Conference focuses on cancer health disparities in minority and underserved ...
Organizers and attendees of a three-day conference on cancer health disparities in minority and underserved populations, wrapping up today in Atlanta, hope that research shared there will help bring them closer to closing the gap in survival rates and other positive health outcomes.
The gathering is the sixth of its kind sponsored by the American Association for Cancer Research.
Apart from economic issues that often hinder low-income cancer patients from accessing health care early enough that would allow treatment to begin when it's most effective, "There are a lot of issues surrounding the genomics of cancer and issues surrounding ancestry, and how that influences one's cancer risk," said conference co-chair Dr. Christopher Li. "We're just at the beginning of that [exploration]."
By assembling people from a variety of disciplines to tackle disparities from all angles, the problem can be eliminated more quickly, said Li, head of the translational research program at the Fred Hutchinson Cancer Research Center in Seattle.
"These disparities in the United States have been longstanding," he said. But glimmers of hope have emerged in recent years.
In recent years, research has shown the effectiveness of patient navigators in helping people access cancer treatments, he said. In Delaware, a colorectal cancer treatment and screening program helped eliminate disparities between black and white men.
But progress on the scientific front, in the form of clinical trials that test drugs and other therapies, is slower to come by.
"A lot of it relates to inherent barriers within minority populations with wanting to participate," said Li, a breast cancer researcher. While many individual cancer centers have taken steps to increase the diversity of their patient population in those trials, "there remains an inherent fear and skepticism about what research means."
Rafael Guerrero-Preston, an epidemiologist and assistant professor in head and neck surgery at the Johns Hopkins University School of Medicine and its Sidney Kimmel Comprehensive Cancer Center, wants to expand the research findings he presented over the weekend.
A team of researchers led by Guerrero-Preston offered an analysis of the genetic and epigenetic origins of the most common types of head and neck cancer, believed to be the first and most in-depth analysis of that kind based on race.
Of the more than 300 epigenetic changes (those brought upon by environmental influences) they identified in tumor and blood samples from 68 black and 168 white head and neck cancer patients, the researchers found that four of those modifications are the most common.
They identified a handful of genetic mutations present in black patients, in addition to some chemical changes affecting gene activity.
The researchers' analysis revealed that black patients as a whole didn't survive as long after diagnosis than white patients. It also showed that molecular changes depended on the location of the original tumor.
"For the first time, we're taking look at the combination of mutations and epigenetic changes [and seeing the frequency that those changes are] happening in blacks and non-Latino whites," he said.
The information can help improve risk assessment, early detection and targeted therapy for all patients, regardless of their race.
But Guerrero-Preston needs more minority patients willing to participate in studies that are needed to replicate those initial findings.
"We need to do these studies in a larger population," he said. More studies may help explain why the death rate among black patients from the most common forms of head and neck cancer is roughly 18 percent higher than that of white patients, even as the decline in smoking in the United States has contributed to fewer deaths from head and neck cancers.
"We hope to compare 100 black patients with 100 white patients. And we want to [conduct more genetic analyses] one with 100 black, 100 white and 100 Puerto Rican patients," Guerrero-Preston said.
Only then can precise survival numbers, measured in months or in years, can be ascribed to any particular genetic mutation or combination of changes, he said. "That's the only way to move forward."
Among the more than 250 other studies presented over the weekend:
*Black women with breast cancer, whose tumors contained higher levels of the protein HSET, did not live as long as women whose tumors did not have the protein. They also found that white women with high levels of the protein didn't have the same poor survival outcomes. The Georgia State University researchers who made the discovery say that HSET represents a potential new biomarker that may be used as a predictor of a breast cancer's aggressiveness, leading to better treatment planning.
*Knowledge about the effectiveness of the human papillomavirus ( HPV) vaccine in preventing cervical cancer was lacking in nearly three-fourths of survey respondents, ages 9 to 27 years. Using data from the National Cancer Institute's Health Information National Trends Survey from 2012 to 2013, researchers identified respondents in the vaccine age group. Of 1,417 who took the survey, 70 percent didn't know how successful the HPV vaccine was at preventing cervical cancer, with 78 percent of non-Hispanic blacks reporting uncertainty.In addition, only 25 percent of respondents reported having talked with a health care provider about the HPV vaccine.
*Researchers from the Fred Hutchinson Cancer Research Center in Seattle found that women with interruptions in health insurance coverage or with low income levels (annual family income of less than $50,000) were much more likely to not receive breast cancer care that follows recommended treatment guidelines compared to those whose insurance coverage was uninterrupted or whose annual family income exceeded $90,000.
Except for the HPV study, funded by the American Cancer Institute, all of the previously mentioned studies were partially or fully funded by the National Cancer Institute.
Moving forward, researchers will be focusing on to what extent the roll-out of the Affordable Care Act, designed to help more people access health care, will have on changing the level of disparities seen in cancer and other diseases, said Li, the conference's co-chair.