Cancer Prevention in Adolescents, Colorectal Screening, Germ Cell Tumors
Our research focuses on three main areas: (1) adolescent behaviors that predispose to adult malignancy (e.g., diet, tobacco and alcohol consumption, and level of physical activity); (2) prevention policies for both primary and secondary cancer; and (3) treatment of germ cell tumors in pediatric patients. Three cohort studies serve as the basis for this research: Nurses' Health Study I (NHS I), Nurses' Health Study II (NHS II), and the Growing Up Today Study (GUTS).In analyzing tobacco use among the 16,600 children who participate in GUTS, we have focused on identifying factors that predispose children to progress through the stages of tobacco uptake: abstainer, contemplator, experimenter, occasional user, regular user, and addicted user. We found that increased risk of cigarette use was due to excessive weight concerns, willingness to use tobacco promotional items, use of cigars, and low self-esteem. Among women in the NHS I, we have investigated the relation between alcohol use during adolescence, diet during adolescence, and risk of breast cancer. Whereas no effect was demonstrable for alcohol use during adolescence, the null result may reflect only the low level of drinking among this generation of women. However, we found that increased consumption of potatoes, rice, and french fries during adolescence increased risk of breast cancer, as did increased consumption of fish. Refinement of this work is under way via a more extensive adolescent diet questionnaire sent to 60,000 participants of NHS II.We also have completed a cost-effectiveness model of 26 strategies for screening for colorectal cancer, which confirmed that an annual fecal occult blood test with a sigmoidoscopy every 5 years is both effective and cost-effective. Most other strategies recommended recently by a task force of the Agency for Health Care Policy and Research were actually more costly and less effective. The model allows clinicians to examine the tradeoffs between strategies and to tailor recommendations to the patient.In clinical care, Dr. Frazier is the national expert on germ cell tumors in pediatric patients and oversees the care of these patients referred to DFCI. In addition, she is cochair of two national protocols that opened in 1999 for the treatment of low-risk and high-risk pediatric germ cell tumors and chair of the COG Germ Cell subcommittee in COG Rare Tumors.