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 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 450 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

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

Adaptive Randomization of Aerobic Exercise During Chemotherapy in Colon Cancer

This Bayesian, two-stage, response-adaptive, dose-ranging trial of aerobic exercise during chemotherapy will include 219 stage II-III colon cancer survivors recruited from three diverse racial, and geographic regions (Baton Rouge, LA; Boston, MA; Oakland, CA). In stage 1 of the study, patients are randomized equally to 1 of 5 groups: attention control (stretching) or one of four doses of moderate-intensity aerobic exercise at 75 min/wk, 150 min/wk, 225 min/wk, or 300 min/wk. In stage 2 of the study (starting after 33% of subjects are enrolled), randomization probabilities will be optimized, contingent upon stage 1 efficacy (measured by chemotherapy toxicities and relative dose intensity) and feasibility (measured by exercise adherence) using a longitudinal model to maximize the use of incomplete data, predictive probabilities to guide decisions, and a dose-response model to borrow information across adjacent doses.
Investigator: Caan, Bette
Funder: National Cancer Institute

Association between pre-diagnosis hepatic fat infiltration and risk of liver metastasis and mortality in a large cohort of stage I-III colorectal cancer survivors

The first aims of this study are to radiologically confirm and classify liver metastasis according to size, location and number using CT scans obtained post-diagnosis during follow-up and to confirm and identify previously undetected NAFLD/NASH cases and assess degree of hepatic fat infiltration using CT-scans obtained at the time of diagnosis/ cancer workup. We will then assess whether independent of body fatness and prognostic factors pre-existing NAFLD and NASH is associated with higher risk of liver metastasis and CRC mortality and associations are stronger among NAFLD patients with higher degree of hepatic fat infiltration. We will also assess whether observed associations are modified by co-morbidities related to dysregulated insulin and lipid metabolism (e.g., history of diabetes, cardiovascular disease, visceral obesity, sarcopenia).
Investigator: Caan, Bette
Funder: National Cancer Institute

Characterizing the Risk of Chemotherapy Side Effects Based on Epigenetic Age and Modification by Resistance Training Intervention

This study is investigating whether an individual's epigenetic age — a molecular marker of biological age — at the start of chemotherapy is associated with chemotoxicity in patients receiving treatment for colon cancer and whether resistance training during chemotherapy attenuates that association. We will also investigate if chemotherapy changes these patients' epigenetic age and whether resistance training attenuates those changes.
Investigator: Caan, Bette
Funder: National Cancer Institute

Ms. LILAC: Muscle Mass in the Life and Longevity After Cancer (LILAC) Study

In WHI, we use the LILAC study and the Long Life Study 2 to collect D-3 creatine to measure muscle mass in older women who are cancer survivors and a matched control group of older women who have not had cancer. Specifically, we will develop age-standardized percentile curves to characterize the distribution of D-3 muscle mass in the cancer survivor and control groups; examine whether the relationship between muscle mass, physical function, and functional decline differs in cancer survivors and controls by assessing the cross-sectional relationship between muscle mass and physical function; the longitudinal relationship between muscle mass and functional decline; and use machine learning methods to create multivariate risk-prediction algorithms to detect low muscle mass in the cancer survivor and control groups.
Investigator: Caan, Bette
Funder: National Cancer Institute

CANcer Cachexia Action Network/CANCAN

This study will include 1500 patients with advanced lung, pancreatic, or colorectal cancer at high risk of cachexia for detailed measurement via biospecimen collection, remote monitoring, questionnaire, and medical record review. The aims are to: identify distinct cachexia subtypes with data-driven clustering; operationalize cachexia subtype definitions, understand their severity, and examine how each subtype is associated with time to death, functional decline, and/or treatment tolerance.; inform treatment decisions for patients likely to progress to cachexia; and validate mechanistic hypotheses and biomarkers developed in related CanCan Projects.
Investigator: Caan, Bette
Funder: Cancer Research UK

Characterizing Colon Cancer Chemotoxicity Risk based on Epigenetic Age and Modification by Resistance Training Intervention

This study will investigate whether epigenetic aging — a molecular marker of biological age — at the start of chemotherapy is associated with chemotoxicity in patients receiving treatment for colon cancer. We will also look at whether chemotherapy treatment is associated with changes in epigenetic age, and the impact that resistance training during chemotherapy treatment has on these associations.
Investigator: Caan, Bette
Funder: National Cancer Institute

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

Association of serum folate levels during pregnancy and prenatal depression

Author(s): Avalos, Lyndsay A; Nance, Nerissa; Caan, Bette; Sujan, Ayesha C; Uriu-Adams, Janet Y; Li, De-Kun; Quesenberry, Charles P; Hedderson, Monique M

J Matern Fetal Neonatal Med. 2023 Dec;36(1):1-4. Epub 2022-11-17.

Current Position(s):

Section Affiliations:

Primary Research Interests:

Studies

Adaptive Randomization of Aerobic Exercise During Chemotherapy in Colon Cancer

Association between pre-diagnosis hepatic fat infiltration and risk of liver metastasis and mortality in a large cohort of stage I-III colorectal cancer survivors

Characterizing the Risk of Chemotherapy Side Effects Based on Epigenetic Age and Modification by Resistance Training Intervention

Ms. LILAC: Muscle Mass in the Life and Longevity After Cancer (LILAC) Study

CANcer Cachexia Action Network/CANCAN

Characterizing Colon Cancer Chemotoxicity Risk based on Epigenetic Age and Modification by Resistance Training Intervention

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

Association of serum folate levels during pregnancy and prenatal depression

Cachexia: A systemic consequence of progressive, unresolved disease

Association of Inflammatory Biomarkers With Survival Among Patients With Stage III Colon Cancer

Long-term Trajectories of Physical Function Decline in Women With and Without Cancer

Association between dietary inflammatory potential and mortality after cancer diagnosis in the Women's Health Initiative

Metabolic abnormalities and survival among patients with non-metastatic breast cancer

Body composition from single versus multi-slice abdominal computed tomography: Concordance and associations with colorectal cancer survival

Adipose tissue radiodensity and mortality among patients with nonmetastatic breast cancer

Adiposity and cancer survival: a systematic review and meta-analysis

The association of abdominal adiposity with premature discontinuation of postoperative chemotherapy in colon cancer

Effect of Lifestyle Coaching or Enhanced Pharmacotherapy on Blood Pressure Control Among Black Adults With Persistent Uncontrolled Hypertension: A Cluster Randomized Clinical Trial

American Cancer Society nutrition and physical activity guideline for cancer survivors

MRI based validation of abdominal adipose tissue measurements from DXA in postmenopausal women

Lifestyle and Cardiovascular Risk Factors Associated With Heart Failure Subtypes in Postmenopausal Breast Cancer Survivors

Effect of Exercise on Sarcopenia among Cancer Survivors: A Systematic Review

Scaling of computed tomography body composition to height: relevance of height-normalized indices in patients with colorectal cancer

Individual- and neighborhood-level socioeconomic status and risk of aggressive breast cancer subtypes in a pooled cohort of women from Kaiser Permanente Northern California

Abdominal adipose tissue radiodensity is associated with survival after colorectal cancer

Dietary Advanced Glycation End-Products (AGEs) and Mortality After Breast Cancer in the Women's Health Initiative (WHI)

Association of germline genetic variants with breast cancer-specific survival in patient subgroups defined by clinic-pathological variables related to tumor biology and type of systemic treatment

Low-fat dietary pattern and breast cancer mortality by metabolic syndrome components: a secondary analysis of the Women's Health Initiative (WHI) randomised trial

Genetic architectures of proximal and distal colorectal cancer are partly distinct

Sarcopenia in the Older Adult With Cancer

Weight stability masks changes in body composition in colorectal cancer: a retrospective cohort study

Alignment of dietary patterns with the Dietary Guidelines for Americans 2015-2020 and risk of all-cause and cause-specific mortality in the Women's Health Initiative Observational Study

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

Authors Response

Recruitment strategies and design considerations in a trial of resistance training to prevent dose-limiting toxicities in colon cancer patients undergoing chemotherapy

Re. "Association between low muscle mass and survival in incurable cancer patients: A systematic review"

The Role of Home-Based Exercise in Maintaining Skeletal Muscle During Preoperative Pancreatic Cancer Treatment

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

Evaluation of automated computed tomography segmentation to assess body composition and mortality associations in cancer patients

Deep learning method for localization and segmentation of abdominal CT

Association of Low Muscle Mass and Low Muscle Radiodensity With Morbidity and Mortality for Colon Cancer Surgery

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

Dietary Intakes of Women's Health Initiative Long Life Study Participants Falls Short of the Dietary Reference Intakes

Myocardial infarction accelerates breast cancer via innate immune reprogramming

Association of Prediagnostic Frailty, Change in Frailty Status, and Mortality After Cancer Diagnosis in the Women's Health Initiative

American Cancer Society guideline for diet and physical activity for cancer prevention

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

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

Lights on MsFLASH: a review of contributions

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

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

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

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

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

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

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

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

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

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

Adipose Tissue Distribution and Cardiovascular Disease Risk Among Breast Cancer Survivors

Pre-Diagnosis Exercise and Cardiovascular Events in Primary Breast Cancer: Women's Health Initiative

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

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

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