The Pathways Study: A prospective study of breast cancer survivorship within Kaiser Permanente Northern California

Marilyn L. Kwan, Christine B. Ambrosone, Marion M. Lee, Janice Barlow, Sarah E. Krathwohl, Isaac Joshua Ergas, Christine H. Ashley, Julie R. Bittner, Jeanne Darbinian, Keren Stronach, Bette J. Caan, Warren Davis, Susan E. Kutner, Charles P. Quesenberry, Carol P. Somkin, Barbara Sternfeld, John K. Wiencke, Shichun Zheng, Lawrence H. Kushi

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


Objective: With 2.3 million breast cancer survivors in the US today, identification of modifiable factors associated with breast cancer recurrence and survival is increasingly important. Only recently new studies have been designed to examine the impact of lifestyle factors on prognosis, including Pathways, a prospective study of women with breast cancer in Kaiser Permanente Northern California (KPNC). Methods: Pathways aims to examine the effect on recurrence and survival of (1) lifestyle factors such as diet, physical activity, quality of life, and use of alternative therapies and (2) molecular factors such as genetic polymorphisms involved in metabolism of chemotherapeutic agents. Eligibility includes any woman diagnosed with invasive breast cancer within KPNC, no previous diagnosis of other invasive cancer, age 21 years or older, and ability to speak English, Spanish, Cantonese, or Mandarin. Newly diagnosed patients are identified daily from electronic pathology records and are enrolled within two months of diagnosis. An extensive baseline interview is conducted, blood and saliva samples are collected, and body measurements are taken. Women are followed for lifestyle updates, treatment, and outcomes by self-report and query of KPNC databases. Results: Recruitment began in 9 January, 2006, and as of 16 January, 2008, 1,539 women have been enrolled along with collection of 1,323 blood samples (86%) and 1,398 saliva samples (91%). Conclusions: The Pathways Study will become a rich resource to examine behavioral and molecular factors and breast cancer prognosis.

Original languageEnglish (US)
Pages (from-to)1065-1076
Number of pages12
JournalCancer Causes and Control
Issue number10
StatePublished - Dec 2008
Externally publishedYes


  • Breast cancer
  • Complementary and alternative therapy
  • Diet
  • Prognosis
  • Prospective cohort study
  • Quality of life

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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