UCCCC researchers are tackling the issue of cancer disparities, discovering better methods for providing cancer care to underserved populations. Much of this research benefits the people in local neighborhoods, as well as at-risk populations throughout the world. Here is a sampling of some of the discoveries made in recent years.
Breast Cancer SPORE
The University of Chicago Specialized Program of Research Excellence (SPORE) in Breast Cancer performs significant work in health disparities research. Working with local communities, SPORE researchers are striving to accumulate a unique collection of samples to determine the reasons behind cancer health disparities. Olufunmilayo Olopade, MBBS, FACP, the Walter L. Palmer Distinguished Service Professor of Medicine and Human Genetics, director of the Center for Clinical Cancer Genetics and Global Health, and associate dean for global health, is the primary investigator of the Breast Cancer SPORE.
By reaching out to members of South Side communities, researchers are fostering trust between UChicago and its neighbors. The Breast Cancer SPORE has a full-time recruiter, located in The University of Chicago Breast Center, who informs patients about SPORE activities, patient services, education and outreach, tissue acquisition, and clinical trials. The team is working to advance research on the prevention, early detection, and treatment of breast cancer, specifically focusing on the interplay of genes and the environment in the development of triple-negative breast cancer. These cancer cells do not have estrogen receptors, progesterone receptors, or large amounts of HER2/neu protein, which are therapeutic targets for many cancer treatments. Consequently, this form of cancer tends to be more aggressive, less responsive to treatment, and more likely to strike young women and those of African ancestry. The team seeks to identify and characterize genes relevant to the development of this cancer, determine their role in inherited susceptibility, and perform genetic epidemiologic analyses that can be used in the clinic.
Recent findings in the laboratory have revealed differences in tumor biology between Whites and African Americans. For example, Africans and African Americans have more poorly differentiated tumors that lack estrogen receptor expression compared to Whites. These biological differences lead to cancers that are more difficult to diagnose and treat, which lead to poorer health outcomes. Thus, the findings suggest that disparities in cancer epidemiology are, in part, due to genetic differences among racial/ethnic populations.
In related research, Suzanne Conzen, MD, associate professor of medicine, and Martha McClintock, PhD, professor of psychology and founder of The University of Chicago's Institute for Mind and Body, have long been interested in the impacts of stress and social isolation on breast cancer risk. Using mice models, they demonstrated that social isolation can promote tumor growth. The study shows that isolation is associated with altered gene expression in mouse mammary glands, and that these changes are accompanied by larger tumors, indicating a possible correlation between stress and cancer risk among humans.
Hormone Replacement Therapy
In 2002, many women halted their use of hormone replacement therapy in response to findings of the Women's Health Initiative trial, which demonstrated that hormone supplements increased coronary heart disease and breast cancer risk. Afterward, the incidence of invasive breast cancer among women over the age of 50 in the United States declined during 2002 and 2003. UCCCC researchers, however, found that the decrease in breast cancer incidence was not observed among women of African American ancestry in the same age group. Researchers at the UCCCC, including Dezheng Huo, PhD, assistant professor of epidemiology, and Dr. Olopade, investigated why this trend was not equal across racial groups. Although African Americans showed a similar decrease in the use of hormone therapy, no benefit was observed. The researchers suspected that the observed racial disparity resulted from differences in biology. For example, nearly 80% of breast cancers in White women are estrogen receptor positive, a type of tumor that relies on estrogen for growth, compared to approximately 60% and 30% among African Americans and Nigerian women, respectively.
Attitudes and Behaviors
A study led by William Dale, MD, PhD, assistant professor of medicine, and chief of geriatrics and palliative medicine, found that a majority of African American men radically underestimate the threat of prostate cancer even when a blood test or other diagnostic procedure indicates that they have an increased risk. At the time of prostate biopsy, 55% of these men said it was "impossible" they had cancer; this compares with only 20% of Whites who have similar reactions. Men who feel that they do not have prostate cancer, particularly when they are actually at higher risk than their white counterparts, are less likely to seek early diagnostic testing and treatment. This could be one reason why African American men are often diagnosed late during the development of prostate cancer, and why their mortality rate is significantly higher than their White counterparts.
Andrea King, PhD, associate professor of psychiatry and director of the Substance Abuse Clinic, and Lisa Sanchez-Johnsen, PhD, assistant professor of psychiatry and medicine, and director of multicultural health research and latino health research, recognize the urgent need for treatments and prevention strategies to overcome ethnic and cultural barriers. Their work on a community-based, culturally tailored smoking cessation program for African Americans living on the Southside has provided initial clues on the utility of culturally sensitive approaches to increase treatment retention and quit rates. Dr. Sanchez-Johnsen is also working to reduce cancer risk factors among Latinos. She is developing interventions for overweight Latino women that encourage healthy diets and physical activity, address harmful body image issues, and deter smoking. She is also investigating cultural variables underlying obesity in Puerto Rican and Mexican women.
Genetic, Cultural, and Biobehavioral Traits
Blase Polite, MD, assistant professor of medicine, and his colleagues found a plausible link between the genetic, cultural, and biobehavioral traits of women and their susceptibility to some cancers. They found that African American women with metastatic breast cancer have lower survival rates than White women, even when both groups receive the identical treatment regimen. A study published recently by Monica Peek, MD, MPH, assistant professor of medicine, and her colleagues found that training physicians and health workers in cultural sensitivity and communication with economically disadvantaged African American patients could increase the participation of these patients in breast cancer screening. Dr. Peek discovered that many African American women said that health professionals do not treat them respectfully. They also reported feeling that health professionals do not adequately explain the importance of potentially life-saving mammograms. Many of the participants in the study said they had heard rumors about women who had bad experiences with mammograms and received unnecessary or incorrect treatments, including unneeded mastectomies. These impressions discourage women from obtaining adequate care and regular mammograms, increasing the burden of cancer in that population.
Environment and Genetics
Habibul Ahsan, MBBS, MMedSc, professor of health studies researches the interrelationships between environmental and genomic (hereditary) factors in cancer and develops and evaluates disease prevention interventions in humans. Ongoing major research projects include studies of: 1) individuals with early onset breast cancer; 2) cancer risk from arsenic exposure in Bangladesh; 3) genetic susceptibility to arsenic-related skin tumors; and 4) the ability of vitamin E and selenium to prevent cancer and cancer-related death in populations exposed to arsenic.
These UCCCC studies represent a small sampling of the many research efforts that are helping scientists and health officials understand and address cancer health disparities. This new knowledge can have profound impacts on the health of individuals in at-risk groups. The UCCCC's community outreach program is essential for bringing the full benefits of these research advances to the community.
