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

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

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

Author(s): Cespedes Feliciano EM; Avrutin E; Caan BJ; Boroian A; Mourtzakis M

J Cachexia Sarcopenia Muscle. 2018 Jul 31.

Current Position(s):

Section Affiliations:

Primary Research Interests:

Studies

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

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

Post-diagnosis social networks and breast cancer mortality in the After Breast Cancer Pooling Project

Visceral adiposity and cancer survival: a review of imaging studies

Re: High- and low-fat dairy intake, recurrence, and mortality after breast cancer diagnosis. Response.

Fine-Mapping of Common Genetic Variants Associated with Colorectal Tumor Risk Identified Potential Functional Variants

Metabolic Dysfunction, Obesity, and Survival Among Patients With Early-Stage Colorectal Cancer

Post-diagnosis Weight Change and Survival Following a Diagnosis of Early Stage Breast Cancer

Exercise and Prognosis on the Basis of Clinicopathologic and Molecular Features in Early Stage Breast Cancer; The LACE and Pathways Studies

Vitamin D receptor gene polymorphisms, dietary promotion of insulin resistance, and colon and rectal cancer

PPARgamma, energy balance, and associations with colon and rectal cancer

Low-energy reporters: evaluation of potential differential reporting in case-control studies

Red wine consumption not associated with reduced risk of colorectal cancer

Dual energy X-ray absorptiometry spine scans to determine abdominal fat in postmenopausal women

Exercise and Risk of Cardiovascular Events in Women With Nonmetastatic Breast Cancer

Analysis of Body Mass Index and Mortality in Patients With Colorectal Cancer Using Causal Diagrams

Effect of Postdiagnosis Weight Change on Hot Flash Status Among Early-Stage Breast Cancer Survivors

Relationship of pre-diagnostic body mass index with survival after colorectal cancer: Stage-specific associations

The effect of patient and contextual characteristics on racial/ethnic disparity in breast cancer mortality

Association between dietary inflammatory potential and breast cancer incidence and death: Results from the Women's Health Initiative

Enhancing Breast Cancer Recurrence Algorithms Through Selective Use of Medical Record Data

Impact of very low physical activity, BMI, and comorbidities on mortality among breast cancer survivors

Validation of self-reported comorbidity status of breast cancer patients with medical records; the California Breast Cancer Survivorship Consortium (CBCSC)

CYP24A1 variant modifies the association between use of oestrogen plus progestogen therapy and colorectal cancer risk

RE; Body Mass Index, PAM50 Subtype, and Outcomes in Node-Positive Breast Cancer; CALGB 9741

​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.

Is heart rate variability associated with frequency and intensity of vasomotor symptoms among healthy perimenopausal and postmenopausal women?

A pooled analysis of post-diagnosis lifestyle factors in association with late estrogen-receptor positive breast cancer prognosis

Common Genetic Variation and Survival after Colorectal Cancer Diagnosis: A Genome-Wide Analysis

A Candidate-Pathway Approach to Identify Gene-Environment Interactions: Analyses of Colon Cancer Risk and Survival

Pooled Analysis of Six Pharmacologic and Nonpharmacologic Interventions for Vasomotor Symptoms

An evaluation and replication of miRNAs with disease stage and colorectal cancer-specific mortality

Overweight, Obesity, and Postmenopausal Invasive Breast Cancer Risk: A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trials

Mendelian randomization study of body mass index and colorectal cancer risk

Racial/Ethnic and Socioeconomic Differences in Short-Term Breast Cancer Survival Among Women in an Integrated Health System

Association of high obesity with PAM50 breast cancer intrinsic subtypes and gene expression

Longitudinal study of acculturation and BMI change among Asian American men

Association of aspirin and NSAID use with risk of colorectal cancer according to genetic variants

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.