decided to postpone the May 6-7 meeting because of uncertainties regarding the COVID-19 outbreak. In lieu of an in-person meeting, there will be a series of webinars offered, which will include updates on some of the major WHI-affiliated studies. This series begins Monday, April 27th. Please see below for a complete schedule of presentations and speakers. If you have questions, please contact Ellen Kim at the Clinical Coordinating Center.
For those unable to attend, it is expected that videos of the presentations will be posted to the website.
All times Pacific Daylight Time
Please click here to read the selected poster abstracts.
The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services.
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