Whitney Robinson

Overview:

I design studies and interpret results from big datasets to figure out why rates of health and disease vary across groups.  More generally, I love thinking up new ways to draw causal inference from observational data.

Non-cancerous gynecologic conditions, like endometriosis, fibroids, and PCOS, are my particular focus.  They affect the well-being of a huge number of people but can be difficult to diagnose and treat.  And treatment often involves complex trade-offs regarding quality of life, fertility, and permanence of treatment effectiveness.  I typically investigate these questions using health care data that were not originally intended for research, such as electronic health records, state physician licensing data, etc.

As a Faculty Epidemiologist in the OB-GYN Department, I genuinely love seeing others thrive in their research.  I have a gift for identifying where people can add the most value on a research team. 

Positions:

Instructor in the Department of Obstetrics and Gynecology

Community Outreach & Education Division
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 2008

University of North Carolina - Chapel Hill

Publications:

Premenopausal gynecologic surgery and survival among black and white women with breast cancer.

PURPOSE: In the United States, hysterectomies and oophorectomies are frequently performed before menopause for benign conditions. The procedures are associated with reduced breast cancer-specific mortality among White women. The relationship between premenopausal gynecologic surgery and mortality in Black women with breast cancer is unknown. METHODS: This investigation used incident invasive cases of breast cancer from Phases 1 and 2 of the Carolina Breast Cancer Study a population-based study that recruited Black and White women in North Carolina between 1993 and 2001. Premenopausal gynecologic surgery was operationalized in three categories: no surgery; hysterectomy with bilateral oophorectomy; hysterectomy with conservation of ≥ 1 ovary. Mortality was ascertained using the National Death Index, last updated in 2016. Multivariable-adjusted Cox Proportional Hazard Models were used to estimate the effect of premenopausal surgery on breast cancer-specific and all-cause mortality RESULTS: Hysterectomy with bilateral oophorectomy was associated with reduced breast cancer-specific mortality (HR 0.68; 95% CI 0.49, 0.96). White and Black women had a similar reduction in breast cancer-specific mortality. (HR among white: 0.66; 95% CI 0.43, 1.02), (HR among Black: 0.67; 95% CI 0.37, 1.21). CONCLUSIONS: There was a similar reduction in breast cancer-specific mortality following premenopausal, pre-diagnosis hysterectomy with bilateral oophorectomy across both Black and White women.
Authors
Roberson, ML; Nichols, HB; Olshan, AF; A Troester, M; Robinson, WR
MLA Citation
Roberson, Mya L., et al. “Premenopausal gynecologic surgery and survival among black and white women with breast cancer.Cancer Causes Control, vol. 31, no. 2, Feb. 2020, pp. 105–12. Pubmed, doi:10.1007/s10552-019-01255-2.
URI
https://scholars.duke.edu/individual/pub1501088
PMID
31828465
Source
pubmed
Published In
Cancer Causes Control
Volume
31
Published Date
Start Page
105
End Page
112
DOI
10.1007/s10552-019-01255-2

Racial Differences in PAM50 Subtypes in the Carolina Breast Cancer Study.

Background: African American breast cancer patients have lower frequency of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2 (HER2)-negative disease and higher subtype-specific mortality. Racial differences in molecular subtype within clinically defined subgroups are not well understood. Methods: Using data and biospecimens from the population-based Carolina Breast Cancer Study (CBCS) Phase 3 (2008-2013), we classified 980 invasive breast cancers using RNA expression-based PAM50 subtype and recurrence (ROR) score that reflects proliferation and tumor size. Molecular subtypes (Luminal A, Luminal B, HER2-enriched, and Basal-like) and ROR scores (high vs low/medium) were compared by race (blacks vs whites) and age (≤50 years vs > 50 years) using chi-square tests and analysis of variance tests. Results: Black women of all ages had a statistically significantly lower frequency of Luminal A breast cancer (25.4% and 33.6% in blacks vs 42.8% and 52.1% in whites; younger and older, respectively). All other subtype frequencies were higher in black women (case-only odds ratio [OR] = 3.11, 95% confidence interval [CI] = 2.22 to 4.37, for Basal-like; OR = 1.45, 95% CI = 1.02 to 2.06, for Luminal B; OR = 2.04, 95% CI = 1.33 to 3.13, for HER2-enriched). Among clinically HR+/HER2- cases, Luminal A subtype was less common and ROR scores were statistically significantly higher among black women. Conclusions: Multigene assays highlight racial disparities in tumor subtype distribution that persist even in clinically defined subgroups. Differences in tumor biology (eg, HER2-enriched status) may be targetable to reduce disparities among clinically ER+/HER2- cases.
Authors
Troester, MA; Sun, X; Allott, EH; Geradts, J; Cohen, SM; Tse, C-K; Kirk, EL; Thorne, LB; Mathews, M; Li, Y; Hu, Z; Robinson, WR; Hoadley, KA; Olopade, OI; Reeder-Hayes, KE; Earp, HS; Olshan, AF; Carey, LA; Perou, CM
MLA Citation
Troester, Melissa A., et al. “Racial Differences in PAM50 Subtypes in the Carolina Breast Cancer Study.J Natl Cancer Inst, vol. 110, no. 2, Feb. 2018. Pubmed, doi:10.1093/jnci/djx135.
URI
https://scholars.duke.edu/individual/pub1277817
PMID
28859290
Source
pubmed
Published In
J Natl Cancer Inst
Volume
110
Published Date
DOI
10.1093/jnci/djx135

The spatial distribution of gender differences in obesity prevalence differs from overall obesity prevalence among US adults.

PURPOSE: Although obesity disparities between racial and socioeconomic groups have been well characterized, those based on gender and geography have not been as thoroughly documented. This study describes obesity prevalence by state, gender, and race and/or ethnicity to (1) characterize obesity gender inequality, (2) determine if the geographic distribution of inequality is spatially clustered, and (3) contrast the spatial clustering patterns of obesity gender inequality with overall obesity prevalence. METHODS: Data from the Centers for Disease Control and Prevention's 2013 Behavioral Risk Factor Surveillance System were used to calculate state-specific obesity prevalence and gender inequality measures. Global and local Moran's indices were calculated to determine spatial autocorrelation. RESULTS: Age-adjusted, state-specific obesity prevalence difference and ratio measures show spatial autocorrelation (z-score = 4.89, P-value < .001). Local Moran's indices indicate the spatial distributions of obesity prevalence and obesity gender inequalities are not the same. High and low values of obesity prevalence and gender inequalities cluster in different areas of the United States. CONCLUSIONS: Clustering of gender inequality suggests that spatial processes operating at the state level, such as occupational or physical activity policies or social norms, are involved in the etiology of the inequality and necessitate further attention to the determinates of obesity gender inequality.
Authors
Gartner, DR; Taber, DR; Hirsch, JA; Robinson, WR
MLA Citation
Gartner, Danielle R., et al. “The spatial distribution of gender differences in obesity prevalence differs from overall obesity prevalence among US adults.Ann Epidemiol, vol. 26, no. 4, Apr. 2016, pp. 293–98. Pubmed, doi:10.1016/j.annepidem.2016.02.010.
URI
https://scholars.duke.edu/individual/pub1501114
PMID
27039046
Source
pubmed
Published In
Ann Epidemiol
Volume
26
Published Date
Start Page
293
End Page
298
DOI
10.1016/j.annepidem.2016.02.010

Body size across the life course and risk of premenopausal and postmenopausal breast cancer in Black women, the Carolina Breast Cancer Study, 1993-2001.

BACKGROUND: It is believed that greater adiposity is associated with reduced risk of breast cancer in premenopausal but increased risk in postmenopausal women. However, few studies have evaluated these relationships among Black women or examined anthropometric measures other than near-diagnosis body mass index (BMI). PURPOSE: This study investigated associations between measures of body size across the life course and breast cancer risk among Black and White women living in the US South. METHODS: We used data from the Carolina Breast Cancer Study, a population-based case-control study of invasive breast cancer in North Carolina women aged 20-74 years. We assessed nine body size variables, including age 10 relative weight; age 18 BMI; adult weight gain; "reference" BMI 1 year before interview; and post-diagnosis measured BMI and abdominal obesity measures. RESULTS: Among premenopausal Whites, heavier childhood relative weight was associated with decreased cancer risk [odds ratio (OR) 0.48 95 % confidence interval 0.33-0.70]. Among premenopausal Blacks, greater adult waist circumference and waist-to-hip ratio (WHR) were associated with increased risk [waist OR 1.40 (1.00-1.97) and high tertile WHR OR 2.03 (1.29-3.19)], with associations for WHR in a similar direction in Whites. Among postmenopausal women, recalled body size was not associated with risk, except for increased risk associated with adult weight gain among White non-hormone therapy users. ER/PR status and hormone therapy use also modified other associations. DISCUSSION: In this population, greater adult BMI was not associated with increased breast cancer risk, but some measures of early-life body size and abdominal obesity were associated with risk.
Authors
Robinson, WR; Tse, CK; Olshan, AF; Troester, MA
MLA Citation
Robinson, Whitney R., et al. “Body size across the life course and risk of premenopausal and postmenopausal breast cancer in Black women, the Carolina Breast Cancer Study, 1993-2001.Cancer Causes Control, vol. 25, no. 9, Sept. 2014, pp. 1101–17. Pubmed, doi:10.1007/s10552-014-0411-5.
URI
https://scholars.duke.edu/individual/pub1501085
PMID
24924530
Source
pubmed
Published In
Cancer Causes Control
Volume
25
Published Date
Start Page
1101
End Page
1117
DOI
10.1007/s10552-014-0411-5

Obesity before age 30 years and risk of advanced prostate cancer.

Adult obesity has shown little association with prostate cancer risk, but obesity at younger ages may be associated with reduced risk. In 1997-2000, the relation between obesity before age 30 years and incident advanced prostate cancer was investigated in a population-based case-control study of African-American and White men (568 cases, 544 controls) in California. Unconditional logistic regression was used to estimate odds ratios and 95% confidence intervals, adjusted for age, race, family history of prostate cancer, and saturated fat intake. Measures of obesity for age 10 years tended to be inversely associated with prostate cancer (odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.46, 1.38 for selecting the "obese" pictogram and OR = 0.76, 95% CI: 0.52, 1.11 for reporting being heavier than peers). The decreased risk was more pronounced at ages 20-29 years (OR = 0.53, 95% CI: 0.28, 1.00 for the "obese" drawing, OR = 0.59, 95% CI: 0.40, 0.88 for being heavier than peers, and OR = 0.40, 95% CI: 0.20, 0.81 for body mass index > or =30 kg/m(2)). In addition, both "obese" and small waist size at ages 20-29 years showed inverse trends. This research implicating early-life body size in prostate cancer development helps to elucidate causal mechanisms, such as altered sex hormone profiles during critical developmental periods, potentially involved in development of the disease.
Authors
Robinson, WR; Stevens, J; Gammon, MD; John, EM
MLA Citation
Robinson, Whitney R., et al. “Obesity before age 30 years and risk of advanced prostate cancer.Am J Epidemiol, vol. 161, no. 12, June 2005, pp. 1107–14. Pubmed, doi:10.1093/aje/kwi150.
URI
https://scholars.duke.edu/individual/pub1501123
PMID
15937019
Source
pubmed
Published In
American Journal of Epidemiology
Volume
161
Published Date
Start Page
1107
End Page
1114
DOI
10.1093/aje/kwi150