Marilyn L. Kwan, PhD

marilyn.l.kwan@kp.org

Marilyn L. Kwan, PhD, is a Research Scientist III (equivalent to Professor academic rank) at the Division of Research, Kaiser Permanente Northern California. She graduated from University of California, Berkeley, with her PhD in Epidemiology in May 2004 and completed a one-year postdoctoral fellowship in September 2005, also at UC Berkeley. Dr. Kwan joined the Division of Research in July 2005, where her current research focus is breast and bladder cancer prognosis and survival. Specifically, her interests include lifestyle and molecular factors and their associations with cancer recurrence, survival, and quality of life. She also studies the long-term health effects of cancer treatment specifically lymphedema, fractures, and cardiovascular disease, in breast cancer survivors.

Dr. Kwan’s research has been funded by the National Cancer Institute, American Cancer Society, and California Breast Cancer Research Program.

Current Positions

Research Scientist III, Division of Research, Kaiser Permanente Northern California

Section Affiliations

Cancer

Primary Research Interests

Cancer Epidemiology
Secondary Lymphedema After Breast Cancer
Quality of Cancer Care
Childhood Leukemia
Nutrition
Obesity

Related Websites

Studies

Improving Multidisciplinary Care for Patients with Muscle Invasive Bladder Cancer

Under a 4R Oncology Model (Right Information/Right Care/Right Patient/Right Time), patients and clinicians collaboratively discuss and document a comprehensive, multidisciplinary, and personalized care plan in the treatment setting after cancer diagnosis. This study will investigate whether a 4R care plan, along with early ascertainment of cases of patients with muscle invasive bladder cancer who are surgical candidates, facilitates appropriate treatment selection (as measured by changes in stage of disease and/or plan of care) and shortens time from diagnosis to initiation of neoadjuvant chemotherapy. We also will determine if this process facilitates the consolidation of radical cystectomies to higher volume surgeons and leads to lower complication rates (as measured by 30-day readmission rates).

Investigator: Kwan, Marilyn

Funder: TPMG Delivery Science Projects Program

Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging — Extension Study

This study is an extension of the Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC). Our aims are to evaluate patterns of medical imaging and associated radiation exposure in children and adults and to determine the risk of pediatric cancers associated with pediatric exposure to medical imaging, focusing on leukemia and including children born in the health system.

Investigator: Li, De-Kun; Kwan, Marilyn

Funder: University of California, San Francisco (UCSF)

Treatment Patterns and Clinical Outcomes in Patients with HR+/HER2- and HR+/HER2+ Metastatic Breast Cancer in an Integrated Health Care System

This is an observational, retrospective cohort study of patients diagnosed with HR+/HER2 – and HR+/HER2+ metastatic breast cancer (mBC) who initiated first-line systemic therapy in the metastatic setting. Study aims are: 1) Among HR+/HER2- mBC patients diagnosed from 2015-2020, describe demographic and clinical characteristics, treatment characteristics, and real-world progression-free survival. 2) Among HR+/HER2+ mBC patients diagnosed from 2012-2020, describe demographic and clinical characteristics, treatment characteristics, and progression-free survival and overall survival. 3) Identify demographic and clinical factors associated with first- and second-line treatment receipt (HR+/HER2-), treatment selection (HR+/HER2+), and their clinical outcomes.

Investigator: Kwan, Marilyn

Funder: Pfizer Inc.

Energy Balance, mTOR Pathway Signaling, and Breast Cancer Prognosis: The Pathways Study

This application will use the Pathways Study resource to investigate genetic and non-genetic factors in the interplay of energy balance, mTOR signaling, and breast cancer prognosis. mTOR expression will be determined in tumor tissue from tissue microarrays that are being created in the Pathways Study, and its role in breast cancer outcomes will be examined.

Investigator: Kwan, Marilyn

Funder: National Cancer Institute

Recurrence, Treatment, and Complication Patterns of Intermediate Risk Non-muscle Invasive Bladder Cancer

This study will comprehensively assess the clinical course of intermediate risk non-muscle invasive bladder cancer (NMIBC) in 291 patients diagnosed at Kaiser Permanente Northern California who are enrolled in the Be-Well Study. Intermediate risk NMIBC is an understudied form of one of the most common urologic cancers in the U.S. We will examine recurrence and progression patterns of intermediate risk NMIBC; determine complications associated with its diagnosis and treatment; and characterize healthcare utilization related to its surveillance.

Investigator: Kwan, Marilyn

Funder: UroGen Pharma, Inc.

Predictors of CVD among Breast Cancer Survivors in an Integrated Health System

This study will comprehensively examine clinical and behavioral predictors of cardiovascular disease (CVD) outcomes among breast cancer survivors, and will maximize unique patient and data resources available at Kaiser Permanente Northern California (KPNC). We will compare CVD events in the Pathways Study, a cohort of female KPNC members age ≥21 years diagnosed with invasive breast cancer (n=4,453, R01CA105274) with CVD events in a new age, race/ethnicity, history of comorbidity, and length of KPNC membership matched cohort of healthy KPNC female members (n=22,265). Results from this study will have important implications for identifying breast cancer subgroups at high risk of CVD and identifying potential targets for intervention, such as medication adherence and control of CVD risk factors.

Investigator: Kwan, Marilyn

Funder: National Cancer Institute

Impact of Low IL-10 Levels at Birth and Leukemia Risk

The objectives of this retrospective cohort study of an established case-control study of childhood leukemia are to understand the relationships among immune status at birth, infectious exposures during childhood, and leukemogenesis, and to use this understanding to decrease the incidence of childhood acute lymphoblastic leukemia (ALL). The aims are to: 1) Assess whether a low interleukin-10 level at birth is associated with an increased incidence of early infections characterized by severe clinical symptoms from medical records and self-report; and 2) Determine whether decreased interleukin-10 can contribute to increased ALL in the setting of immune system activation.

Investigator: Kwan, Marilyn

Funder: National Cancer Institute

Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging

The aims of this multiple PI grant are to: 1) Evaluate patterns of medical imaging (utilization and radiation dose) and estimate cumulative exposure to ionizing radiation from medical imaging in a) children (0-18 years old) and b) pregnant women, from 1996-2016; 2) Determine the risk of childhood leukemia among children and adolescents following exposure to all medical imaging examinations that deliver ionizing radiation from 1996-2016 and followed through 2017. We will also examine effects due to exposure from CT exams alone; 3) Determine the risk of childhood cancers among children and adolescents following fetal, in utero (maternal pregnancy) exposure to medical imaging from 1996-2016 followed through 2017; 4) In the subset of the population with complete information during in utero and child or adolescent exposure to medical imaging, assess the cumulative impact of these exposures on childhood cancers.

Investigator: Kwan, Marilyn

Funder: National Cancer Institute

Diet and Lifestyle in a Prospective Study of Bladder Cancer Survivors

This study involves a new prospective cohort of more than 1,800 non-muscle invasive bladder cancer cases to investigate the role of cruciferous vegetable intake, along with associated individual genetic profiles, on reducing recurrence and progression of disease and improving the efficacy of current treatment modalities.

Investigator: Kwan, Marilyn

Funder: National Cancer Institute

Lifestyle and Molecular Factors of Bone Health in Breast Cancer Survivors

This project will investigate the impact of modifiable lifestyle factors, germline genetic variations, and serum biomarkers, on adverse skeletal outcomes among aromatase inhibitor users, as well as develop a prediction model for risk of fractures for postmenopausal breast cancer patients taking aromatase inhibitors.

Investigator: Kwan, Marilyn

Funder: National Cancer Institute

Urinary Diversion Among Bladder Cancer Survivors: Cost, Complications and QOL

This mixed-method, comparative effectiveness study will compare costs, complications, patient- and family-centered outcomes related to urinary diversion. Study participants will include bladder cancer patients undergoing cystectomy and their family caregivers within three Kaiser Permanente regions with a membership base of over six million enrollees.

Investigator: Kwan, Marilyn

Funder: National Cancer Institute

Publications

A prospective study of vitamin D, proinflammatory cytokines, and risk of fragility fractures in women on aromatase inhibitors for breast cancer

Authors: Liang, Emily;Lo, Joan C;Kushi, Lawrence H;Kwan, Marilyn L;Yao, Song;et al.

Breast Cancer Res Treat. 2024 Nov;208(2):349-358. Epub 2024-07-08.

Marilyn L. Kwan, PhD

Current Positions

Section Affiliations

Primary Research Interests

Related Websites

Studies

Improving Multidisciplinary Care for Patients with Muscle Invasive Bladder Cancer

Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging — Extension Study

Treatment Patterns and Clinical Outcomes in Patients with HR+/HER2- and HR+/HER2+ Metastatic Breast Cancer in an Integrated Health Care System

Energy Balance, mTOR Pathway Signaling, and Breast Cancer Prognosis: The Pathways Study

Recurrence, Treatment, and Complication Patterns of Intermediate Risk Non-muscle Invasive Bladder Cancer

Predictors of CVD among Breast Cancer Survivors in an Integrated Health System

Impact of Low IL-10 Levels at Birth and Leukemia Risk

Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging

Diet and Lifestyle in a Prospective Study of Bladder Cancer Survivors

Lifestyle and Molecular Factors of Bone Health in Breast Cancer Survivors

Urinary Diversion Among Bladder Cancer Survivors: Cost, Complications and QOL

Publications

A prospective study of vitamin D, proinflammatory cytokines, and risk of fragility fractures in women on aromatase inhibitors for breast cancer

Trends in HR+ metastatic breast cancer survival before and after CDK4/6 inhibitor introduction in the United States: a SEER registry analysis of patients with HER2- and HER2+ metastatic breast cancer

Cancer Diagnosis During Pregnancy and Livebirth Outcomes in the Adolescent and Young Adult Horizon Study

Blood Pressure and Cardiovascular Risk in Women With Breast Cancer: The Pathways Heart Study

Association between Neighborhood Stressors and Allostatic Load in Breast Cancer Survivors: The Pathways Study

The Influence of Dietary Isothiocyanates on the Effectiveness of Mitomycin C and Bacillus Calmette-Guérin in Treating Nonmuscle-Invasive Bladder Cancer

Epidemiology of early vs. Late recurrence among women with Early-Stage estrogen Receptor-Positive breast cancer in the pathways study

Triamcinolone Acetonide Subconjunctival Injection as Stand-alone Inflammation Prophylaxis after Phacoemulsification Cataract Surgery

Modifying Effects of Genetic Variations on the Association Between Dietary Isothiocyanate Exposure and Non-muscle Invasive Bladder Cancer Prognosis in the Be-Well Study

Clinical, Epidemiologic, and Pathologic Significance of ERBB2-Low Expression in Breast Cancer

Diet quality and cardiovascular disease risk among breast cancer survivors in the Pathways Study

A polygenic score associated with fracture risk in breast cancer patients treated with aromatase inhibitors

Risk of adverse birth outcomes after adolescent and young adult cancer

Adherence to cardiovascular medications and risk of cardiovascular disease in breast cancer patients: A causal inference approach in the Pathways Heart Study

Environmental and Occupational Exposures and Prognosis in Patients with Non-Muscle Invasive Bladder Cancer in the Be-Well Study

Hypothetical interventions on diet quality and lifestyle factors to improve breast cancer survival: the Pathways Study

Alcohol consumption and prognosis and survival in breast cancer survivors: The Pathways Study

Neighborhood attributes and cardiovascular disease risk in breast cancer survivors: The Pathways Study

Development of cardiometabolic risk factors following endocrine therapy in women with breast cancer

Associations of post-diagnosis lifestyle with prognosis in women with invasive breast cancer

Associations of dietary isothiocyanate exposure from cruciferous vegetable consumption with recurrence and progression of non-muscle-invasive bladder cancer: findings from the Be-Well Study

Caring for Children in Relation to Financial Hardship, Advance Care Planning, and Genetic Testing Among Adolescent and Young Adults with Cancer

A Mendelian Randomization Analysis of 55 Genetically Predicted Metabolic Traits with Breast Cancer Survival Outcomes in the Pathways Study

Development and testing of a polygenic risk score for breast cancer aggressiveness

Development of cardiometabolic risk factors following endocrine therapy in women with breast cancer

Pregnancy attempts among adolescent and young adult cancer survivors

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

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

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

Medical imaging utilization and associated radiation exposure in children with down syndrome

Reply to M.S. Ewer et al

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

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

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

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

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

UACA locus is associated with breast cancer chemoresistance and survival.

3 QUESTIONS ON… Cardiometabolic risk factors in breast cancer survivors: With Marilyn Kwan, PhD, Senior Research Scientist in the Division of Research at Kaiser Permanente Northern California…Marilyn Kwan

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

Description of Major Osteoporotic Fractures in Women with Invasive Breast Cancer Who Received Endocrine Therapy

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

Leukemia Risk in a Cohort of 3.9 Million Children With and Without Down Syndrome

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

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

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

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

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

Racial/ethnic disparities in survival after breast cancer diagnosis by estrogen and progesterone receptor status: A pooled analysis

Long-term medical imaging use in children with central nervous system tumors

Trends in Imaging for Suspected Pulmonary Embolism Across US Health Care Systems, 2004 to 2016

Effects of cooking methods on total isothiocyanate yield from cruciferous vegetables

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

History of Early Childhood Infections and Acute Lymphoblastic Leukemia Risk Among Children in a U.S. Integrated Health Care System

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

Hospital Characteristics and Breast Cancer Survival in the California Breast Cancer Survivorship Consortium

The effect of multiple recruitment contacts on response rates and patterns of missing data in a survey of bladder cancer survivors 6 months after cystectomy

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

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

Decision Regret Related to Urinary Diversion Choice Among Cystectomy Patients

A Scalable Database of Organ Doses for Common Diagnostic Fluoroscopy Procedures of Children: Procedures of Historical Practice for Use in Radiation Epidemiology Studies

Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016

Germline Genetic Variants in GATA3 and Breast Cancer Treatment Outcomes in SWOG S8897 Trial and the Pathways Study