Johns Hopkins University Baltimore, Maryland
Professor of Epidemiology and Oncology Johns Hopkins Bloomberg School of Public Health Sidney Kimmel Comprehensive Cancer Center
Examining the factors associated with racial and ethnic disparities in the mortality rates for patients with second breast cancers.
While deaths from breast cancer have decreased significantly, the number of new diagnoses made each year has not. Even if women have been successfully treated for their cancer, their cancer may return or another (breast or non-breast) primary cancer may develop, sometimes long after their initial diagnosis. According to a national SEER (Surveillance, Epidemiology, and End Results) database, the cumulative incidence of developing any second cancer among breast cancer patients is between 15-20 percent at 25 years, including a seven percent incidence of developing a new primary breast cancer. In addition, the National Cancer institute has identified second cancers as an underexplored area of research. Dr. Visvanathan has examined the incidence and impact of second cancers in patients initially diagnosed with breast cancer. In the first of its kind, large population-based study, Dr. Visvanathan examined the mortality differences in breast cancer survivors with a second primary cancer (other than breast cancer) compared to those breast cancer survivors with no second cancer. Her results suggest that prior breast cancer history significantly impacts cancer prognosis in women diagnosed with a second cancer—these patients had a 30 percent increase in mortality compared to women who have a single primary cancer. Dr. Visvanathan will build of these findings and focus on mortality rates associated with the incidence of second breast cancers specifically. She will also utilize her significant expertise in disparities research to focus on those factors that influence mortality rates across racial and ethnic lines. She hopes to address critical gaps in our current knowledge, inform clinical practice, and develop more targeted interventions to address disparities and reduce mortality from second breast cancers for all patients.
Through her large population-based study, Dr. Visvanathan demonstrated that the mortality rate was 82 percent higher with a second breast cancer compared to the first. Moreoever, mortality from second breast cancers is higher among Black and Hispanic women compared to non-Hispanic white women. For second breast cancers, the complexity of making treatment decisions may be multi-factorial due to: possible adverse effects from prior treatments; standard treatment regimens may be too harsh the second time around; non-adherence to oral cancer or cardiac medications may impact survival; financial toxicity may be too great; or comorbidities may be worsened by age or prior treatments. Dr. Visvanathan is investigating these factors as well as those related to racial/ethnic differences that can explain the greater negative impact a second breast cancer has on Black and Hispanic women. She hopes that these studies will help identify key contributors to the racial/ethnic disparities observed in second breast cancer mortality and ultimately provide interventions to improve patient outcomes.
Kala Visvanathan is a Professor in the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health and the Department of Medical Oncology at Johns Hopkins School of Medicine. Dr. Visvanathan is Director the Clinical Cancer Genetics and Prevention Service and the Cancer Epidemiology Track at Johns Hopkins.
She received her medical degree from the University of Sydney in Australia. She subsequently went on to complete her training in Internal Medicine and Medical Oncology at Royal Prince Alfred Hospital, an academic teaching hospital of the University of Sydney in Australia and at the Sidney Kimmel Comprehensive Cancer Center Johns Hopkins School of Mediine. Dr. Visvanathan also completed training in clinical/cancer epidemiology at the Johns Hopkins Bloomberg School of Public Health.
Her research is focused on primary and secondary prevention of breast and ovarian cancer. Trained as a medical oncologist and cancer epidemiologist, a large part of her research is transdisciplinary and focused on translating results from the laboratory to populations, to identify at risk groups, preventable targets and to evaluate agents that have the potential to impact the natural history of breast and ovarian cancer. She conducts both observational studies and clinical prevention/early detection studies Specific exposures of interest include hormonal exposures, inflammation, genetic and epigenetic changes, DNA damage/repair, obesity and oxidative damage. She has recently co-chaired the American Society of Clinical Oncology national guideline on breast cancer risk reduction.
2004
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