By Meghan Oliver

Sentinel Staff Writer

Sisterhood is more than just a blood relation between women. It's an impenetrable, enduring connection that can outlast that of friends, boyfriends and even husbands. But the bond between sisters may prove even more valuable as Sister Study continues its research on female siblings to fight breast cancer.

Created about five years ago, the National Institute of Environmental Health's Sister Study is a prospective research analysis on the sisters of women who have or have had breast cancer. The goal is to obtain and examine the genes of sisters and the environmental conditions to which they have been exposed in an effort to uncover how such factors interact and participate in the development of breast cancer.

Dr. Dale Sandler, chief of the epidemiology branch at the NIEHS, is leading the study with Dr. Clarice Weinberg, chief of the biostatistics branch. Sandler said although she was aware of the current amount of breast cancer research, it was clear that a study needed be done that focused on the environments in which women were raised. Sisters seemed to be ideal candidates to study.

"Women with sisters who have breast cancer are two times as likely to have breast cancer than others," Sandler said. Study participants, therefore, will be more likely to develop breast cancer than a random sampling of women.

But it's not just the genes sisters share that increases the risk of breast cancer. Exposure to certain toxins in the environment can also negatively affect their genes, possibly leading to the disease.

"If there's some exposure [to a breast cancer victim] from something in the environment in childhood, the sister is most likely to have been exposed, too," Sandler explained.

Environmental factors the Sister Study looks at might include garden pesticides, chemicals they may have been exposed to or handled at work, factories or plants they may have lived near and their mother's exposure to such factors while pregnant with them.

Beyond genes and a shared childhood, the bond sisters have made them ideal candidates for studies such as this, Sandler said.

"Sisters of women with breast cancer have a special interest. They have this special connection, and seem to be more interested in doing something to honor their sister, share in their sister's struggle and [have an] interest in how they might prevent breast cancer in themselves and in future generations."

The study targets women between the ages of 35 and 74, and after an initial sample collection of blood, urine, toenail clippings and house dust, follows them for 10 years after their start date in the study by sending yearly questionnaires.

Fifty thousand women are currently being sought to enroll in the Sister Study, and Sandler says African-American and other minority women are especially needed for research. Less research has been done on minority women for several reasons.

Wish Martin, a 61-year-old African-American breast cancer survivor, said in the past, minority women have not received the same medical information as Caucasian women. Martin, of Baltimore, was in town May 18 at Senior Health & Fitness Day at the Wayne K. Curry Sports & Learning Center in Landover to spread the word on Sister Study.

Martin said that historically, African-Americans have talked less openly about disease, often whispering words such as "cancer." She said she was taught that once doctors "opened you up" to examine cancer, the cancer would spread.

Sandler had heard similar things, saying that in some minority groups, it's taboo to talk about body and health issues.

"It's become very trendy for young white women to talk about breast cancer," Sandler said. "They understand that cancer is not a death sentence. In some cultures, that's not the case -- you don't talk about breasts, you don't talk about cancer."

This, Sandler said, is detrimental to cancer prevention.

"You need to find out what grandma died from," she said.

Socioeconomics play a role as well in cancer prevention and treatment, as those with less money may not have insurance, or may be underinsured and not get the proper attention they need from doctors to detect such diseases as breast cancer, Sandler explained.

What's frightening about the lack of breast cancer information getting to African-American women is that although the risk for development of breast cancer is greater for white women, the mortality rate is actually higher for African-American women. Sandler said African-American women have a more aggressive form of breast cancer.

While the reason behind this is unclear, Sandler explained that it is not due to poor health care, but that "the tumors appear to be biologically different, and we need to understand why."

Older women, too, are needed in the Sister Study, as the risk for breast cancer increases with age.

"The media focuses on young women, but they don't realize that the older women get it more often," said Sandler. "The reasons that women develop breast cancer at age 70 may be very different than women who develop it at age 40," making studies on varying age groups important.

Martin, who first learned of her own breast cancer at the age of 46, had never had a mammogram until the one that exposed the cancer.

"I was just so busy taking care of my family," she said. "I put myself last."

She said she has always led a healthy life—avoiding red meat and pork, and taking care of colds with herbs—so the news of cancer was particularly shocking.

"I think I was devastated, but I took it and gave it to God. Even though I ate right and took care of myself, God had a mission for me -- to spread the word."

Since recovering from breast cancer, Martin has a personal motto. "I spread the word on breast cancer as quickly as breast cancer spreads itself."

Her quick recovery time after her mastectomy grabbed doctors' attention, and along with 12 other women, she was asked to begin a support group for women whose recovery was not quite as smooth. Together, the women formed Sister Surviving, Inc., based in Baltimore, with biweekly meetings for women with breast cancer. She said there are now about 100 members.

When Martin's sisters, Fluffy and Dottie, were told about Sister Study, they signed up "immediately, without hesitation" Martin said. "I'm the baby so of course they're going to look out for the baby. We're joined at the hip," she said smiling.

While she said her faith had a great deal to do with her recovery and strength throughout the cancer, she is adamant that women learn to take care of their bodies on their own.

"I believe in putting yourself in God's hands, but God also wants you to look out for yourself (and) educate yourself. He gives us the intelligence... to take care of ourselves."

Martin, who has two daughters, two sons and four granddaughters, makes it a point to tell them all, even the men, to check their breasts for lumps. Men currently make up 1 percent of breast cancer diagnoses.

"I figured if I had breast cancer, anybody could get it," she said. "I needed to tell (my family) to be cautious and mindful of their bodies."

To participate in Sister Study, log on to www.sisterstudy.org, or call (877)-4SISTER.

Photo by Marketa Ebert