NIH/NCI Research, Prevention and Training Initiatives Addressing CHD among African Americans
Despite recent declines in cancer death rates among African Americans and tremendous advances in cancer prevention and treatment, African Americans continue to experience a disproportionately higher share of the cancer burden.
CRCHD recognizes some of the NIH/NCI Research, Prevention and Training initiatives that address cancer health disparities among African Americans
- Basic Research
- Genomic Research
- Clinical Research
- Community & Population Based Research
- Culturally Tailored Communications
- Building a Diverse Workforce
Recent biological evidence from one NCI-supported study, for example, indicates that multiple circulatory micro RNAs (miRNA), such as miR-101, 628-5p and miR-212, are differentially expressed in serum among African American, compared with Caucasian prostate cancer patients. Downstream targets for these miRNA are currently being explored, and these circulatory miRNAs have the potential to be minimally invasive biomarkers for this ethnically diverse disease.
Evidence from another recent NCI study suggests that certain genetic alterations of a protein that inhibits inflammation are associated with increased susceptibility to colon cancer in African Americans. Taken altogether, these findings contribute to an enhanced and more precise picture of the biological roots of cancer disparities, and may provide biomarkers that can be used as a way to measure response to treatment.
In an effort to advance the understanding of cancer at the molecular level, with the ultimate goal of improving clinical outcomes, NCI supports numerous cancer genomics studies focused on the systematic analysis of changes in the genomes of tumors. New findings from genomic profiling of tumors from individuals from diverse populations are enhancing our understanding of cancer biology and driving improvements in cancer screening, diagnosis, drug development, and care.
In the case of breast cancer, for example, we know that the overall rate of new breast cancer cases is not higher for racial and ethnic minorities; however, a distinct molecular subtype of breast cancer—triple negative breast cancer (TNBC)—is significantly higher in African American women than in all other racial and ethnic groups. It is advances in genomics, through programs such as The Cancer Genome Atlas (TCGA), that are helping to clarify that this disparity in TNBC rates is not due to a disparity in care or access to care, but that the disease itself is different in African American women. This sort of knowledge has potential to lead to more precise therapies tailored to each subtype.
One ongoing study, for example, has revealed that the genetic risk factors selected from genome-wide association studies (GWAS) for Europeans were different from risk alleles identified in African Americans for colorectal cancer.
Recent emphasis in TCGA has been placed on recruiting African American patient samples, as there has historically been a very low rate of sample accrual from this population. In recent months, TCGA has quadrupled the proportion of African American patient samples in the analysis pipeline. Currently, close to 400 cases distributed across all cancers studied in the TCGA pipeline are known to be of African American patients compared with a total of almost 6,000 cases, or 6.3% of samples accrued. This is one of the largest racially and ethnically diverse tumor cohorts to be comprehensively characterized in this fashion, and with all data in the public domain, it will continue to grow throughout the duration of the project.
To further our understanding of the TNBC response to different therapies, ongoing clinical trials are examining the role of anti-angiogenesis agents, platinum compounds, PARP inhibitors, and other targeted agents in TNBC. In addition, molecular profiling is being used to help determine which subtypes of TNBC will respond to the different therapies. NCI is supporting, for example, a pre-operative study to see if adding other drugs to standard neoadjuvant chemotherapy can help shrink TNBC faster and lower the risk of the cancer coming back in other parts of the body. This study is specifically working to encourage accrual from African American women.
In another NCI project, investigators are identifying genotypes that confer high risk for developing multiple myeloma, known to disproportionately affect African Americans. DNA from patient specimens indicated that presence of a single nucleotide polymorphism was inversely associated with multiple myeloma in African Americans while no association between this single nucleotide polymorphism and multiple myeloma risk was observed for whites. Identification of ethnic-specific genetic risk factors for multiple myeloma could facilitate screening approaches and inform subsequent treatment strategies.
NIH's National Institute on Minority Health and Health Disparities (NIMHD) is supporting clinical research to better understand the disproportionate mortality of African American men due to prostate cancer. Current projects are examining the relationship between obesity and poor prostate cancer outcomes, and have identified multilevel models to predict tumor aggressiveness that include tumor biomarkers, individual risk factors, and macro-environmental risk factors. Another NIMHD-funded clinical trial is evaluating the impact of patient navigation on improving surgical resection rates among African Americans with early-stage lung cancer.
Promoting interest and participation in clinical trials is a very important aspect of NIH's work, as well. An example of research to develop best practices for this is the NCI Partnerships to Advance Cancer Health Equity (PACHE) program in South Carolina. That program developed and tested an intervention consisting of a 30-minute educational presentation on clinical trials. Findings indicated the intervention significantly increased positive perceptions of cancer clinical trials in a predominantly African American female group compared to groups where the intervention was not used.
Community & Population Based Research
In South Florida, a Community Network Program Center (CNPC) assessed the efficacy of screening compliance in African American women using a home-based human papillomavirus (HPV) test. Self-sampling resulted in a much higher compliance rate with home-based screening compared to going for Pap smears at a health clinic.
To increase availability of and access to colonoscopy services among African Americans, the South Carolina CNPC trained primary care physicians to perform colonoscopies, which increased the colonoscopy rates in African Americans enrolled in the program more than fivefold compared to no change in the control group consisting of whites.
Culturally Tailored Communications
NCI strives for the most effective strategies to communicate cancer information to African Americans. In 2011, NCI developed Anyone Can Get Skin Cancer-Learn How to Protect the Skin You're In! a brochure to raise awareness of the risk of skin cancer in people with darker skin and to dispel the belief that only people with light skin are at risk for skin cancer. NCI has also developed the Breast Cancer Risk Assessment Tool (BCRAT), which estimates a woman's personal risk of developing invasive breast cancer. Used widely by clinicians for counseling patients, it was initially developed based on data for white women. Researchers have now developed a model to predict breast cancer risk in African American women.
Similarly, the NCI Geographical Management of Cancer Health Disparities Program including Biospecimen Science (G/BMaP) is adapting and expanding upon patient education materials, created in recent years by collaborations between NCI's Cancer Information Service (CIS) and CNPCs across the nation to develop patient education modules on biospecimens and biorepositories that are culturally relevant to African Americans.
Advances in understanding the factors related to cancer etiology and outcomes require diverse population participation in biospecimen donation. To heighten awareness of, and interest in the importance of biospecimen collection among culturally diverse communities, NCI recently launched The National Biospecimen Awareness and Collection Campaign, with the ultimate goal of advancing the ability to diagnose, treat, and prevent cancer among all people, as well as reduce cancer disparities among high-risk population groups.
Emphasis is placed on increasing awareness of and education around the importance of biospecimen collection among racially and ethnically diverse populations, and recruiting tissue source sites serving mostly racially and ethnically diverse populations, with particular focus on African American patient samples.
Building a Diverse Workforce
As part of its commitment to making sure that current cancer health disparities are reduced or eliminated, and all Americans share equally in the medical advances that result from cancer research, NCI is helping to build a diverse workforce for the biomedical sciences. NCI is attracting and engaging talented students from African American populations and other backgrounds traditionally underrepresented in cancer research, and providing a smoother path towards careers in science and medicine.
The NCI Continuing Umbrella of Research Experiences (CURE) program concentrates on offering training support to those individuals who might not otherwise have the opportunity to pursue careers in cancer research. Support is available from the high school level extending through the independent cancer researcher level.
NCI provides training, fellowships, and other professional educational opportunities for students and scientists to receive support through NCI funding. NCI also provides postdoctoral training opportunities in cancer prevention and control through its Cancer Prevention Fellowship Program. The purpose of this program is to train individuals from a variety of health sciences disciplines in the field of cancer prevention and control.
Reducing and ultimately eliminating cancer health disparities among African Americans and other racially and ethnically diverse populations in the U.S. continues to be one of NIH/NCI's top priorities in their efforts to improve and protect the health and well-being of all Americans. Significant progress has been made in addressing and communicating cancer research findings through engagement and collaborative efforts with diverse communities, at the same time, there is still much work to be done to reduce the unequal burden of cancer that still exists in this country.
Additional progress is expected as NIH/NCI continues to build upon the success of these collaborations in the coming years to advance the science and move closer to achieving the goal of eliminating cancer health disparities. NIH/NCI is unwavering in their commitment to reaching the day when diversity is a given and disparities no longer exist.
- 1. DeSantis, C. et al. Cancer Statistic for African Americans, 2013. CA: A Cancer Journal for Clinicians. American Cancer Society (in press).
- 2. Jemal, A. et al. Annual Report to the Nation on the Status of Cancer, 1975-2009, Featuring the burden and Trends in Human Papillomavirus (HPV)-Associated Cancers and HPV Vaccination Coverage Levels. Journal of the National Cancer Institute. 2013, 105(3):175-201.