Many of us within numerous oncology settings–clinical practice, research, education, and administration–can acknowledge our diverse roles and contributions to the “War On Cancer.” However, we must be cognizant of other venues where nurses’ beneficence has been crucial to this crusade. Such is the case of the “Nurses’ Health Study” (NHS), sometimes referred to as the “Harvard Nurse Study.”
In 1976, the initial cohort of 121,700 female registered nurses completed a two-page questionnaire whose intent was to prospectively examine the relationship between the use of oral contraceptives, cigarette smoking, and the risk of major illnesses in women.1 With follow-up questionnaires mailed every 2 years since then, investigators have focused on extensive lifestyle details (i.e., use of exogenous hormones, diet, obesity, exercise, mood and mental health, and work variables) and their relationship with mortality.
This novel study has been credited with the identification of key data determining risk factors and their association with diabetes, stroke, heart disease, depression, and suicide. Findings have been critically significant in our knowledge about cancer.2 Case in point are the following.
The first influential risk-associated finding related to ovarian cancer emanated from the Nurses’ Health Study when a strong inverse relationship was identified between tubal ligation and ovarian cancer risk. Study-related information about endometrial cancer, considered a model of hormone-related carcinogenesis, resulted in the identification of both risk-reducing and risk-enhancing factors. These included heightened risk stemming from postmenopausal estrogen when unopposed by progesterone, early menarche, and later menopause. Reduced endometrial cancer risk was associated with advanced age at pregnancy and last childbirth at age 40 years or older.
Pancreatic cancer, among the most fatal worldwide, was diagnosed in 796 participants in the NHS between the years 1976-2012. Epidemiologic factors identified a link between cigarette smoking and pancreatic cancer risk. Other risk corollaries have subsequently included an association with obesity, vitamin D levels, and genetic variants.
The Nurses’ Health Study is the largest and longest cohort study of lifestyle and health within the US.1 High ongoing participation rates by nurses in this study have contributed to our recognition of preventable lifestyle factors related to major causes of mortality nationwide. In particular, after 4 decades of follow-up, the Nurses’ Health Study has influenced both cancer prevention strategies and improved survival for numerous cancers. It is timely to acknowledge these nurses contributions along with ours already “in the trenches.”
- Colditz GA, Manson JE, Hankinson SE. The Nurses’ Health Study: 20-year Contribution to the Understanding of Health Among Women. J Womens Health. 1997 Feb;6(1):49-62.
- Birmann BM, Barnard ME, Bertrand KA, et al. Nurses’ Health Study Contributions on the Epidemiology of Less Common Cancers: Endometrial, Ovarian, Pancreatic and Hematologic. Am J Public Health. 2016 September; 106(9): 1608–1615.