Bette J. Caan, DrPH

People

Kaiser Permanente Division of Research
2000 Broadway
Oakland, CA 94612

(510) 891-3719 (phone)
bette.caan@kp.org
Kaiser Permanente Researcher Profiles

Dr. Bette Caan is a senior research scientist and a nutritional epidemiologist at the Kaiser Permanente Northern California Division of Research. She has been at the Division of Research since 1983. Dr. Caan holds a master's degree in nutrition from Columbia University, a master's degree in epidemiology from the University of California, Berkeley, and a doctorate in public health nutrition from the University of California, Berkeley.

Dr. Caan is the Director of the Early Stage Investigator Training Program. She also directs a research program in the examination of modifiable lifestyle risk factors for the prevention and progression of cancer, with a focus on body composition and energy balance risk factors. Dr. Caan has expertise in the assessment of diet and body composition and the conduct of dietary intervention trials. She has authored or co-authored over 400 publications while a researcher at DOR. Her research publications cover a wide range of topics, primarily in nutrition and body size, cancer epidemiology, and women's health.

Dr. Caan is currently the Principal Investigator of several federally funded research projects including two large observational studies examining effects of body composition on breast and colorectal cancer outcomes; an intervention trial studying if strength training can reduce side effects of chemotherapy; and the LILAC Women's Health Initiative (WHI) Cancer Survivor Cohort, a cohort of 20,000 older women diagnosed with cancer during the WHI follow-up period currently being followed for recurrence and survival and survivorship outcomes. Dr. Caan has recently published several papers on the obesity paradox in cancer, advocating that body mass index (BMI) misclassifies patients with regard to adiposity; she is also in part responsible for identifying the obesity paradox. However, equally important in explaining the obesity paradox is that low muscle or sarcopenia is an important, underappreciated risk factor for poor survival, and that it is highly prevalent in normal-weight cancer patients.

Current Position(s):

Research Scientist III, Division of Research, Kaiser Permanente Northern California
Director, Early Stage Investigator Training Program

Section Affiliations:

Primary Research Interests:

Dietary risk and anthropometric risk factors for cancer survival
Dietary intervention trials
Dietary and body composition measurement and assessment
Women’s health

Studies

Cancer and Body Composition Webinar Series

This monthly webinar series, attended by approximately 200 people from diverse disciplines, is ongoing and focuses on topics relevant to body composition and cancer. The Division of Research will host 10 webinar speakers who are prominent in the field; archive recordings; and write a paper summarizing advances in the field.
Investigator: Caan, Bette
Funder: National Cancer Institute

Body Composition and the Obesity Paradox in Clear-Cell Renal Cell Carcinoma

Aim 1: Determine associations among body mass index (BMI), body composition variables, and tumor subtype. The amount and quality of muscle, visceral adipose tissue, and subcutaneous adipose tissue will be derived from existing pre-surgical CT scans; and ccA/ccB subtypes will be derived from archived tumor specimens using NanoString. Aim 2. Identify body composition variables independently associated with ccRCC prognosis after accounting for tumor subtype. Multivariable models adjusting for demographics, BMI, comorbidities, and known prognostic factors will estimate how body composition variables are associated with disease progression, cancer-specific, and overall survival and whether these associations are modified or mediated by tumor subtype. Aim 3. Identify novel pathways through which body composition may affect prognosis.
Investigator: Caan, Bette
Funder: National Cancer Institute

Circulating Biomarker Consortium for Pancreatic Early Detection

This is a retrospective case-control study to examine the timing and magnitude of loss of muscle and adiposity prior to diagnosis of pancreatic cancer.
Investigator: Caan, Bette
Funder: Dana Farber Cancer Institute

Resistance Training to Reduce Chemotoxicity in Colon Cancer

The goal of this study is to test a randomized intervention of up to six months of home-based resistance training and protein supplementation versus a waitlist control. The intervention will begin during the first month of chemotherapy and continue through completion of treatment. The study will examine differences in chemotherapy outcomes, including reductions in dosing, treatment delays, and early discontinuation of treatment; differences in total combined number of moderate and severe grade 3 and 4 toxicities; and pre and post intervention differences in the pharmacokinetics of FOLFOX (colon cancer chemotherapy regimen), changes in body composition, functional status, and strength. If improving muscle mass through resistance training leads to a reduced risk of chemotoxicities, CT scans routinely performed for clinical diagnosis could be used to identify high-risk patients who will benefit from tailored exercise guidelines.
Investigator: Caan, Bette
Funder: National Cancer Institute

WHI Cancer Survivor Cohort

The primary goal of this research project is to create an infrastructure within WHI to build a resource for the study of molecular epidemiology and cancer survivorship. Cancer survivors will be followed annually with surveys; tumor tissue will be acquired; and methodological studies will be established to develop electronic linkages with HMO and Medicare data for treatment and outcomes.
Investigator: Caan, Bette
Funder: National Cancer Institute

MsFLASH: Living a Healthy Menopause

The aims of this study are: 1) Conduct a 4-arm, double-blind, placebo-controlled randomized trial among postmenopausal women with vaginitis symptoms (moderate/severe vaginal dryness, burning, itching, pain or dyspareunia in the absence of infection) to compare the efficacy of: (a) the probiotic Lactin V, (b) ultra-low dose vaginal estrogen, (Vagifem 10 mcg), and (c) the combination of Lactin V + Vagifem to (d) matching placebos for relief of vaginitis symptoms after 8 weeks of treatment using the most bothersome symptom score as the primary trial outcome. 2) Using the cases recruited for the trial and a group of matched controls (women without symptoms of postmenopausal vaginitis), conduct a case-control study to determine whether patterns of vaginal bacterial colonization, such as pro-inflammatory anaerobic species, differ among women with and without symptoms of postmenopausal vaginitis.
Investigator: Caan, Bette
Funder: National Institute on Aging

Exploring the Role of Sarcopenia in Obesity and Breast Cancer Survival

The aim of this study is to gain a better understanding of the role of sarcopenia and body composition in the relationship between obesity and risk of breast cancer progression. We propose to use existing CT scans performed as a part of regular clinical care in this novel application to examine: 1) levels of fat and muscle mass among newly diagnosed breast cancer patients to determine prevalence of sarcopenia among underweight, normal weight, overweight, mildly obese and morbidly obese breast cancer survivors; 2) relationships between categories of fat mass and lean muscle mass at diagnosis (including sarcopenic obesity) and breast tumor characteristics predictive of risk of recurrence and death including disease stage, subtype (ER, PR, and Her2 Neu status), and proliferation markers, 3) relationships between body composition and chemotoxicity; and 4) associations between categories of fat mass and muscle mass and breast cancer-specific and overall mortality.
Investigator: Caan, Bette
Funder: National Cancer Institute

Highlighted Publications

No results found matching criteria

Publications

Prenatal Depression and Diet Quality During Pregnancy

Author(s): Avalos LA; Caan B; Nance N; Zhu Y; Li DK; Quesenberry C; Hyde RJ; Hedderson MM

J Acad Nutr Diet. 2020 Feb 08.

Current Position(s):

Section Affiliations:

Primary Research Interests:

Studies

Cancer and Body Composition Webinar Series

Body Composition and the Obesity Paradox in Clear-Cell Renal Cell Carcinoma

Circulating Biomarker Consortium for Pancreatic Early Detection

Resistance Training to Reduce Chemotoxicity in Colon Cancer

WHI Cancer Survivor Cohort

MsFLASH: Living a Healthy Menopause

Exploring the Role of Sarcopenia in Obesity and Breast Cancer Survival

Highlighted Publications

Publications

Prenatal Depression and Diet Quality During Pregnancy

Associations between nutritional factors and chemotherapy toxicity in older adults with solid tumors

Prediagnosis social support, social integration, living status, and colorectal cancer mortality in postmenopausal women from the women's health initiative

Lights on MsFLASH: a review of contributions

Sustained weight loss and risk of breast cancer in women ≥50 years: a pooled analysis of prospective data

Body Composition, Adherence to Anthracycline and Taxane-Based Chemotherapy, and Survival After Nonmetastatic Breast Cancer

It's Absolutely Relative: The Effect of Age on the BMI-Mortality Relationship in Postmenopausal Women

Guideline-concordant endometrial cancer treatment and survival in the Women's Health Initiative Life and Longevity After Cancer study

Post diagnosis loss of skeletal muscle, but not adipose tissue, is associated with shorter survival of patients with advanced pancreatic cancer

Statins as a free pass: Body mass index and other cardiovascular risk factors among lipid-lowering medication users and nonusers in the California Men's Health Study

Intentional weight loss, weight cycling, and endometrial cancer risk: a systematic review and meta-analysis

Adipose Tissue Distribution and Cardiovascular Disease Risk Among Breast Cancer Survivors

The Association of Abdominal Adiposity with Mortality in Patients with Stage I-III Colorectal Cancer

An Environmental Scan of Biopsychosocial and Clinical Variables in Cohort Studies of Cancer Survivors

The Effect of Reverse Causality and Selective Attrition on the Relationship Between Body Mass Index and Mortality in Postmenopausal Women

Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women

DNA repair and cancer in colon and rectum: novel players in genetic susceptibility

Body Composition and Cardiovascular Events in Patients With Colorectal Cancer: A Population-Based Retrospective Cohort Study

Muscle segmentation in axial computed tomography (CT) images at the lumbar (L3) and thoracic (T4) levels for body composition analysis

Facebook advertising for recruitment of midlife women with bothersome vaginal symptoms: A pilot study

Meta-analysis of 16 studies of the association of alcohol with colorectal cancer

Adipose Tissue Distribution and Survival Among Women with Nonmetastatic Breast Cancer

Sexual frequency and pain in a randomized clinical trial of vaginal estradiol tablets, moisturizer, and placebo in postmenopausal women

Bariatric Surgery is Associated With Reduced Risk of Breast Cancer in Both Premenopausal and Postmenopausal Women

Post-cancer diagnosis dietary inflammatory potential is associated with survival among women diagnosed with colorectal cancer in the Women's Health Initiative

The association of medical and demographic characteristics with sarcopenia and low muscle radiodensity in patients with nonmetastatic colorectal cancer

Genetic variant predictors of gene expression provide new insight into risk of colorectal cancer

Discovery of common and rare genetic risk variants for colorectal cancer

The evolution of body composition in oncology-epidemiology, clinical trials, and the future of patient care: facts and numbers

Mendelian randomization analysis of C-reactive protein on colorectal cancer risk

Non-alcoholic fatty liver disease and colorectal cancer survival

Diet-related inflammation and risk of prostate cancer in the California Men's Health Study

Differences in molecular features of triple-negative breast cancers based on the age at diagnosis

Screening for low muscularity in colorectal cancer patients: a valid, clinic-friendly approach that predicts mortality

Influence of smoking, body mass index and other factors on the preventive effect of nonsteroidal anti-inflammatory drugs on colorectal cancer risk

Novel Common Genetic Susceptibility Loci for Colorectal Cancer

Stratified probabilistic bias analysis for BMI-related exposure misclassification in postmenopausal women

Changes in Overall Diet Quality in Relation to Survival in Postmenopausal Women with Breast Cancer: Results from the Women's Health Initiative

Mendelian randomisation study of age at menarche and age at menopause and the risk of colorectal cancer

Muscle radiodensity and mortality in patients with colorectal cancer

The deterioration of muscle mass and radiodensity is prognostic of poor survival in stage I-III colorectal cancer: a population-based cohort study (C-SCANS)

The Obesity Paradox in Cancer: How Important Is Muscle?

A Mixed-Effects Model for Powerful Association Tests in Integrative Functional Genomics

Associations of pre-existing co-morbidities with skeletal muscle mass and radiodensity in patients with non-metastatic colorectal cancer

The Importance of Body Composition in Explaining the Overweight Paradox in Cancer-Counterpoint

The Plausibility of the Obesity Paradox in Cancer-Response-Reply to Point

Reparameterization of PAM50 expression identifies novel breast tumor dimensions and leads to discovery of a genomewide significant breast cancer locus at 12q15

Association of Muscle and Adiposity Measured by Computed Tomography With Survival in Patients With Nonmetastatic Breast Cancer

The combined association of modifiable risk factors with breast cancer risk in the Women's Health Initiative

Determining Risk of Colorectal Cancer and Starting Age of Screening Based on Lifestyle, Environmental, and Genetic Factors

The Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) Study: Description and Baseline Characteristics of Participants

Association between post-cancer diagnosis dietary inflammatory potential and mortality among invasive breast cancer survivors in the Women's Health Initiative

Cardiometabolic risk factors and survival after breast cancer in the Women's Health Initiative

Association Between Weight Loss and the Risk of Cancer after Bariatric Surgery

Multiple Gene-Environment Interactions on the Angiogenesis Gene-Pathway Impact Rectal Cancer Risk and Survival

Research priorities in cancer cachexia: The University of Rochester Cancer Center NCI Community Oncology Research Program Research Base Symposium on Cancer Cachexia and Sarcopenia

Bariatric Surgery and the Risk of Cancer in a Large Multisite Cohort

Use of iDXA spine scans to evaluate total and visceral abdominal fat

Muscle mass at the time of diagnosis of nonmetastatic colon cancer and early discontinuation of chemotherapy, delays, and dose reductions on adjuvant FOLFOX: The C-SCANS study

Methodological considerations for disentangling a risk factor's influence on disease incidence versus postdiagnosis survival: The example of obesity and breast and colorectal cancer mortality in the Women's Health Initiative

Association of Systemic Inflammation and Sarcopenia With Survival in Nonmetastatic Colorectal Cancer: Results From the C SCANS Study

Explaining the Obesity Paradox: The Association between Body Composition and Colorectal Cancer Survival (C-SCANS Study)

Effect of depression before breast cancer diagnosis on mortality among postmenopausal women

Body mass index, PAM50 subtype, recurrence and survival among patients with nonmetastatic breast cancer

Adiposity, post-diagnosis weight change, and risk of cardiovascular events among early-stage breast cancer survivors

Weight fluctuation and cancer risk in post-menopausal women: The Women's Health Initiative

Association of Weight Change after Colorectal Cancer Diagnosis and Outcomes in the Kaiser Permanente Northern California Population

The Comparative Effectiveness of Diabetes Prevention Strategies to Reduce Postpartum Weight Retention in Women With Gestational Diabetes Mellitus; The Gestational Diabetes' Effects on Moms (GEM) Cluster Randomized Controlled Trial.