Gretchen L. Gierach, Ph.D., M.P.H.
Integrative Tumor Epidemiology Branch
Dr. Gretchen Gierach is interested in the study of the etiology of hormonally-related female cancers, particularly in the molecular mechanisms underlying breast carcinogenesis. Her interdisciplinary research program has a special emphasis on the molecular epidemiology of mammographic density, one of the strongest risk factors for breast cancer.
Epidemiologic Studies of Mammographic Density and Breast Cancer Risk
The tissue composition of the breast is reflected mammographically by the pattern of distribution of fibroglandular and fatty tissue. A higher component of fat results in lower mammographic density. Conversely, a higher proportion of fibroglandular tissue results in greater density. Studies have consistently demonstrated that high mammographic density is a strong breast cancer risk factor. Therefore, understanding factors that affect mammographic density and their underlying mechanisms are important, yet understudied, research questions.
The BREAST Stamp Project aims to characterize the radiologic, histologic, and molecular features of dense breast tissue and to understand how the microenvironment of dense breasts promotes neoplastic transformation of the breast epithelium. Data relating mammographic density to molecular markers of breast cancer are limited. To improve the clinical value of mammographic density as a risk marker, Dr. Gierach and her colleagues are conducting molecular epidemiologic studies to characterize dense and non-dense breast tissues.
In addition to addressing how molecular epidemiologic factors may influence mammographic density and its associated breast cancer risk, Dr. Gierach is also working to address other ways in which density may relate to breast carcinogenesis. In light of emerging evidence indicating that reductions in mammographic density may predict response to tamoxifen treatment, Dr. Gierach and her colleagues initiated a study within Kaiser Permanente Northwest to determine whether breast cancer patients who experience large reductions in density following tamoxifen treatment have an improved prognosis. They have also conducted the Ultrasound Study of Tamoxifen, in which they used novel ultrasound tomography methods to assess changes in volumetric breast density within the first year of tamoxifen therapy. These studies may provide support for future investigations evaluating change in mammographic density as a “biosensor” of factors that increase or decrease breast cancer risk.
Epidemiologic Studies of the Hormonal Etiology of Breast Cancer
Compelling evidence implicates endogenous hormones in breast carcinogenesis. To increase understanding of the role of hormones as etiologic factors in breast cancer, Dr. Gierach and her colleagues incorporate state-of-the-art methods to reliably and sensitively measure systemic hormones and characterize local hormone production in the breast to provide new etiologic insights. They also conduct epidemiologic studies to evaluate the influence of endogenous and exogenous hormones on both radiologic and histologic measures of breast tissue composition, which could help determine the extent to which hormones may influence breast cancer risk through modifying breast histology.
To address a critical need to better understand risk factors associated with second primary breast cancers in the growing population of breast cancer survivors, Dr. Gierach is conducting research within a breast cancer survivors' cohort to investigate the hormonal etiology of contralateral breast cancer. Within this cohort, she is also conducting ancillary studies integrating serial mammographic images and archival tissues to examine radiologic and molecular mechanisms associated with risk of contralateral breast cancer development.
Dr. Gierach earned both her M.P.H. and Ph.D. degrees in epidemiology from the University of Pittsburgh with a focus in cancer epidemiology and women’s health. She joined the Division as an NCI Cancer Prevention Fellow, continued as a tenure-track investigator and was awarded tenure in 2017. She served as Deputy Chief of the Integrative Tumor Epidemiology Branch from 2018 through 2020 and was appointed Chief in 2021. She also serves as chair of the Division’s Breast Cancer Working Group and co-chair of the DCEG Hormone Laboratory Advisory Committee.
Dr. Gierach is the recipient of the DCEG Molecular Epidemiology Research Funding Award, NCI Merit Award in Cancer Prevention Research Training, and Award to Advance Research on Cancers in Women from the NCI Office of Science Planning and Assessment and the NIH Office of Research on Women’s Health.
- Sampson JN, Falk RT, Schairer C, Moore SC, Fuhrman BJ, Dallal CM, Bauer DC, Dorgan JF, Shu XO, Zheng W, Brinton LA, Gail MH, Ziegler RG, Xu X, Hoover RN, Gierach GL. Association of Estrogen Metabolism with Breast Cancer Risk in Different Cohorts of Postmenopausal Women. Cancer Res. 2017;77(4):918-925.
- Gierach GL, Curtis RE, Pfeiffer RM, Mullooly M, Ntowe EA, Hoover RN, Nyante SJ, Feigelson HS, Glass AG, Berrington de Gonzalez A. Association of Adjuvant Tamoxifen and Aromatase Inhibitor Therapy With Contralateral Breast Cancer Risk Among US Women With Breast Cancer in a General Community Setting. JAMA Oncol. 2017;3(2):186-193.
- Sun X, Gierach GL, Sandhu R, Williams T, Midkiff BR, Lissowska J, Wesolowska E, Boyd NF, Johnson NB, Figueroa JD, Sherman ME, Troester MA. Relationship of mammographic density and gene expression: analysis of normal breast tissue surrounding breast cancer. Clin Cancer Res. 2013;19(18):4972-4982.
- Gierach GL, Ichikawa L, Kerlikowske K, Brinton LA, Farhat GN, Vacek PM, Weaver DL, Schairer C, Taplin SH, Sherman ME. Relationship between mammographic density and breast cancer death in the Breast Cancer Surveillance Consortium. J Natl Cancer Inst. 2012;104(16):1218-27.
- Nyante SJ, Sherman ME, Pfeiffer RM, Berrington de Gonzalez A, Brinton LA, Aiello Bowles EJ, Hoover RN, Glass A, Gierach GL. Prognostic significance of mammographic density change after initiation of tamoxifen for ER-positive breast cancer. J Natl Cancer Inst. 2015;107(3).
Related Scientific Focus Areas
Genetics and Genomics
This page was last updated on Friday, January 21, 2022