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5 Questions for… Marilyn Kwan

Researcher seeks to understand how wellness factors affect survivorship in breast and bladder cancer patients.

Marilyn L. Kwan, PhD, researches recurrence, survival, and quality of life in breast and bladder cancer patients. Kwan’s important 2015 study found that women who breastfed were nearly 40 percent less likely to have a recurrence of breast cancer. She is principal investigator of the Be-Well Study, one of the largest and most comprehensive efforts to better understand bladder cancer and the impact of wellness and lifestyle factors on outcomes and survival.

Thinking back, is there a single moment that sparked your interest in your life’s work?

Left to right, Kwan with Cordelia, Ronin and husband Nader Shihabi in Puerto Vallarta, Mexico.

Like many others, I know people who have been affected by cancer, but that was not the sole reason why I decided to pursue cancer research. Having worked in bench laboratories since high school, I always had a strong interest in researching human health. My interest in epidemiology, population-based studies, and public health research was sparked by attending a seminar at UC San Francisco about a study conducted by the San Francisco Department of Public Health on hospital infections in cancer patients.

What do you hope to learn from the Be-Well study?

One of the most important questions we seek to answer is whether what you eat can reduce the risk of bladder cancer recurring or being detected at a more advanced stage. Vegetables such as broccoli, kale, and cauliflower contain high levels of isothiocyanates, phytochemicals that have cancer-preventing properties. We think these vegetables might improve the prognosis and survival of bladder cancer patients.

Your research has focused primarily on cancers of the breast and bladder. What should people know about screening for and survivorship of these cancers? 

Given high screening rates and advances in treatment, the prognosis and survival after a breast cancer diagnosis are very good, with an overall 5-year survival rate of 99 percent for localized disease. Kaiser Permanente recommends following the American Cancer Society’s screening recommendations for regular mammograms in women at normal risk. Regular manual breast self-exams are no longer recommended. Women at high risk because of family history need to begin screening earlier or more often, and should consult with their doctors.

Half of all bladder cancers are diagnosed before the tumor has spread beyond the layer of cells in which it developed, and the 5-year survival rate for these localized cancers is 96 percent. While there is currently no standard or routine screening test for bladder cancer, research into the potential use of urine or metabolic biomarkers is promising.

What are the future directions of your work?

I would like to design behavioral interventions to help survivors reduce their risk of long-term effects from treatment, such as heart- disease and bone-related conditions. I am also very excited to start doing supplemental studies to Be-Well, such as investigating how body composition might affect prognosis and survival in patients.

What do you like to do in your free time?

I enjoy spending time with my two kids Cordelia, 11, and Ronin, 9. We like to be outdoors riding bikes, taking walks, or playing basketball, or indoors baking, watching movies, and reading books. I am also an avid CrossFitter, a strength and conditioning program with a mix of aerobic exercise, calisthenics, and Olympic weightlifting. Last year I received my certification to be a CrossFit Level 1 trainer. Some day I hope to conduct lifestyle research involving CrossFit in cancer survivors.

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