Lawrence H. Kushi, ScD

People

Kaiser Permanente Division of Research
2000 Broadway
Oakland, CA 94612

(510) 891-3837 (phone)
larry.kushi@kp.org
Kaiser Permanente Researcher Profiles

Lawrence H. Kushi, ScD, is Director of Scientific Policy at the Kaiser Permanente Northern California Division of Research. Prior to joining the Division of Research, Dr. Kushi was at Columbia University, where he held the Ella McCollum Vahlteich Chair in Human Nutrition in the Department of Health and Behavior Studies, Teachers College; and he was a member of the Herbert Irving Comprehensive Cancer Center at Columbia-Presbyterian Medical Center. Dr. Kushi is internationally recognized for his expertise in nutritional epidemiology, and his research interests focus on the role of diet and nutrition in the etiology of coronary artery disease and breast and other cancers. He serves on a grant review committee for the American Cancer Society and has served on various American Cancer Society committees to develop guidelines for the dietary prevention and management of cancer. Dr. Kushi has also served on review committees for the Epidemiology and Disease Control Study Section of the National Institutes of Health, and the Integration Panel of the Breast Cancer Research Program of the US Army Medical Research and Materiel Command. He was formerly the chair of the Food and Nutrition Section of the American Public Health Association; on the executive committee of the American Society of Preventive Oncology; and has worked at the Fred Hutchinson Cancer Research Center and the University of Minnesota School of Public Health. Dr. Kushi graduated from Amherst College and the Harvard School of Public Health.

Current Position(s):

Research Scientist III, Division of Research, Kaiser Permanente Northern California
Director of Scientific Policy, Division of Research, Kaiser Permanente, Northern California
Adjunct Professor of Nutrition, Teachers College, Columbia University, New York, NY

Section Affiliations:

Cancer

Primary Research Interests:

Nutritional epidemiology
Diet and nutrition in the etiology of coronary artery disease
Diet and nutrition in the etiology and prognosis of breast and other cancers

Related Website(s):

Studies

Influence of Comorbidities and Inflammatory Biomarkers in Disparities in Ovarian Cancer Treatment, Treatment Response, and Survival

This project examines racial and ethnic disparities in ovarian cancer patients diagnosed and treated in KPNC from 2000 to 2023. It is an ancillary study to an NCI-funded research project (R01 CA243188) led by MPIs Kushi, Doherty (University of Utah), Bandera (Rutgers University), and Gomez (UCSF). This is the largest multiethnic cohort of ovarian cancer survival to date to examine clinical and medical care; neighborhood and geospatial factors; reclassification of subtypes with updated information; and, in a subset of cases, tumor characteristics. This ancillary study extends this project with collection of pre-diagnostic information to explore the role of comorbid conditions. It also supports additional tumor assays examining inflammation markers in contributing to disparities in ovarian cancer outcomes.
Investigator: Kushi, Lawrence
Funder: The V Foundation for Cancer Research

Racial/Ethnic Disparities in Ovarian Cancer Treatment and Survival: An Integrative Approach

We reported previously that African American and Hispanic women have worse survival after ovarian cancer diagnosis than white women, and Asian women have similar survival. We will investigate reasons for these disparities, focusing on tumor subtypes, health care, and neighborhood-level factors.
Investigator: Kushi, Lawrence
Funder: National Cancer Institute

Breast White Adipose Tissue Inflammation and Breast Cancer Outcomes

We will assess the incidence and severity of breast white adipose tissue (B-WAT) inflammation in mastectomy specimens from approximately 1,900 Pathways Study participants to examine associations of various factors with B-WAT inflammation incidence and severity at the time of breast cancer surgery, and to examine whether B-WAT inflammation impacts breast cancer recurrence, second primary breast cancer, and breast cancer progression-free survival. We will also investigate the associations of inflammatory blood biomarkers, body composition, and lifestyle factors such as diet and physical activity with B-WAT inflammation and severity. This collaborative project includes investigators at the Fred Hutchinson Cancer Research Center, Memorial Sloan Kettering Cancer Center, Roswell Park Comprehensive Cancer Center, and Weill Cornell Medical College, where Dr. Andrew Dannenberg, who co-leads this project, is located.
Investigator: Kushi, Lawrence
Funder: National Cancer Institute

Kaiser Permanente Interregional Cancer Statistics Project

A Kaiser Permanente interregional cancer statistics report will be developed to include incidence and 5-year relative survival rates for breast, colorectal, and lung cancer. The development of new mortality measures will be explored, along with improved routine capture and reporting of these measures. Work will include a landscape review of current procedures and methods used by regional cancer committees to generate region-specific reports; generation of estimates of cancer-specific mortality and all-cause mortality; and assessment of interregional available death and cause of death data. Finally, sustainable reporting processes will be created to enhance the organization's ability to produce this report on an annual basis.
Investigator: Kushi, Lawrence
Funder: Center for Effectiveness and Safety Research

Geospatial, Multilevel, and Contextual Approaches in Cancer Control and Population Sciences

This funding expands on neighborhood resources developed under the U01 grant (geocoded residential histories, linkage to census and area databases, virtual neighborhood audits). Aim 1: Develop methods to use remote sensing data and machine learning techniques to characterize neighborhood attributes (e.g., green space, proximity to blue space, night-time light) and enhance the neighborhood infrastructure of the Pathways Study cohort. Aim 2: Demonstrate their applicability by examining the impact of social and built environment attributes on allostatic load among the Pathways cohort of breast cancer survivors. This work provides an opportunity to apply a comprehensive suite of neighborhood attributes to better understand multilevel factors and outcomes in breast cancer survivors.
Investigator: Kushi, Lawrence
Funder: National Cancer Institute

Comprehensive Translational Science Analytics Tools for the Global Health Agenda

This project builds on a previous Community Benefit grant award to examine changes in cervical and colorectal cancer screening as a result of the implementation of the Patient Protection and Affordable Care Act. It will examine impacts on colorectal cancer incidence and mortality. This will be supported through a collaboration with Dr. Donna Spiegelman of Yale University, through an NIH Pioneer Award to Dr. Spiegelman, DP1 ES025459
Investigator: Kushi, Lawrence
Funder: National Institute of Environmental Health Sciences

Germline and Tumor Genomic Analyses of Breast Cancer in Latinas

This project expands a consortium of studies examining germline genetic mutations in breast cancer risk in Latinas. It builds on a study that will include approximately 550 Latina women with breast cancer in the Pathways Study; genetic data from Latina women without breast cancer will be contributed from Kaiser Permanente Northern California’s Research Program on Genes, Environment and Health. Led by Susan Neuhausen, PhD, of City of Hope, and Elad Ziv, MD, of UC San Francisco, this project further incorporates Latina cases and controls from studies led by Dr. Neuhausen. While this project includes investigation of tumor DNA, Pathways Study and Kaiser Permanente Northern California participants will not be included in that aspect.
Investigator: Kushi, Lawrence
Funder: National Cancer Institute

Adolescent and Young Adult Female Cancer Survivors - Cancer Experience Survey

This study aims to: 1) assess reproductive intentions and receipt of fertility counseling or preservation in relation to post-diagnosis birth outcomes among adolescent and young adult cancer survivors in North Carolina and the Kaiser Permanente Northern California and Kaiser Permanente Southern California health systems; 2) examine infertility, pregnancy loss history, and use of infertility services among adolescent and young adult cancer survivors within those health systems compared to the U.S. general population; and 3) examine the frequency of self-reported cancer recurrence among adolescent and young adult female cancer survivors in North Carolina and in those health systems, and examine the impact of cancer recurrence on post-diagnosis birth rates. Current recommendations for when to attempt pregnancy after cancer diagnosis (typically two to five years) are often based on identified periods of highest cancer recurrence risk, rather than optimal timing for achieving pregnancy, but recurrence information is rarely available.
Investigator: Kushi, Lawrence
Funder: University of North Carolina

Obesity, Chemotherapy Dosing, and Breast Cancer Outcomes

Body size is associated with survival in women with breast cancer in complicated ways. Chemotherapy to treat breast cancer is typically dosed based on body size, often as a function of body surface area. Previously, there was concern that obese patients may receive doses of chemotherapy that may be too toxic given their higher body surface area, resulting in dose capping. This has resulted in the suggestion that obese women were receiving less-than-optimal doses for cancer treatment. Indeed, in 2012, the American Society of Clinical Oncology recommended that doses of chemotherapy not be capped. This project, enabled by availability of detailed infusion data, examines the impact of body size on chemotherapy dosing and subsequent outcomes. The project builds upon pilot work conducted in the Pathways Study cohort of 4,505 women with breast cancer, expands to other women with electronic data only, and includes over 4,000 women with breast cancer at Kaiser Permanente Washington. This project is led by Dr. Elizabeth Kantor at Memorial Sloan Kettering Cancer Center.
Investigator: Kushi, Lawrence
Funder: National Cancer Institute

End-of-Life Care for Adolescents and Young Adults with Cancer: An Evaluation of Care and Development of Patient-Centered Quality Measures

This project examines aspects of end-of-life care for people diagnosed with adolescent and young adult cancers (ages 15 to 39 years). Current measures of end-of-life care quality were designed for older adults; a coherent set of measures to characterize high-quality end-of-life care for adolescent and young adult cancer patients does not exist. This study seeks to answer the questions: What is the quality of end-of-life care for adolescents and young adults with cancer, and what is a patient-centered definition of high-quality end-of-life care for adolescents and young adults facing terminal illness? The aims of this project are to examine the quality of end-of-life care in adolescent and young adult cancer patients, identify sources of variation in end-of-life care, and develop a set of indicators of end-of-life care quality suitable for adolescent and young adult cancers. Data from about 1,800 patients diagnosed from 2000 to 2015 with adolescent and young adult cancers in Kaiser Permanente Northern California and Kaiser Permanente Southern California will be included in data-only aspects, with in-depth interviews of patients, family members, and providers from these Kaiser Permanente regions and the Dana-Farber Cancer Institute to better identify factors that may improve end-of-life care quality. This project is led by Dr. Jennifer Mack at the Dana Farber Cancer Institute.
Investigator: Kushi, Lawrence
Funder: National Cancer Institute

Clinical Pregnancy Outcomes in Adolescent and Young Adult Female Cancer Survivors

Post-diagnosis fertility is a critical issue for adolescent and young adult cancer survivors (diagnosed at age 15 to 39 years), with little information on the impact of cancer diagnosis and treatment on pregnancy outcomes. This study focuses on five leading cancer types among female adolescent and young adult cancer survivors: breast, melanoma, thyroid, and Hodgkins and non-Hodgkins lymphomas. We will analyze North Carolina state-wide cancer registry data linked to claims and offspring birth records from 2003 to 2012, as well as data from Kaiser Permanente Northern California (KPNC) and Kaiser Permanente Southern California (KPSC) for 2000 to 2016. Study aims include assessment of adverse pregnancy outcome risk among 7,200 female adult and young adult cancer survivors at KPNC and KPSC, with 1,300 births, matched five-to-one to 36,000 women without a prior cancer diagnosis on age and enrollment year. Adverse pregnancy outcome risk will also be assessed among 8,000 female adult and young adult cancer survivors in North Carolina, matched five-to-one on maternal age, state, and delivery year. Additionally, the impact of fertility preservation counseling and use on risk of adverse pregnancy and birth outcomes will be evaluated.
Investigator: Kushi, Lawrence
Funder: National Cancer Institute

Infrastructure for Pathways, a Prospective Study of Breast Cancer Survivorship

This grant provides core infrastructure support for the Pathways Study (Kushi, PI), a prospective cohort study of breast cancer survivorship and prognosis. Since 2006, the study enrolled 4,505 women diagnosed with invasive breast cancer in KPNC. Activities (Ambrosone, Christine, Roswell Park Cancer Institute, Co-PI) include ongoing follow-up of participants, active and passive ascertainment of outcomes, collection of tumor specimens, linkage to KPNC electronic records, enhancement of area-level data from contextual databases through virtual neighborhood audits, provision of genotypic data from genome-wide assays, and establishment of a community and participant advisory board. These activities enhance the Pathways Study to make it an unparalleled, outstanding resource for studies of breast cancer prognosis.
Investigator: Kushi, Lawrence
Funder: National Cancer Institute

Highlighted Publications

American Cancer Society guidelines on nutrition and physical activity for cancer prevention: Reducing the risk of cancer with healthy food choices and physical activity

Author(s): Kushi LH; Doyle C; McCullough M; Rock CL; Demark-Wahnefried W; Bandera EV; Gapstur S; Patel AV; Andrews K; Gansler T; The American Cancer Society 2010 Nutrition and Physical Activity Guidelines Advisory Committee

CA Cancer J Clin. 2012 Jan-Feb;62(1):30-67.

Current Position(s):

Section Affiliations:

Primary Research Interests:

Related Website(s):

Studies

Influence of Comorbidities and Inflammatory Biomarkers in Disparities in Ovarian Cancer Treatment, Treatment Response, and Survival

Racial/Ethnic Disparities in Ovarian Cancer Treatment and Survival: An Integrative Approach

Breast White Adipose Tissue Inflammation and Breast Cancer Outcomes

Kaiser Permanente Interregional Cancer Statistics Project

Geospatial, Multilevel, and Contextual Approaches in Cancer Control and Population Sciences

Comprehensive Translational Science Analytics Tools for the Global Health Agenda

Germline and Tumor Genomic Analyses of Breast Cancer in Latinas

Adolescent and Young Adult Female Cancer Survivors - Cancer Experience Survey

Obesity, Chemotherapy Dosing, and Breast Cancer Outcomes

End-of-Life Care for Adolescents and Young Adults with Cancer: An Evaluation of Care and Development of Patient-Centered Quality Measures

Clinical Pregnancy Outcomes in Adolescent and Young Adult Female Cancer Survivors

Infrastructure for Pathways, a Prospective Study of Breast Cancer Survivorship

Highlighted Publications

American Cancer Society guidelines on nutrition and physical activity for cancer prevention: Reducing the risk of cancer with healthy food choices and physical activity

Lifestyle factors and survival in women with breast cancer

Publications

"The simple life experiences that every other human gets": Desire for normalcy among adolescents and young adults with advanced cancer

Natural history of multiple recurrences in intermediate-risk non-muscle invasive bladder cancer: lessons from a prospective cohort

Pregnancy attempts among adolescent and young adult cancer survivors

Reply to M.S. Ewer et al

Management of ovarian and breast cancer risk in non-BRCA HBOC pathogenic variant carriers in a large California health care system

Impact of Racial/Ethnic Discrimination on Quality of Life among Breast Cancer Survivors: The Pathways Study

Associations between childhood obesity and pubertal timing stratified by sex and race/ethnicity

Smoking Behaviors and Prognosis in Patients With Non-Muscle-Invasive Bladder Cancer in the Be-Well Study

Assessment of genetic susceptibility to multiple primary cancers through whole-exome sequencing in two large multi-ancestry studies

Patient, Family, and Clinician Perspectives on Location of Death for Adolescents and Young Adults With Cancer

Results and lessons from dual extraction of DNA and RNA from formalin-fixed paraffin-embedded breast tumor tissues for a large Cancer epidemiologic study

Telehealth for Preoperative Evaluation of Patients With Breast Cancer During the COVID-19 Pandemic

Risk of severe clinical outcomes among persons with SARS-CoV-2 infection with differing levels of vaccination during widespread Omicron (B.1.1.529) and Delta (B.1.617.2) variant circulation in Northern California: A retrospective cohort study

Risk of heart failure with preserved versus reduced ejection fraction in women with breast cancer

Mission, Organization, and Future Direction of the Serological Sciences Network for COVID-19 (SeroNet) Epidemiologic Cohort Studies

Risk of Cardiometabolic Risk Factors in Women With and Without a History of Breast Cancer: The Pathways Heart Study

Risk of Cardiovascular Disease in Women With and Without Breast Cancer: The Pathways Heart Study

Fertility Preservation and Financial Hardship among Adolescent and Young Adult Women with Cancer

Quantifying cancer risk from exposures to medical imaging in the Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC) Study: research methods and cohort profile

American Cancer Society nutrition and physical activity guideline for cancer survivors

Associations between infant growth and pubertal onset timing in a multiethnic prospective cohort of girls

UACA locus is associated with breast cancer chemoresistance and survival.

Impact of the Affordable Care Act on Colorectal Cancer Incidence and Mortality

Factors influencing genetic counseling and testing for hereditary breast and ovarian cancer syndrome in a large US health care system

Positive predictive value and sensitivity of ICD-9-CM codes for identifying pediatric leukemia

Care in the time of COVID-19: impact on the diagnosis and treatment of breast cancer in a large, integrated health care system

The Friends of Cancer Research Real World Data (RWD) Collaboration Pilot 2.0: Methodological Recommendations from Oncology Case Studies

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

Modeling risks of cardiovascular and cancer mortality following a diagnosis of loco-regional breast cancer

Plant-Based Dietary Patterns and Breast Cancer Recurrence and Survival in the Pathways Study

Development and Validation of a Simulation Model-Based Clinical Decision Tool: Identifying Patients Where 21-Gene Recurrence Score Testing May Change Decisions

Patient, Family, and Clinician Perspectives on End-of-Life Care Quality Domains and Candidate Indicators for Adolescents and Young Adults With Cancer

Cross-ancestry GWAS meta-analysis identifies six breast cancer loci in African and European ancestry women

Childhood Socioeconomic Status and Menarche: A Prospective Study

Girls' Pubertal Timing and Tempo and Mental Health: A Longitudinal Examination in an Ethnically Diverse Sample

The Adolescent and Young Adult (AYA) Horizon Study: An AYA cancer survivorship cohort

"I Had to Make Them Feel at Ease": Narrative Accounts of How Women With Breast Cancer Navigate Social Support

Clustering of Social and Physical Pain Variables and Their Association With Mortality in Two Population-Based Cohorts

Diet Quality and Breast Cancer Recurrence and Survival: The Pathways Study

Cross-cancer evaluation of polygenic risk scores for 16 cancer types in two large cohorts

A prospective study of lifestyle factors and bone health in breast cancer patients who received aromatase inhibitors in an integrated healthcare setting

Development of a longitudinal two-biomarker algorithm for early detection of ovarian cancer in women with BRCA mutations

Early life household intactness and timing of pubertal onset in girls: a prospective cohort study

Streamlining genetic testing for women with ovarian cancer in a Northern California health care system

Effects of cooking methods on total isothiocyanate yield from cruciferous vegetables

Pan-cancer study detects genetic risk variants and shared genetic basis in two large cohorts

Obesity and related conditions and risk of inflammatory breast cancer: a nested case-control study

Urinary polycyclic aromatic hydrocarbons in relation to anthropometric measures and pubertal development in a cohort of Northern California girls

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

A polygenic risk score for breast cancer in U.S. Latinas and Latin-American women

Distinct trajectories of moderate to vigorous physical activity and sedentary behavior following a breast cancer diagnosis: the Pathways Study

Feasibility, patient compliance and acceptability of ovarian cancer surveillance using two serum biomarkers and Risk of Ovarian Cancer Algorithm compared to standard ultrasound and CA 125 among women with BRCA mutations

Impact of the Affordable Care Act on Colorectal Cancer Outcomes: A Systematic Review

Validity of state cancer registry treatment information for adolescent and young adult women

Adjuvant endocrine therapy for breast cancer patients: impact of a health system outreach program to improve adherence

Serum bone markers and risk of osteoporosis and fragility fractures in women who received endocrine therapy for breast cancer: a prospective study

Material and psychological financial hardship related to employment disruption among female adolescent and young adult cancer survivors

Distinct trajectories of fruits and vegetables, dietary fat, and alcohol intake following a breast cancer diagnosis: the Pathways Study

Is breast cancer in Asian and Asian American women a different disease?