The Cancer Health Disparities (CHD) journal covers all aspects of disparities including social, cultural, behavioral, environmental, genetic, and epigenetic determinants contributing to differences in cancer incidence, prevalence, death, survivorship, and burden of cancer that exist among different populations around the world. The overall aim is to publish high-quality, high-impact, and innovative research articles in all areas related to cancer health disparities. CHD journal publishes case reports, multidisciplinary editorial, commentary, hypothesis, short and full-length reviews, full-length original clinical or basic science research articles, and short articles of immediate scientific or clinical significance. These include disparities at the metabolic, molecular, genetic, epigenetic, physiological, clinical, diagnostic, prevention, and therapeutic levels.
The Company of Scientists and Physicians
Interventions Addressing Breast Cancer Mammography Screening Barriers in Non-Hispanic Black Women: An Integrative Review
Breast cancer disparity in Non-Hispanic Black women is a major concern due to higher breast cancer death rates in this population. This integrative review explores interventions aimed at increasing screening mammography in this population. A literature search was conducted of full-text, peer-reviewed articles published over ten years between 2013-2023 using Cumulated Index to Nursing and Allied Health Literature and PubMed. Of the 396 articles identified, nine met the inclusion criteria. The studies identified used various strategies to implement screening interventions in Non-Hispanic Black women that were culturally tailored and considered social determinants of health, barriers to breast cancer screening, engaging community, and patient navigation. These findings suggest that focused interventions should consider the challenges to Non-Hispanic Black women to schedule and complete mammogram screenings. Future research is recommended to conduct interventional studies with Non-Hispanic Black women specifically tailored to meet their needs to promote engagement in the recommended mammography screening guidelines.
Copyright (c) 2024 Cancer Health Disparities
Strong Tumor Expression of ALDH1A1 is Associated with Black Race, Metabolic Disorders, and Poor Breast Cancer Outcomes
Racial differences in tumor biology may explain worse breast cancer outcomes in Black women relative to White women. This study provides a comparative racial analysis in Black and White women in terms of Aldehyde dehydrogenase 1 member A1 (ALDH1A1) expression and its association to clinicopathological features. Expression of ALDH1A1 in both tumor and stromal cells was assessed by immunohistochemistry in tissue microarrays containing 253 breast tumors including 161 tumors from White patients and 92 from Black patients. Relationships to clinicopathological features for strong and moderate to low ALDH1A1 staining were determined using Pearson’s Chi Square and an odds ratio was determined. Survival and recurrence were analyzed using Kaplan-Meier curves and Mantel Log-Rank tests. Multivariate analysis was conducted using Cox-proportional hazards tests. Black, obese, and diabetic women showed higher staining intensity in both tumor and stromal tissue. Strong tumor staining was associated with Black race, advanced stage, high grade obesity and diabetes. Strong stromal expression was associated with estrogen receptor positivity, and prediabetes/diabetes. Patients with strong tumor ALDH1A1 had shorter recurrence free and overall survival compared to those with moderate to low expression. When stratified by race, Black women with strong tumor ALDH1A1 expression had shorter recurrence free survival compared to White women. Strong tumor ALDH1A1 staining was an independent predictor of poor overall survival in both Black and White women. These findings indicate that ALDH1A1 expression is associated with poor outcomes in breast cancer, particularly in Black women, and provide the first link between tumor ALDH1A1 expression, obesity, and diabetes.
Breast cancer; ALDH1A1, Black women, metabolic disorders, obesity
Racial/Ethnic Disparities in Thyroid Cancer Stratified by Risk Factors: A Literature Review
In the United States, thyroid cancer incidence has increased dramatically within the last few decades. Recent research suggests that this incidence along with cancer stage and mortality vary by race/ethnicity, highlighting health disparities in the United States. There are several risk factors for thyroid cancer incidence that may contribute to these disparities. The goal of this literature review is to analyze whether these potential risk factors impact incidence and aggressiveness differently by race/ethnicity, implicating their possible role in influencing thyroid cancer disparities in the United States. Through PubMed searches, we have reviewed recent literature on U.S. populations. We found that chromosomal alterations/non-hereditary conditions, autoimmunity, thyroid nodules, and socioeconomic differences potentially impacted thyroid cancer incidence and aggressiveness by race/ethnicity, whereas sex disparities did not. Six potential risk factors showed some variations by race/ethnicity but either did not specifically examine their relationship to thyroid cancer or did not impact thyroid cancer incidence and aggressiveness. Three other potential risk factors have not yet been studied regarding their influence on thyroid cancer incidence and outcomes for racial/ethnic groups in the United States. Therefore, we identify a critical need for subsequent research to examine these potential risk factors for different racial/ethnic groups and contribute toward our understanding of racial/ethnic health disparities in the United States. We also present several research areas relating to thyroid cancer health disparities that require further study.
Thyroid cancer, health disparities, incidence, mortality
Based on personal polymorphism and algorithmic interpretation, pharmacogenomics interventions in healthcare are chosen, directing pharmacotherapies in patients. As a part of precision medicine, pharmacogenomics offers a unique chance to set the bar for treating patients as particular individuals with specific needs. Like with any intervention, the benefit-to-risk ratio needs to be considered. Information gaps and people’s lack of knowledge of pharmacogenomics will always be problems, as will their unfamiliarity with the subject. As there are more genes, there are more potential diseases and environmental factors that could mask the impact of genes. As a result, multigene models in vast populations must always be considered for research. There aren’t many studies that look at how pharmacogenomics affects health disparities. Additional research is needed to assess health differences between ethnic groups and nations and within a single country.
Copyright (c) 2022 Cancer Health Disparities
The CAPCI Network: A CAncer Prostate Consortium of India for Conducting Next-Generation Genomic Sequencing Studies
The CAncer Prostate Consortium of India (CAPCI) was established in September 2020 by a group of researchers and clinicians interested in identifying inherited and somatic risk factors that are related to theonset of prostate cancer (PCa). The consortium aims to improve the patient care and treatment in India byexploring and expanding the utility of genomic repositories associated with PCa. These aims are reached by advancing discovery in genome science particular to Indian phenotypes, translating scientific discoveries to improved standard of care. One of the impending goals of the consortium is to combine the data from the west and other sub-population ancestries, and identify common and exclusive risk profiles associated with PCa in Indian scenarios. These findings would additionally allow us to validate in experimental settings to explore the molecular mechanisms underlying pathogenesis of PCa besides understanding new personalized therapeutic regimens.
Breast and Cervical Cancer Disparities in Alabama: Current Scenario, Ongoing Efforts to Reduce the Disparity Gaps, and What More We Could be Doing
Over the years, we have made considerable progress in our understanding of the biology of various cancers leading to advancements in cancer management strategies. Consequently, we have witnessed steady improvement in survival rates of cancer patients post-diagnosis, although the progress has been slow for some cancer types. Moreover, the advances in cancer care have not equally benefited all the minority and ethnic populations residing in the United States. The state of Alabama has one of the most diverse demographics in the country and as a result, we witness significant health disparities among our populations. Breast and cervical cancers are two major cancer types that disparately affect the women in our state. Here, we discuss the extent of disparities in the diagnosis and death rates from these cancers in the state of Alabama and potential underlying causes affecting the health outcomes. We also discuss ongoing efforts undertaken to reduce the disparity gaps and provide a perspective for addressing these disparities more effectively.
Copyright (c) 2023 Cancer Health Disparities
Cancer Health Disparities Drivers with BERTopic Modelling and Pycaret Evaluation
The complex interplay of social, behavioural, lifestyle, environmental, health system, and natural health variables contribute to disparities in cancer treatment across racial and ethnic groups. Consequently, it is necessary to identify the variables contributing to cancer health inequalities and develop strategies to achieve health equality. Pubmed abstract on Cancer health disparities was scraped with a bio.Entrez python package. Preprocessed data with regex and Natural tool kit(NLTK), topic modelling with BERTopic embeddings, and c-TF-IDF to construct dense clusters and analyse top topics linked with Cancer health disparities. Model evaluation with Pycaret coherence score and web app deployment with Streamlit. The results showed that Topic 32 with terms obese, female, male, school, survey, student, post, and discrepancy had the best coherence score of 0.3687. In contrast, topic 8 with terms prevalence, adult, income, high, usage, diabetes, education, elderly, change and low, received the least coherence score of 0.3255. The model classifies each Subject Word score based on the scores, the granular topic concerns and trends related to cancer health disparities, investigates the connection between drivers of cancer health disparities, and evaluates the model with their coherence score values.
Racial/Ethnic Disparities in HPV-associated Anogenital Cancers Among Males in the United States: A Population-Based Retrospective Cohort Study
Little is known regarding racial/ethnic differences in human papillomavirus (HPV)-associated anogenital cancer among males. We examined age-adjusted incidence, late-stage diagnosis, survival and mortality of anogenital cancers among males in the United States. This population-based retrospective cohort study included 39,601 males diagnosed with HPV-associated invasive penile and anorectal cancers between 2005-2016 from the North American Association of Central Cancer Registries. We evaluated the association of race/ethnicity with outcomes using multivariable logistic regression, adjusted survival curves, and Cox proportional hazard modeling, adjusting for age, insurance, residential characteristics (metropolitan/non-metropolitan, area poverty, and geographic region), stage, and treatment. We also assessed interaction of race/ethnicity with other covariates in our late-stage and mortality models. Hispanic and Non-Hispanic (NH) Black males had highest age-adjusted incidence of penile and anorectal cancer, respectively. Higher odds of late-stage penile cancer was observed among NH Black (adjusted odds ratios [aOR] 1.22, 95% CI 1.07-1.39) and Hispanic males (aOR 1.17, 95% CI 1.04-1.31). Higher odds of late-stage anorectal cancer was observed among NH Black (aOR 1.25, 95% CI 1.14-1.36) and NH Other males (aOR 1.29, 95% CI 1.01-1.66). Compared to all other groups, NH Black males had the lowest cumulative and mean survival of both cancers and higher cancer-specific mortality (penile adjusted hazards ratios [aHR] 1.23, 95% CI 1.01-1.49; anorectal aHR 1.25, 95% CI 1.10-1.42). Racial/ethnic disparities in HPV-associated anogenital cancers differ depending on site. Interventions to increase HPV vaccination rates, early detection, and treatment of anogenital cancers in males are needed, particularly among men of color.
Racial differences in prostate tumor microenvironment: implications for disparate clinical outcomes and potential opportunities
Disparities in cancer are common among the racial and ethnical minorities in the United States and are of significant social and clinical concern. Prostate cancer is the most commonly diagnosed non-cutaneous malignancy in American men and exhibits substantial racial disparities with African American men bearing the highest burden in terms of incidence and mortality. A multitude of factors, including socioeconomic, behavioral, and access to healthcare, have been implicated as the underlying causes of such disparities. More recent data also suggest that there are inherent genetic and biological differences in prostate tumors of patients having distinct racial backgrounds. Tumor microenvironment has tremendous impact on the course of cancer progression and clinical outcome and may also contribute to the racial disparities observed in prostate cancer. A better understanding of critical differences in the tumor microenvironment components will provide newer directions to study the biological causes of prostate cancer health disparities and may identify novel therapeutic targets. This review discusses the findings related to the tumor microenvironment differences between the of African American and Caucasian American prostate cancer patients to suggest their potential significance in prostate cancer disparities.
Highlights from First International Conference on Cancer Health Disparities
The first International Conference on Cancer Health Disparities (ICCHD) was held on August 13-14, 2021, in Harlingen, TX, USA. This two-day ICCHD-2021 was organized by the University of Texas Rio Grande Valley, School of Medicine (UTRGV-SOM). About 200 national and international delegates from 10 countries attended this hybrid meeting in person and through online digital methods. The event delegates were representatives from NIH, CPRIT, and the City of Harlingen, in addition to clinicians, faculty, researchers, scientists, bioinformaticians, geneticists, bioethicists, and others. Abstracts were submitted through an online portal, reviewed, and accepted for inclusion in the program. Under the theme of Cancer Health Disparities, this event featured a number of special talks and showcased the work done by researchers from a broad array of disciplines (academia, community, health care) to identify gaps and/or solutions to multi-faceted heath and health disparity issues impacting minority and underserved populations across the country and worldwide. The conference was comprised of six sessions: Session 1: Introduction to the conference and tackling cancer health disparities; Session 2: Elimination of cancer health disparities; Session 3: Cancer cellular and molecular biology; Session 4: Diversity and Inclusion in cancer research: Session 5: Poster and oral presentations; Session 6: Early Career Investigator talks; and an award ceremony and closing remarks. This conference report summarizes the meeting’s content, discussions, and conclusions.
research symposium, cancer health disparities, cancer biology, drug delivery, medical research.
Racial Disparities in the Genetic Landscape of Lung Cancer
Lung cancer has the highest cancer-related mortality worldwide and in the United States. Reduced tobacco consumption and advancement in therapies have led to a modest decline in lung cancer death rates over the past two decades; the overall survival rate is still disappointing. Moreover, race-associated disparities are also observed, especially in the clinical outcomes. While differences in socioeconomic status and lifestyle could be significant contributing factors, differences in the genetic landscape of lung cancer among different racial groups have also been reported. In this review, we shed light on the genetic heterogeneity of lung cancer and race-associated differences in genetic alterations to build a framework for future studies to understand the biological basis of lung cancer disparities.
Copyright (c) 2021 Cancer Health Disparities
The Association Between Racial Segregation and Racial Disparities in Clinical Trial Accrual at an NCI Cancer Center
This quality improvement project examines the relationship between racial segregation in the Stanford Cancer Institute’s (SCI) catchment area and racial disparities in clinical trial accrual using Geographic Information System (GIS) analysis. It also briefly reviews strategies other cancer centers have used to address the effect of segregation on minority patient accrual in their catchment area. 215 studies in the gastrointestinal oncology clinic trials department at the SCI between 2012 –2020 were reviewed to collect data on race, ethnicity, and zip code of all available trial patients. These variables were plotted in the SCI’s catchment area using ArcGIS Online. A total of 848 patients were analyzed. The ethnicities of our trial patients were 61% White (n=514), 25% Asian/Pacific Islander (n=210), 13% Latinx (n=107), 2% Black (n=14), and <1% American Indian (n=3). 79% of Black patients were in non-interventional trials, and GIS analysis showed that 63% (7/11) of Black patients in the Bay Area resided in the East Bay (Contra Costa and Alameda County) – these areas were also associated with high rates of poverty and low access to personal transportation. This analysis showed racial disparities in clinical trial accrual at an NCI CCC and demonstrated how racial segregation has contributed to this disparity using GIS. While the analysis is limited due to a lack of descriptive variables in our database, supplementary data from the U.S. Census demonstrated a positive correlation between racial segregation and economic conditions that preclude minority patient enrollment – higher poverty rates and lack of personal transportation.
Characteristics of Incident Liver Cancer Cases in the District of Columbia Metropolitan Area
The District of Columbia (D.C.) has the highest liver cancer incidence in the United States (U.S.), but the reasons for this are not fully known. We examined socio-demographic, clinical and behavioral characteristics of incident liver cancer cases in D.C., Maryland (MD) and Virginia (VA) to identify potential risk factors.We obtained data from D.C., MD and VA cancer registries for individuals diagnosed with hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC) between 2013 and 2016. We estimated age-adjusted incidence rates and conducted descriptive analyses stratified by state/territory, sex, stage at diagnosis, and race/ethnicity. 5,928 incidents HCC/ICC cases occurred between 2013-2016. Age-adjusted incidence rates (per 100,000) for HCC/ICC were highest in D.C. (12.2, 95% CI=10.9, 13.5), for males (12.6, 95% CI=12.2, 12.9), and non-Hispanic Blacks (11.3, 95% CI=10.8, 11.8) and Asian/Pacific Islanders (APIs) (10.8, 95% CI=9.7, 11.9). Racial disparities in HCC/ICC incidence were widest in D.C. A substantial proportion of cases were missing data on country of birth and behavioral risk factors. Mean age at diagnosis, marital status, country of birth, insurance status, and alcohol and tobacco use history varied across analytic sub-groups. Non-Hispanic Blacks, APIs and males experience a high burden of liver cancer in the D.C. metropolitan area. There are several socio-demographic disparities by state/territory, sex, and race/ethnicity. More data on country of birth, behavioral risk factors, and comorbidities are urgently needed to understand their contribution to the burden of liver cancer in the D.C. metropolitan area.
Advancing Health Equity and Biomedical Researcher Diversity: A New AIM-AHEAD Consortium
Despite widespread knowledge regarding racial and ethnic health disparities, little has changed over the last decades. A creative, inclusive, and competitive biomedical research workforce is the foundation for turning discovery into health for all. To date, the expertise for advancing data-driven medicine based on artificial intelligence and machine learning (AI/ML) approaches has resided in majority-oriented institutions with little demonstrated experience in engaging minority-serving institutions or communities. Lack of diversity of both data and researchers runs the risk of creating and perpetuating harmful biases in the analytical algorithms, practice, and outcomes, thus fostering continued health disparities and inequities. Thus, the National Institutes of Health recently launched an Artificial Intelligence and Machine Learning Consortium to Advance Health Equity and Researcher Diversity (AIM-AHEAD) program. This two-year planning, assessment and capacity building program will be led by the AIM-AHEAD Coordinating Center comprised of a consortium of institutions and organizations that have a mission to serve minorities and underrepresented or underserved communities impacted by health disparities. This AIM-AHEAD research and development program seeks to illuminate underlying issues in health systems and research endeavors that need to be addressed to improve health for diverse communities.
Adaptation of a Community Health Advisor Intervention to Increase Colorectal Cancer Screening Among African Americans in the Southern United States
Community health advisor (CHA) interventions increase colorectal cancer (CRC) screening rates. Focus groups and learner verification were used to adapt National Cancer Institute CRC screening educational materials for delivery by a CHA to African American community health center patients. Such academic-community collaboration improves adoption of evidence-based interventions. This short article describes the adaptation of an evidence-based cancer education intervention for implementation in an African American community.
Race is Related with Increased COVID-19 Infection and Outcomes in Oncology Patients
We seek to assess racial disparities in oncology patients with COVID19 compared to appropriately matched controls with and without COVID19. All patients treated at the Seidman Cancer Center with a diagnosis of COVID19 and cancer were identified from the electronic medical record using ICD9/ICD10 codes for cancer diagnoses and database of all patients diagnosed with COVID19. Two control groups, cancer patients without COVID19 and patients without cancer but with COVID19, were generated and matched 3:1 on age at date of data extraction, age at cancer diagnosis, and sex to COVID19 positive cancer cases. African Americans (AA) and Whites made up 8.6% vs. 76.9% of the baseline oncologic population without COVID19, respectively. AA representation (41.0%) was significantly increased in cancer patients positive for COVID19 compared to those negative for COVID19 (p<0.001). In the comparison of patients with COVID19 with or without cancer, the proportion of AA cases was greater in the non-oncologic population (41.0% vs. 47.6%, p=0.014). AA are disproportionately affected with COVID19 in oncologic and benign populations. Despite similar rates of adverse outcomes to COVID19 in cancer patients by race, we found a 32.4% increase in the AA proportion compared to those without COVID19. These findings suggest COVID19 prevention policies and future studies should account for racial differences in the oncology population.
What Do We Want? Increased Hispanic Accrual on Cancer Clinical Trials! When Do We Want It? Now!
The Hispanic population is one of the fastest growing ethnicities in the United States. Cancer is leading cause of death in this demographic group and have up to 50% higher cancer mortality rates compared to the non-Hispanic white population in the United States. Hispanics face numerous cancer health disparities, including poverty, obesity, and access to health care and insurance. In our previous study, we noted a poor Hispanic accrual rate of 3.9% in all phase II and III cancer clinical trials published in the United States in 2012 and argued for better representation. To assess if a change was made seven years later, we reexamined the clinical trials published in the United States in 2019. We found 48 cancer clinical trials meeting our inclusion criteria. Only 23 (48%) reported information regarding minority accrual. Of these, 8 (17% of all) reported Hispanic accrual. Altogether, of the 2559 patients reported in the 8 clinical trials, 104 (4.1%) were of Hispanic ethnicity, which nearly matches the 3.9% that we reported in 2014. In this manuscript, we highlight the disproportionately low rates of Hispanic accrual in cancer clinical trials and propose processes that will increase representation.
Intersection of COVID-19, Cancer, and Racial Health Disparities
In this article, the authors explore the intersection between the COVID-19 pandemic with cancer and the health disparities experienced by African Americans. Using extant literature and contemporaneous data, they point out how overlooking the intersections of this triad could lead to the exacerbation of existing disparities for cancer patients based on race and ethnicity. They suggest best practices to balance cancer treatment and survivorship with increasing the potential COVID-19 exposures for patients, families, and health care workers. Drawing upon their analysis, the authors offer a list of recommendations and strategies for system level responses that are designed to foster practice and policy for cancer care health care equity and relate to cancer care equity, infection prevention and control, and cancer pain management, that may reduce disparities among African Americans.
COVID-19; cancer; racial health disparities
Enhancing African American Participation in Biospecimens: A Case in Point for Pancreatic Cancer
Diseases of the pancreas (i.e. chronic pancreatitis, diabetes and pancreatic cancer) disproportionally affect the African American community. Challenges associated with engaging the African American community in biospecimen research are longstanding. We surveyed a number of pancreas-related biobanks and data repositories for African American representation. While some of the biobanks and databases surveyed contain biospecimens and data from African American donors at levels that reflect minority representation among the general population, others do not. A number of factors have historically contributed to reduced participation of the African Americans community in biospecimen donation including medical mistrust, lack of transparency, fear and a poor knowledge and understanding about the use of biospecimens for research. Suggestions for increasing African American participation in organ and biospecimen donation include educational interventions, particularly in community groups, and providing printed and online recruitment materials to patients, patient advocates and care partners. Increasing awareness of the many benefits of biospecimen donation among African Americans will positively affect health disparities research into pancreatic cancer and other diseases.
Pancreatic Cancer, Health Disparities, African Americans, Biospecimen
Psychosocial Stress, Glucocorticoid Signaling, and Prostate Cancer Health Disparities in African American Men
Recent advances in our understanding of racial disparities in prostate cancer (PCa) incidence and mortality have provided important insights into the psychosocial, socioeconomic, environmental, and molecular contributors. There is, however, limited mechanistic knowledge of how the interplay between these determinants influences prostate tumor aggressiveness in African American (AA) men and other men of African Ancestry. Growing evidence indicates that chronic psychosocial stress in AA populations leads to sustained glucocorticoid signaling through the glucocorticoid receptor (GR), with negative physiological and pathological consequences. Compelling evidence indicates that treatment of castration-resistant prostate cancer (CRPC) with anti-androgen therapy activates GR signaling. This enhanced GR signaling bypasses androgen receptor (AR) signaling and transcriptionally activates AR-target genes and GR-target genes, resulting in increased prostate tumor resistance to anti-androgen therapy, chemotherapy, and radiotherapy. Given its enhanced signaling in AA men, GR—together with specific genetic drivers—may promote CRPC progression and exacerbate tumor aggressiveness in this population, potentially contributing to PCa mortality disparities. Ongoing and future CRPC clinical trials that combine standard of care therapies with GR modulators, both agonists and antagonists, should increase the participation of AA patients and carefully assess racial differences in therapy response and clinical outcomes.
NACP: Partnership for Native American Cancer Prevention
Cancer trends over a two-decade period show a greater reduction in cancer mortality rates for non-Hispanic Whites than for Native Americans. The Partnership for Native American Cancer Prevention (NACP) was established to address cancer health disparities that impact Native Americans. The partners are Northern Arizona University, the University of Arizona Cancer Center and Arizona’s tribal communities. The activities include outreach, research and cancer education. Overall, NACP seeks to expand capacity for culturally-sensitive and community-relevant research on cancer, and to continue developing respectful collaborations that will empower sovereign Native American communities to define, implement, and achieve their goals for cancer health equity.
Cancer, health disparities, American Indian, Native American, collaboration, research, education, outreach
Racial Disparities in Expression of GDF15 and NFκB in Prostate Cancer and Benign Prostatic Epithelium
Prostate cancer (PC) outcomes are more adverse for African-American (AA) than white (W) men. Growth differentiation factor 15 (GDF15, PDF, NAG-1) is a stress-induced anti-inflammatory cytokine with immunosuppressive and tumor growth-promoting functions. GDF15 inversely regulates NFκB, a transcription factor enabling pro-inflammatory gene expression and becomes constitutively activated in androgen-independent PC. Tissue microarrays (TMAs), prepared from prostatectomy tissue at three institutions, comprised 688 cases (364 W and 324 AA). Each case included ≥3 tumor punches plus ≥3 non-neoplastic punches. TMAs were stained separately for GDF15 and NFκB and evaluated by two pathologists, using the 0-3+ scale. PC, compared to benign epithelium, had elevated mean GDF15 expression (1.93 vs. 0.99) and also, NFκB (1.18 vs. 0.96, both P<0.0001). Only in AA men did PC show gradewise or stagewise altered expression of these markers. In AA men, GDF15 expression fell as stage rose in PC (P=0.007) and also in benign epithelium (P =0.003). In W men, GDF15 expression in benign epithelium fell as stage (P=0.01) and grade (P=0.01) rose. NFκB expression was higher in AA than W men only in high-grade PC (P =0.01). NFκB expression rose with increasing tumor grade only in AA men (P =0.027) and in the benign prostate component only in W men (P=0.007). Benign and tumor NFκB expression did not vary with stage. PC showed significant alterations in GDF15 and NFκB expression in accord with cancer aggressiveness in AA men only: stagewise decrease in GDF15, and gradewide increase in NFκB. Findings suggest a disparity for immune response by race in prostate carcinogenesis.
Racial disparity, prostate cancer, GDF15, NFÎºB
Copyright (c) 2020 Cancer Health Disparities
Hysterectomy-corrected Cervical Cancer Incidence Reveal Larger Racial Disparities in Texas 2012-2014
The purpose of this study was to determine the race specific age-standardized and age-specific annual Texas cervical cancer incidence after correcting for hysterectomy prevalence. A registry-based cross-sectional study design using Texas State level data for the years 2012-2014 was used to evaluate cervical cancer incidence after applying a correction for hysterectomy and examined racial disparities by age and race. We merged into a single database annual age- and race-stratified hysterectomy prevalence, cervical cancer incident case counts, population at-risk denominators and US Census 2000 population weights using the Behavioral Risk Factor Surveillance System (BRFSS) and Texas Cancer Registry (TCR), and used these data to estimate hysterectomy-corrected, age-standardized and age-specific cervical cancer incidence. Significant differences in hysterectomy prevalence by race were seen. For women aged 35-44 years, hysterectomy rates were highest in non-Hispanic whites. Among non-Hispanic blacks and Hispanics, the prevalence of hysterectomy peaked between the ages of 55 and 64 years, but thereafter continued to increase dramatically with age but only in non-Hispanic whites. The largest adjustment between corrected and uncorrected cervical cancer rates (17.1%) was in non-Hispanic white women followed by Hispanics (4.1%) and non-Hispanic blacks (3.6%). Failing to correct reported cervical cancer rates underestimates the true burden of disease. Hysterectomy prevalence in Texas also suggest disparities in access to care based on race. These findings provide further evidence-based information to develop more effective region and ethnic specific cervical cancer prevention programs using unbiased estimates of disease burden.
Liver cancer incidence and mortality: Disparities based on age, ethnicity, health and nutrition, molecular factors, and geography
Liver cancer (LCa) is the fifth and eighth leading cause of cancer death for men and women, respectively. However, despite improvements in treatment strategies and options, it has limited therapeutic options. Worldwide, the prevalence of LCa varies widely. Various factors are associated with the development of LCa, and its incidence, morbidity, and mortality rates differ due to disparities that are multifactorial and complex, including genetic and geographic factors. The frequency of LCa varies by race/ethnicity, age and sex and relates to viral infections, lifestyle, nutrition, obesity, and health. In addition, various molecular factors, including cytokines, hormones, apoptosis, and mutations, are involved in disparities in the progression and mortality of LCa. Here, we provide an overall perspective on LCa by presenting available information on these associated factors and discussing their importance in its disproportionate incidences and clinical outcomes.
Liver cancer, health disparity, nutrition and health, morbidity
A Genetic Roadmap of Gallbladder Cancer Disparities: A Potential for Development of Targeted Therapies
Gallbladder cancer (GBC) is an aggressive disease with a dismal prognosis and resistance to chemotherapy. Due to difficulties in early diagnosis of GBC, about 90% of patients are detected at advanced stages with palliative care being the only viable option. While surgery remains the mainstay treatment for early GBC, most patients who undergo surgical resection present with high degrees of recurrence. Unfortunately for many patients, surgical resection is not considered a possibility due to the time at which they are diagnosed. Adjuvant therapies in the form of radiation and/or embolization of the tumor have been probed for the disease with moderate success. While there have been multiple studies (both retrospective and pooled analysis) that suggest an added advantage of combining adjuvant therapy with surgical resection, data from prospective studies is limited. Interestingly, GBC affects women, American Indian, Alaska Native, and black people, and certain Asian ethnic groups in peculiar geographic locations such as Chile, India, China more than other groups elsewhere. These disparities in gender and ethnicities demonstrate the need for better understanding of underlying genetic events of GBC so that molecularly targeted therapies could be developed to provide hope for improving treatment response and better outcome. However, for GBC not much progress has been made mainly due to the lack of understanding of molecular pathogenesis of this disease. This article presents a review of literature focused on molecular and genetic alterations in GBC, and as to how effective targeted therapeutic strategies can be developed with demonstrated survival benefit.
Cervical Cancer Outcome by Type of Health Care Facilities: National Cancer Database, 2004-2015
The National Cancer Database from 2004 to 2015 was analyzed to identify cervical cancer outcomes associated with demographic and clinical characteristics measured by types of facility. Chi-Square tests were used to compare proportions and logistic regression to determine factors associated with cervical cancer outcomes. Women treated at Academic/Research Programs (ARPs) were younger at diagnosis, more likely black, less educated and more in Stage 2, lived further away from treatment facilities, had less comorbidities and better 5- year survival, and were more likely to be alive at 30 and 90 days after surgery compared to other programs. Women treated at Community Cancer Programs were more likely 75 and older at diagnosis, more likely to receive radiation treatment and more in Stage 4, more living in rural areas and less than 10 miles from the facility, and had more comorbidities, and lower 5-year survival compared to other programs. Women treated at Comprehensive Community Cancer Programs were more likely white and educated, had more private insurance, and underwent surgery. Women treated at Integrated Network Cancer Programs were more likely to live in urban, south region, and in Stage 1B2, had more surgery and one comorbidity, and died fewer than 30 days after surgery. The type of facility and treatment had varied effects on mortality and 5-year survival. Considering the different cervical cancer outcomes from different health care facilities, further research is needed to identify what factors influence women to choose a health care facility for their treatment and how this choice can affect different health outcomes.
Cervical cancer, type of facility, mortality, survival
Copyright (c) 2019 Cancer Health Disparities
Standardized Global Behavioral and Epidemiological Measures for Prostate Cancer Studies in Black Men
Multicenter trans-national studies may be required to understand the complex causes of and solutions to prostate cancer disparities in Black men. In 2014, two cancer epidemiology consortia supported by the US National Cancer Institute (NCI) - the Prostate Cancer Transatlantic Consortium (CaPTC), and African-Caribbean Cancer Consortium (AC3) - formed a consortia alliance to address the disproportionate burden of prostate cancer in Black men. As part of the alliance, this global study focused on developing standardized and culturally tailored data elements and measures for prostate cancer research in these populations. The study objective was achieved by a Consensus Working Group using the NCI–Grid-Enable Measures (GEM) platform. The Consensus Working Group members were assigned to three Special Interest Groups to focus on behavioral, epidemiology and clinical topics. Based on crowd-sourcing methodology, the initial standardization decisions were made by each group using GEM. This was followed using nominal group technique to build consensus. Finally, a one-day consensus development conference was held to facilitate the input of the scientific community. The use of the GEM platform, nominal group technique and a consensus development conference resulted in agreement among stakeholders for a recommended set of measures that included 25 behavioral scales and 24 epidemiological scales. The measures developed in this process will facilitate data harmonization and data sharing for multiethnic studies of Black men globally and these measures can be used by other researchers in this area
Colorectal Cancer Education and Screening Program For The Un- or Under- Insured In A Primarily Rural Setting in Northeast Texas: Design and Methods
Background: Although early detection and screening for colorectal cancer saves lives, screening rates remain suboptimal, especially for minorities, underserved populations, older adults (>60), men, un/under insured, and those living in rural settings. The goal of the colorectal cancer education and screening program is to target the un- or under- insured in a 19-county primarily rural target area to provide: 1) education concerning CRC and CRC screening to 12,000 individuals, and 2) CRC screenings (colonoscopy and/or FIT) to 5,1613 un- or under- insured individuals. Methods: The education outreach team targets local health fairs, clinics, churches, etc. to educate individuals on CRC and the importance of screening. The program aims to then have those individuals electively undergo a colonoscopy and/or a FIT test. The number of those educated and screened is recorded. The results related to colonoscopy, FIT, and follow-up are collected. Results: Primary outcomes include number of individuals educated, number of FIT test/colonoscopies performed and results of screening procedures. Conclusions: This education and screening outreach program is designed to reach primarily rural and underserved populations eligible for colorectal screening. Results of efficacy of program will advance knowledge on how to conduct colorectal cancer outreach programs in rural settings.
Architecture of the Chicago Cancer Health Equity Collaborative – A Partnership Delivering Transformative Cancer Health Equity Research, Education and Community Engagement
Reducing cancer health inequities requires transformation of longstanding structures, including ways of ‘doing business’ and other deeply rooted traditions that perpetuate social injustice. We posit that moving the needle toward cancer health equity requires the building of large-scale partnerships with the infrastructure and reach to reshape the architecture defining how education, training, and research are conducted. It is with this vision that the Chicago Cancer Health Equity Collaborative (ChicagoCHEC) was conceived in response to a call for proposals by the National Cancer Institute (NCI) in 2015 that sought applications for a partnership across a NCI designated comprehensive cancer center and up to two institutions serving underserved health disparitypopulations and underrepresented students. ChicagoCHEC was conceived as a tri-institutional partnership comprised of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, a NCI-designated Comprehensive Cancer Center which serves a diverse nine county catchment area, Northeastern Illinois University, a minority-serving institution known for its connection to minority students, and the University of Illinois Cancer Center at the University of Illinois at Chicago (UIC), a minority-serving institution and leader in community-focused cancer care and disparities research. Established in 2016, ChicagoCHEC is comprised of four functionally distinct cores that together serve the mission of advancing cancer health equity through meaningful scientific discovery, education, training, and community engagement. The successful functioning of of ChicagoCHEC is evident from the fruits borne by the partnership in research, education, and community engagement toward the goal of eradicating cancer health inequities.
cancer; health equity; cancer health disparities; partnership
Relationship between the TP53 SNP rs1800371 and Lung Cancer in African Americans
Background: Germline and somatic mutations in TP53 have been investigated and intensely catalogued. One of these germline mutations, TP53 P47S SNP is only found in populations with African ancestry. The S47 variant was associated with an impaired ability to induce cell death following cisplatin treatment, and with a high rate of spontaneous cancer formation in mice engineered to carry S47. Lung cancer incidence is higher among men of African descent. We therefore tested the hypothesis that P47S was associated with increased risk of lung cancer. Methods: We included 926 controls and 425 cases, all of whom were African Americans. We genotyped rs1800371 using a predesigned Taqman assay. Results: No serine/serine genotypes were detected in the population. The proline/serine genotype was detected in 42 individuals (32/891 controls (3.5%) and 10/434 cases (2.3%). The serine allele was not associated with risk of lung cancer (OR: 0.65, 95% C.I. 0.28-1.48). Conclusions: rs1800371 is not associated with risk of lung cancer among African Americans.