Cancer
Research overview
Cancer is complex and can be a devastating diagnosis for individuals and their families. Our researchers work to improve cancer control on many levels, from prevention and screening through treatment and survivorship.
Kaiser Permanente Washington Health Research Institute (KPWHRI) has been studying how to provide life-saving breast cancer screening since 1986. In a novel initiative, researchers used a computer-based registry and collaborations with organizations across the U.S. before electronic health records existed and multi-site studies were common. The program ultimately led to a rich portfolio of studies not only on breast cancer, but also on colorectal, blood, cervical, lung, and thyroid cancers.
“Decades later, Kaiser Permanente Washington is just as committed to developing and evaluating innovations in cancer care,” said Karen Wernli, PhD, KPWHRI senior investigator.
The core of KPWHRI cancer research lies in its participation in many collaborative networks and programs. “Collaboration increases the power of Kaiser Permanente studies and helps us learn from different populations and health care settings,” said Senior Investigator Jessica Chubak, PhD. Examples of these networks include:
Breast Cancer Surveillance Consortium (BCSC)
The BCSC identifies strategies that detect aggressive breast cancer early, minimize harms, and reach diverse communities. Results help policymakers and health systems improve breast cancer screening and surveillance outcomes. The Kaiser Permanente Washington Breast Imaging Registry contributes to this national effort and the BCSC Statistical Coordinating Center resides at KPWHRI.
Population-based Research to Optimize the Screening Process (PROSPR)
The PROSPR national consortium conducts research to improve screening for cervical, colorectal, and lung cancers. PROSPR results will help optimize and tailor screening for different subgroups of the population.
Kaiser Permanente Research Bank (KPRB) Cancer Cohort
The KPRB Cancer Cohort is a national resource for understanding genetic, lifestyle, and environmental factors that contribute to cancer etiology and survival. Electronic health record data, stored tissue specimens, detailed treatment data, and the ability to follow patients for recurrence and mortality are accelerating progress toward improved cancer care.
Some of the cancer research group’s current studies include:
- The STEP trial, a pragmatic trial testing different interventions to increase cervical cancer screening, including self-sampling kits available by mail
- The CAFÉ study, which is developing and testing ways to prevent and reduce cancer-related financial hardship
- The LARCH study, which is looking at multilevel interventions to increase adherence to lung cancer screening, including partnership with a patient advisory board
- The VOICE study, which is evaluating outcomes for adolescent and young adult cancer patients after cancer treatment, looking at impacts on fertility, survivorship care, and late effects of treatment
- Several BCSC studies, which are focused on identifying factors that drive inequities in breast imaging performance and outcomes, exploring how artificial intelligence can improve outcomes, developing equitable breast cancer risk models, and reducing surveillance imaging failures among women with breast cancer
- Several PROSPR studies, which are looking at ways to improve screening delivery and outcomes for cervical and colorectal cancer
- A cohort study with the University of Wisconsin, which is working to model thyroid cancer incidence and overdiagnosis and understand the role of health care utilization in these outcomes
Past findings include:
- A human-centered-design study in collaboration with Kaiser Permanente Northwest developed a model to help clinical teams talk to cancer patients about cost of care.
- The Systems of Support to Increase Colorectal Cancer Screening and Follow-Up (SOS) study found that mailing cancer screening kits to patients increased regular screening and was more efficient for clinic staff. The research led to implementation of a new program at Kaiser Permanente Washington to help find, treat, and prevent colon cancer.
- Several BCSC studies published new findings on breast cancer overdiagnosis, the benefits and harms of preoperative MRIs, and how best to predict risk of advanced breast cancer.
- Researchers looking at equity in breast cancer screening found that race, income, and education affect access to 3D mammography.
- The ENGAGED-2 study tested a web-based, patient-level intervention that prompted women who had an elevated 5-year breast cancer risk to engage in clinical discussions about chemoprevention.
- The Radiation-Induced Cancers (RIC) study quantified exposure to ionizing radiation in pregnancy over more than 20 years in the U.S. and Ontario, Canada.
- The STOP Colon Cancer in Priority Populations (STOP CRC) program worked with federally subsidized clinic systems caring for low-income and uninsured patients to design a colon cancer screening program that could decrease disparities in screening rates and cancer outcomes.
- A study with the PROSPR consortium found that harms of cancer screening are reported inconsistently across U.S. cancer screening guidelines, and highlighted opportunities to provide better evidence for analysis of harms and benefits to inform screening decisions.
- The PATH trial found that group-based acceptance and commitment therapy could be a viable alternative to standard care for helping people quit smoking.
Recent publications on Cancer
Buist DS, Field TS, Banegas MP, Clancy HA, Doria-Rose VP, Epstein MM, Greenlee RT, McDonald S, Nichols HB, Pawloski PA, Kushi LH. Training in the conduct of population-based multi-site and multi-disciplinary studies: the Cancer Research Network's scholars program. J Cancer Educ. 2017 Jun;32(2):283-292. doi: 10.1007/s13187-015-0925-x. PubMed
Green BB, Anderson ML, Chubak J, Fuller S, Meenan RT, Vernon SW. Impact of continued mailed fecal tests in the patient-centered medical home: year 3 of the systems of support to increase colon cancer screening and follow-up randomized trial. Cancer. 2016 Jan 15;122(2):312-21. doi: 10.1002/cncr.29734. Epub 2015 Oct 21. PubMed
Sampson JN, Wheeler WA, Yeager M, Panagiotou O, Wang Z, Berndt SI, Lan Q, Abnet CC, Amundadottir LT, Figueroa JD, Landi MT, Mirabello L, Savage SA, Taylor PR, De Vivo I, McGlynn KA, Purdue MP, Rajaraman P, Adami HO, Ahlbom A, Albanes D, Amary MF, An SJ, Andersson U, Andriole G Jr, Andrulis IL, Angelucci E, Ansell SM, Arici C, Armstrong BK, Arslan AA, Austin MA, Baris D, Barkauskas DA, Bassig BA, Becker N, Benavente Y, Benhamou S, Berg C, Van Den Berg D, Bernstein L, Bertrand KA, Birmann BM, Black A, Boeing H, Boffetta P, Boutron-Ruault MC, Bracci PM, Brinton L, Brooks-Wilson AR, Bueno-de-Mesquita HB, Burdett L, Buring J, Butler MA, Cai Q, Cancel-Tassin G, Canzian F, Carrato A, Carreon T, Carta A, Chan JK, Chang ET, Chang GC, Chang IS, Chang J, Chang-Claude J, Chen CJ, Chen CY, Chen C, Chen CH, Chen C, Chen H, Chen K, Chen KY, Chen KC, Chen Y, Chen YH, Chen YS, Chen YM, Chien LH, Chirlaque MD, Choi JE, Choi YY, Chow WH, Chung CC, Clavel J, Clavel-Chapelon F, Cocco P, Colt JS, Comperat E, Conde L, Connors JM, Conti D, Cortessis VK, Cotterchio M, Cozen W, Crouch S, Crous-Bou M, Cussenot O, Davis FG, Ding T, Diver WR, Dorronsoro M, Dossus L, Duell EJ, Ennas MG, Erickson RL, Feychting M, Flanagan AM, Foretova L, Fraumeni JF Jr, Freedman ND, Beane Freeman LE, Fuchs C, Gago-Dominguez M, Gallinger S, Gao YT, Gapstur SM, Garcia-Closas M, García-Closas R, Gascoyne RD, Gastier-Foster J, Gaudet MM, Gaziano JM, Giffen C, Giles GG, Giovannucci E, Glimelius B, Goggins M, Gokgoz N, Goldstein AM, Gorlick R, Gross M, Grubb R 3rd, Gu J, Guan P, Gunter M, Guo H, Habermann TM, Haiman CA, Halai D, Hallmans G, Hassan M, Hattinger C, He Q, He X, Helzlsouer K, Henderson B, Henriksson R, Hjalgrim H, Hoffman-Bolton J, Hohensee C, Holford TR, Holly EA, Hong YC, Hoover RN, Horn-Ross PL, Hosain GM, Hosgood HD 3rd, Hsiao CF, Hu N, Hu W, Hu Z, Huang MS, Huerta JM, Hung JY, Hutchinson A, Inskip PD, Jackson RD, Jacobs EJ, Jenab M, Jeon HS, Ji BT, Jin G, Jin L, Johansen C, Johnson A, Jung YJ, Kaaks R, Kamineni A, Kane E, Kang CH, Karagas MR, Kelly RS, Khaw KT, Kim C, Kim HN, Kim JH, Kim JS, Kim YH, Kim YT, Kim YC, Kitahara CM, Klein AP, Klein RJ, Kogevinas M, Kohno T, Kolonel LN, Kooperberg C, Kricker A, Krogh V, Kunitoh H, Kurtz RC, Kweon SS, LaCroix A, Lawrence C, Lecanda F, Lee VH, Li D, Li H, Li J, Li YJ, Li Y, Liao LM, Liebow M, Lightfoot T, Lim WY, Lin CC, Lin D, Lindstrom S, Linet MS, Link BK, Liu C, Liu J, Liu L, Ljungberg B, Lloreta J, Di Lollo S, Lu D, Lund E, Malats N, Mannisto S, Le Marchand L, Marina N, Masala G, Mastrangelo G, Matsuo K, Maynadie M, McKay J, McKean-Cowdin R, Melbye M, Melin BS, Michaud DS, Mitsudomi T, Monnereau A, Montalvan R, Moore LE, Mortensen LM, Nieters A, North KE, Novak AJ, Oberg AL, Offit K, Oh IJ, Olson SH, Palli D, Pao W, Park IK, Park JY, Park KH, Patiño-Garcia A, Pavanello S, Peeters PH, Perng RP, Peters U, Petersen GM, Picci P, Pike MC, Porru S, Prescott J, Prokunina-Olsson L, Qian B, Qiao YL, Rais M, Riboli E, Riby J, Risch HA, Rizzato C, Rodabough R, Roman E, Roupret M, Ruder AM, Sanjose Sd, Scelo G, Schned A, Schumacher F, Schwartz K, Schwenn M, Scotlandi K, Seow A, Serra C, Serra M, Sesso HD, Setiawan VW, Severi G, Severson RK, Shanafelt TD, Shen H, Shen W, Shin MH, Shiraishi K, Shu XO, Siddiq A, Sierrasesúmaga L, Sihoe AD, Skibola CF, Smith A, Smith MT, Southey MC, Spinelli JJ, Staines A, Stampfer M, Stern MC, Stevens VL, Stolzenberg-Solomon RS, Su J, Su WC, Sund M, Sung JS, Sung SW, Tan W, Tang W, Tardón A, Thomas D, Thompson CA, Tinker LF, Tirabosco R, Tjønneland A, Travis RC, Trichopoulos D, Tsai FY, Tsai YH, Tucker M, Turner J, Vajdic CM, Vermeulen RC, Villano DJ, Vineis P, Virtamo J, Visvanathan K, Wactawski-Wende J, Wang C, Wang CL, Wang JC, Wang J, Wei F, Weiderpass E, Weiner GJ, Weinstein S, Wentzensen N, White E, Witzig TE, Wolpin BM, Wong MP, Wu C, Wu G, Wu J, Wu T, Wu W, Wu X, Wu YL, Wunder JS, Xiang YB, Xu J, Xu P, Yang PC, Yang TY, Ye Y, Yin Z, Yokota J, Yoon HI, Yu CJ, Yu H, Yu K, Yuan JM, Zelenetz A, Zeleniuch-Jacquotte A, Zhang XC, Zhang Y, Zhao X, Zhao Z, Zheng H, Zheng T, Zheng W, Zhou B, Zhu M, Zucca M, Boca SM, Cerhan JR, Ferri GM, Hartge P, Hsiung CA, Magnani C, Miligi L, Morton LM, Smedby KE, Teras LR, Vijai J, Wang SS, Brennan P, Caporaso NE, Hunter DJ, Kraft P, Rothman N, Silverman DT, Slager SL, Chanock SJ, Chatterjee N. Analysis of heritability and shared heritability based on genome-wide association studies for thirteen cancer types. J Natl Cancer Inst. 2015 Oct 12;107(12):djv279. doi: 10.1093/jnci/djv279. Print 2015 Dec.
Gard CC, Aiello Bowles EJ, Miglioretti DL, Taplin SH, Rutter CM. Misclassification of Breast Imaging Reporting And Data System (BI-RADS) mammographic density and implications for breast density reporting legislation. Breast J. 2015 Sep-Oct;21(5):481-9. doi: 10.1111/tbj.12443. Epub 2015 Jul 1. PubMed
Jones SM, Rosenberg D, Ludman E, Arterburn D. Medical comorbidity and psychotropic medication fills in older adults with breast or prostate cancer. Support Care Cancer. 2015 Oct;23(10):3005-9. doi: 10.1007/s00520-015-2668-y. Epub 2015 Feb 27. PubMed
Researchers in Cancer
 Melissa L. Anderson, MSPrincipal Collaborative Biostatistician |
 Erin J. Bowles, MPHDirector, Collaborative Science |
 Jessica Chubak, PhDSenior Investigator |
 Yates Coley, PhDAssociate Biostatistics Investigator |
 Andrea J. Cook, PhDSenior Biostatistics Investigator |
 Marlaine Figueroa Gray, PhDAssistant Investigator |
 Beverly B. Green, MD, MPHSenior Investigator |
 Laura E. Ichikawa, MSPrincipal Collaborative Biostatistician |
 Jennifer B. McClure, PhDDirector, Investigative Science |
 Ellen O'Meara, PhDPrincipal Collaborative Scientist |
 Lorella Palazzo, PhDSenior Collaborative Scientist |
 Gaia Pocobelli, PhDSenior Collaborative Scientist |
 Rod L. Walker, MSPrincipal Collaborative Biostatistician |
 Robert D. Wellman, MSPrincipal Collaborative Biostatistician |
 Karen Wernli, PhDSenior Investigator |
 Onchee Yu, MSPrincipal Collaborative Biostatistician |
 Weiwei Zhu, MSSenior Collaborative Biostatistician |
 Yu-Ru Su, PhDAssociate Biostatistics Investigator |
 Brian D. Williamson, PhDAssistant Biostatistics Investigator |
 Noorie Hyun, PhDAssociate Biostatistics Investigator |
 Pamela A. Shaw, PhD, MSSenior Biostatistics Investigator |
 Nicole M. Gatto, PhD, MPHPrincipal Collaborative Scientist |
 Meagan C. Brown, PhD, MPHAssistant Investigator |
 Nora Henrikson, PhD, MPHAssociate Investigator |
 Lily N. Shapiro, PhDCollaborative Scientist |
Affiliate researchers
Wylie Burke, MD, PhD
University of Washington (UW) Department of Medical History and Ethics
Joann G. Elmore, MD, MPH
Harborview Medical Center; UW Department of Epidemiology
Larry Kessler, ScD
UW Department of Health Services
Constance D. Lehman, MD, PhD
Seattle Cancer Care Alliance; UW Department of Radiology
Kathy Leppig, MD
Kaiser Foundation Health Plan of Washington; UW Department of Pathology
Peggy L. Porter, MD
Fred Hutchinson Cancer Research Center (FHCRC); UW Department of Pathology
Emily White, PhD
FHCRC; UW Department of Epidemiology
Rachel Winer, PhD, MPH
Fred Hutchinson/UW Cancer Consortium; UW Department of Epidemiology
News
Increasing access to cervical cancer screening in low-resource health care settings
New study builds on findings that home tests improve screening rates.
News
Predicting breast cancer risk after a high-risk benign lesion diagnosis
New study will develop risk models to improve clinical guidelines and practice.
News
New study: Analysis supports new recommendation to begin mammogram screening at 40
KPWHRI part of multi-site research team.
Breast Cancer Surveillance
Kaiser Permanente Washington Breast Cancer Surveillance Registry
Kaiser Permanente Washington has been part of the national Breast Cancer Surveillance Consortium since 1994. Learn about the Kaiser Permanente Washington Breast Cancer Surveillance Registry here.
Research
Study sheds light on needs of young people with cancer
Understanding emergency department use among adolescent and young adult cancer survivors can help address care gaps.
Research
A simple solution to help catch cervical cancer early
Research finds that mailing HPV test kits directly to patients increases cervical cancer screening rates.
Research
Improving cancer prevention and early detection
How KPWHRI is contributing to better cancer screening and better outcomes for patients.
Research to practice
Helping more patients get screened for cervical cancer
Research on at-home testing for HPV could improve cancer prevention and ease screening for patients.
Healthy findings blog
Improving reporting of cancer screening harms
Aruna Kamineni, PhD, MPH, discusses her recent study on how guidelines report screening risks.
Research
Breast-biopsy delays after mammogram more likely for Black, Asian women
Study suggests disparities at screening sites may influence lag in follow-ups.
Research to practice
Making colon cancer screening easier for patients
KPWHRI’s Kilian Kimbel reflects on how the SOS study helped pave the way for a new program to find colon cancer early.
Research
Roundup of 3 recent studies on breast cancer screening
New research spotlights overdiagnosis, MRI before surgery, and a new way of predicting breast cancer risk
preventive care
Exploring at-home cervical cancer screening
Kaiser Permanente is at the forefront of research looking at using home tests for HPV, a leading cause of cervical cancer.
VOICE STUDY
Understanding young adults’ experiences with cancer
The VOICE study aims to improve the health and health care of people who had cancer as adolescents and young adults.
Healthy findings blog
Prioritizing breast screening during COVID-19
As cancer screening rates rebound, Erin Bowles, MPH, reflects on maintaining “pink ribbon” awareness year-round.
Cancer screening
Breast density is a risk factor for older women, too
Findings in JAMA Network Open could help guide decision-making about breast cancer screening for women 75 and older.
Co-designing with patients
Patient collaboration sparks care innovations
By partnering with patients, KPWHRI researchers developed 2 new interventions to boost lung cancer screening.
Land Acknowledgment
Our Seattle offices sit on the occupied land of the Duwamish and by the shared waters of the Coast Salish people, who have been here thousands of years and remain. Learn about practicing land acknowledgment.