From Focus on UCSF Fresno
Summer 2022
By Barbara Anderson
UCSF Fresno is working in partnership with investigators at the UCSF School of Medicine in San Francisco, Community Regional Medical Center (CRMC) in Fresno, and UC Berkeley on a large OB/GYN observational cohort study to enhance understanding of how multiple exposures to environmental chemicals and pollutants affect pregnant women and their offspring.
Over the next four years, in partnership with CRMC, UCSF Fresno plans to recruit and enroll 7,000 women at the time of childbirth and 700 women in the second trimester of pregnancy as participants in the “Discovering Cancer Risks from Environmental Contaminants and Maternal/Child Health (DREAM Cohort).
Another 3,000 women will be enrolled at UCSF Mission Bay and Zuckerberg San Francisco General.
Study leadership spans the two UCSF campuses, UC Berkeley, and CRMC. Co-Principal investigators of the cohort study are Tracey Woodruff, PhD, MPH, professor of OB/GYN and director of the UCSF Program on Reproductive Health and the Environment and the Environmental Research Translation for Health (EaRTH) Center at UCSF, and Peggy Reynolds, PHD, MPH, professor in the UCSF Department of Epidemiology and Statistics. Rachel Morello-Frosch, PhD, MPH, professor in the Department of Environmental Science, Policy and Management is serving as the site PI for UC Berkeley. Priya Pannerselvam, DO, UCSF assistant clinical professor in the Department of Obstetrics and Gynecology at UCSF Fresno is serving as PI for Fresno site. Subhashini Ladella, MD, director of Maternal Fetal Medicine at Community Medical Centers and volunteer UCSF clinical professor of OB/GYN at UCSF Fresno, brings a long history of collaboration with the UCSF research team and will direct the field activities at CRMC.
“We are very fortunate to have the opportunity to work with a world-class research project, DREAM, at UCSF to study the potential impact of environmental exposures on the cancer risk among women in our community,” said Michael W. Peterson, MD, MACP, UCSF Fresno Associate Dean for Undergraduate Medical Education and Research. “We unfortunately, have some of the highest levels of environmental exposures in some of our neighborhoods in Fresno, and it is important to understand the health impacts of these exposures on women’s health.
The UCSF DREAM study is a state-of-the-art study that will hopefully help answer this important question. This is another concrete example of the commitment that UCSF has made and continues to make to the San Joaquin Valley.”
The DREAM study notes that cancer is the second leading cause of death in women and children in the United States and breast cancer is the most frequently diagnosed cancer site in women – and the second leading cause of cancer death. Over the last decade, the incidence of cancers has markedly increased among women of reproductive age in California, especially among Latinas and Asians, and this is as a modest decline in overall cancer incidence rates has occurred over the same period, the investigators say.
Latina and Asian women of reproductive age, who have a higher incidence of cancer, are large populations seen by OB/GYN faculty at UCSF Fresno. “This study will provide important and new insights into environmental factors that may more negatively and adversely impact the health of diverse populations resulting in higher risks of cancer,” Dr. Ladella said.
Increasingly, evidence points to physical environment factors, particularly endocrine disrupting chemicals, as contributing to cancer risk. And pregnancy, which creates physiological changes, including rapid proliferation of mammary cells, is a time of susceptibility to chemical exposures that can increase cancer risk, especially for breast cancer. The study will focus on pregnancy with the hypothesis that exposures to environmental chemicals that disrupt endocrine and other systems during pregnancy can predispose women and children to cancer, as identified by intermediate cancer risk biomarkers.
The study will focus on environmental exposures to consumer product related chemicals and environmental pollutants in air and water, as well as pesticide use. Investigators will be able to see through time what the impacts are of environmental pollutants and the effects of exposure to different types of chemical agents.
Currently, there is a dearth of knowledge on the exposure and mechanisms of environmental carcinogens associated with common cancers in women, including breast cancer and other hormone-related malignancies, Dr. Woodruff said. “We will target a critical window of cancer susceptibility in women by enrolling and following an economically, geographically, ethnically, and racially diverse participant pool of 10,000 pregnant women and their children in the San Francisco Bay Area and California’s Central Valley.”
Of the overall 10,000 pregnant patients recruited and enrolled over four years at CRMC in Fresno, UCSF Mission Bay and Zuckerberg San Francisco, about 5,300 of the women will be consented for collection of specimens at delivery (surveys, maternal blood, urine and umbilical cord blood). They will have follow-up assessments at years one, two- and a half, and four. The follow-up assessments at the first year and again in years two to three will be done remotely, with participants completing surveys that are collected via email or mail. The participants also will self-collect hair and mail samples from mother and child. The four-year visit will take place at a clinic location and will include collection of maternal blood, child saliva; and hair, nails and urine from mothers and children. A subset of 600 pregnant women will be followed beginning from their second trimester of pregnancy (13-27 weeks).
The other 4,700 participants will consent for sample collections at delivery only; and will give permission for health information for long-term passive surveillance collected from medical records. This group will not be a part of the follow-up assessments at years one, two- and a half, or four.
“The opportunity to collect and bank infant biosamples, concurrent with those of mothers, also positions our cohort to provide important future insights into potential mechanisms for risk of childhood cancer associated with multiple environmental exposures in utero, another period of increased susceptibility,” Dr. Woodruff said. “Focusing on these critical, but understudied windows of exposure, our study will contribute to an enhanced understanding of the relationships between multiple exposures to environmental contaminants and intermediate cancer risk biomarkers leading to more effective prevention of environmentally mediated cancers.”
The Dream Cohort is going to be groundbreaking for the San Joaquin Valley, said Dr. Pannerselvam, who came to UCSF Fresno to serve patients in the medically under resourced region of California and to teach residents. UCSF Fresno’s mission is to improve health in the Valley and this study will help to enhance patient care and resident training, she said. “We need to know what environmental toxins and chemicals our patient population is exposed to so that we can provide more holistic care today and for the next generations to come.”
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