Biography

Dr. Troisi received a Sc.D. from the Harvard School of Public Health in 1994 and joined NCI the same year.

Research Interests

• Hormonal etiologies of reproductive cancers
• The role of maternal, gestational, neonatal and early life factors in breast cancer risk, including endocrine disruptors such as diethylstilbestrol (DES)
• The biology of early life risk factors and implications for cancer risk

DES Follow-up Study

Since 1992, Dr. Troisi, other NCI investigators, and collaborators from five field study centers have been actively following DES exposed and unexposed mothers, daughters and sons, and granddaughters for adverse health effects resulting from this exposure. As DES-exposed offspring are currently reaching the age when cancer rates begin to rise, it is important to continue to monitor long-term risk of cancer and other adverse health outcomes in this unique population. The study also provides a model for assessing a number of hypotheses that address concerns about prenatal hormonal influences on disease risk, both an intriguing area of science and an increasingly controversial environmental issue that affects a substantial proportion of the population.

To date the study has identified excess female breast cancer after age 40 that shows a dose-response effect, as well as increased risk for high-grade lesions of the cervix and vagina. Concern over other hormone-related cancers remains; though to date analyses have been limited due to small numbers of cases. In the sons, investigators observed an excess risk for urogenital anomalies and infertility, and a likely excess of testicular cancer. To examine the effects in the third generation (the daughters of the prenatally exposed daughters), investigators assembled a small cohort in 2000. Given their average age, there have been few relevant disease outcomes. However, investigators noted an elevated risk for infertility—though not statistically significant, this outcome was also seen in DES-daughters. In addition, there were three cases of ovarian cancer in the granddaughters, even though substantially less than one had been expected. While both of these observations remain difficult to interpret, they have added some urgency to expand the cohort and continue to follow-up. More on the DES Follow-up Study.

Keywords

• breast cancer, hormones, growth factors, biomarkers, cohort studies, preeclampsia

Selected Publications

• Hatch EE, Troisi R, Wise LA, Titus-Ernstoff L, Hyer M, Palmer JR, Strohsnitter W, Robboy SJ, Herbst AL, Kaufman RH, Noller K, Hoover RN. Preterm Birth, Birth Weight and Age at Menarche among Women Exposed Prenatally to Diethylstilbestrol (DES). Reproductive Toxicology 2011;31:151-7.
• Titus-Ernstoff, L., Troisi, R., Hatch, E.E., Palmer, J.R., Hyer, M., Kaufman, R., Knoller, K., Herbst, A.L., Hoover, R.N. Birth defects in the sons and daughters of women who were exposed in utero to Diethylstilbestrol (DES). International Journal of Andrology 2010;33:377-84.
• Troisi, R., dos Santos Silva, I., Newbold, RR. Prenatal Risk Factors for Breast Cancer and Clues to the Underlying Biological Mechanisms from Animal and Human Studies. Newnham JP, Ross MG (eds): Early Life Origins of Human Health and Disease. Basel, Karger, 2009, pp 184–192.
• Troisi, R., Hoover, R.N., Thadhani, R., Hsieh, C-C, Sluss, P, Ballard-Barbash, R., Potischman, N. Maternal, Prenatal and Perinatal Determinants of First Trimester Maternal Serum Hormone Concentrations. Br J Cancer 2008;99:1161-1164.
• Titus-Ernstoff, L., Troisi, R., Hatch, E.E., Palmer, J., Hyer, M., Wise, L., Kaufman, R., Adam, E., Strohsnitter, W., Noller, K., Herbst, A.L., Cole, B., Gibson-Chambers, J., Hartge, P., Hoover, R.N. Cancer Occurrence in Offspring of Women Exposed in utero to Diethylstilbestrol (DES). Epidemiology 2008;19:251-257.

Collaborators

DCEG Collaborators

• Roni T. Falk, M.S.; Robert N. Hoover, M.D.; Patricia Hartge, Sc.D.; Sharon Savage, Ph.D.

Other NCI Collaborators

• Jessica Faupal-Badger, Ph.D; Nancy Potischman, Ph.D.

Other Scientific Collaborators

• Ervin Adam, M.D., Methodist Hospital, Houston, T.X.
• Janet Rich-Edwards, Sc.D., Harvard School of Public Health, Boston, M.A.
• Linda Titus-Ernstoff, Ph.D., Dartmouth Medical School, Hanover, N.H.
• A. Lindsay Frazier, M.D., Dana Farber Cancer Institute, Boston, M.A.
• Mika Gissler,Ph.D., National Institute for Health and Welfare, Helsinki, Finland
• Tom Grotmol M.D., Ph.D., Cancer Registry of Norway, Oslo, Norway
• Elizabeth Hatch, Ph.D., Boston University School of Public Health, Boston, M.A.
• Arthur Herbst, M.D., University of Chicago, Chicago, I.L.
• Chung Hsieh, Ph.D., University of Massachusetts, Worcester, M.A.
• Raymond Kaufman, M.D., Methodist Hospital, Houston, T.X.
• Ken Noller, M.D., New England Medical Center, Boston, M.A.
• Julie Palmer, Ph.D., Boston University, Boston, M.A.
• Stanley Robboy, M.D., Duke University Medical Center, Durham, N.C.
• James Roberts, M.D., University of Pittsburgh, Pittsburgh, P.A.
• Henrik Sorensen, D.M.Sc., Ph.D.. Aarhus University, Aarhus, Denmark
• Anne Catherine Staff, M.D., Ph.D., Ulleval University Hospital, Oslo, Norway
• Olof Stephansson, M.D., Ph.D., Karolinska Institute, Stockholm, Sweden
• William Strohsnitter, Ph.D., New England Medical Center, Boston, M.A.
• Steinar Tretli, Ph.D., Cancer Registry of Norway, Oslo, Norway
• Dimitrios Trichopoulos, M.D., Harvard School of Public Health, Boston, M.A.