Social Epidemiologist Seeks Answers on Rising Rates of Early-Onset Cancer

Rebecca Kehm credits the federally funded Americorps program for the U-turn her career ambitions took after she finished her undergraduate premedical studies at Boston College. In 2009, hoping to catch her breath and gain more experience in health care before writing her medical school applications, she applied for an Americorps-funded job at a community health center in Dorchester. Assigned to the quality improvement department, she was initially disappointed not to be working directly with the clinic’s patients. Digging into the data, however, she discovered that her curiosity about what causes disease eclipsed her interest in treating individual patients. “Back then, we were looking at electronic health records and patient surveys,” says Kehm, now an assistant professor in the Department of Epidemiology. “I realized I was very interested in using data to understand patterns.”

Kehm jettisoned her medical school applications and instead earned both an MPH and a PhD from the University of Minnesota School of Public Health. Her dissertation, in social epidemiology, delved into data on childhood cancer, with a focus on how socioeconomic status and risk factors during gestation affect both incidence and survival. Today, her work spans a wide array of questions around disparities in cancer risk, from individual behaviors like personal exercise habits, smoking, or alcohol consumption, to the role of environmental exposures like air pollution. Says Kehm: “The big overarching question driving my research now is what is causing the increase in early-onset cancer.”

You’ve done a lot of work around breast cancer. What’s going on there?

Kehm: Over time, there’s been a huge increase in breast cancer among women under 50. There are a lot of questions about what factors are causing those rates to increase over time. I’ve investigated everything from global incidence patterns to the role of breast tissue composition and how prenatal exposure to air pollution can affect when girls reach puberty and their lifetime risk of developing breast cancer.

How do you see your epidemiological analyses helping folks coping with cancer?

Kehm: Now that I have my own lab, I’ve been working on translational applications, with a project called ACTIVE after BC, which stands for Addressing Comorbidity To thrIVE after Breast Cancer. We know that there are short-term health and wellness benefits in cancer patients and survivors from physical activity. So my lab developed a dance exercise intervention for younger Black and Hispanic breast cancer survivors to reduce their risk of recurrence.

You’ve been a post-doctoral fellow, research scientist, and now a member of the faculty at Columbia Mailman. What’s kept you here through those career transitions?

Kehm: I’ve had so many great opportunities here to explore the questions I’m interested in because we have a really strong school of public health and a cancer center that allows interdisciplinary research across many different fields. Additionally, my mentors have become collaborators.

You had a consultancy for the last five years with the World Trade Center Health Registry. How did that come about?

Kehm: As a postdoc at Columbia Mailman from 2017 to 20, I had a T32 training grant in cancer epidemiology from the NIH. As I was wrapping up that work, I explored other positions outside of academia. I’d met people at the Health Registry, which has a really interesting cohort that can be used to ask cancer questions. One of the reasons I like epidemiology so much is that you can explore a lot of interesting research questions without being so niche and being restricted to exploring just one question over the course of your entire career.

Tell me more about the course you teach each winter in Paris.

Kehm: We teach a two-week, 80-hour graduate-level seminar in epidemiological methods for master's of public health students at École Des Hautes Études En Santé Publique (EHESP), in partnership with Columbia. The course is offered in English and students come from France, across Europe, and Africa and South America. It’s really interesting to work with students around the globe.

What’s the best part of working one-on-one as an advisor to Columbia Mailman master’s students?

Kehm: I try to help them design a question that really interests them. That personal passion fuels people to pursue a career in public health and epidemiology research. Most of my students’ questions have been around cancer. I’m working with them to develop the question, analyze the data, write up their theses. Now we’re in the process of getting papers ready for publication and going through peer review. I find that really rewarding, helping students move toward careers in research and public health.

What’s fueled your own passion for academic public health?

Kehm: It’s the freedom to explore research questions that interest you and that you think are most important to explore. Of course, there are constraints in terms of what can be funded, but you have the freedom to explore questions that you might not be able to explore in a public health department or biotech company. I have the latitude to pursue questions that might get overlooked if you’re just meeting the endpoints of a consulting company.