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Pathways: A Study of Breast Cancer Survivorship

Questions that Pathways hopes to address include:

  • Should women with breast cancer eat a particular diet?
  • How much and what type of exercise is best?
  • Are there particular dietary supplements or herbal remedies that are recommended?
  • What role, if any, do friendships and social networks play in survivorship?

By collecting and analyzing data about a woman’s genetic background, tumor characteristics and lifestyle choices immediately after diagnosis, the study hopes to provide more objective information to help guide women as they make decisions following a breast cancer diagnosis. Pathways will also be studying various genetic factors and their role in treatment and survival and will look at whether certain molecular changes in the tumor may be markers for prognosis.


Pathways enrolled women 21 years and older with a first diagnosis of invasive breast cancer who are members of Kaiser Permanente of Northern California.  Women were recently diagnosed with breast cancer and were not previously diagnosed with invasive cancer. Women who participate in the study do not need to make any changes in their lifestyle or treatment.


Participation in the study involved a 4-hour in-person interview shortly after diagnosis, a blood draw, and a saliva sample. The interview was followed with questionnaires mailed about 6 months after diagnosis, and periodically thereafter. Participants also fill out a 3-day food diary on a periodic basis

Ancillary Studies

Two ancillary studies have been funded that build on the main Pathways study. Women who are enrolled in Pathways have an opportunity to participate in these studies if they fulfill the eligibility criteria.

Racial Disparities in the Initiation and Intensity of Adjuvant Therapy for Breast Cancer

This study will collect information to better understand the use of breast cancer treatment and any differences in treatment and survival amongst women of different racial and ethnic backgrounds. Funded by the U.S. Department of Defense, this study is part of a Breast Cancer Center of Excellence that is based at Columbia University.

Natural History and Cost Analysis of Lymphedema Secondary to Breast Cancer

This study will describe the natural history of lymphedema after breast cancer surgery, examine medical and behavioral risk factors of lymphedema, and estimate costs of treating lymphedema within Kaiser Permanente of Northern California. Funded by the American Cancer Society, it is coordinated at the Division of Research.

Physiology of Aging

This study will look at complex decision-making with regard to considering chemotherapy for all women with invasive breast cancer, in particular with a focus on older women. Age, other health issues, and clinical judgment fail to predict which older women will tolerate chemotherapy. This ancillary study will enroll all women 65 years and older from the Pathways Study to fill gaps in knowledge about chemotherapy in older women from interview and computerized records. An index of “physiological age,” defined as capacity to respond to stressors such as chemotherapy, will be developed and validated. Results will then be used to enhance a widely used web-based clinical decision tool. The coordinating site for this study is Lombardi Cancer Center at Georgetown University in Washington, D.C. Funding is provided by the National Cancer Institute.​

For more information about ancillary studies please click here.

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