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Marcia Cruz-Correa, M.D., Ph.D.
University of Puerto Rico

Finds Link between Human Papillomavirus and Colorectal Cancer

Marcia Cruz-Correa, M.D., Ph.D.

CRCHD grantee Marcia Cruz-Correa, M.D., Ph.D., bolstered by her team of researchers from the University of Puerto Rico (UPR), have discovered a link between human papillomavirus (HPV) and colorectal cancer (CRC) in tissue samples from a large cohort of CRC patients. HPV is the most common sexually transmitted infection in the United States. It has been linked to cervical and anal cancers, but may be prevented by a vaccine. CRC is one of the leading causes of cancer-related deaths in the underserved in the United States.

Cruz-Correa is also lead primary investigator on a CRCHD Partnerships to Advance Cancer Health Equity (PACHE) grant between UPR Medical School and M.D. Anderson Cancer Center in Texas.

After a preliminary analysis of 260 CRC patients, the investigators demonstrated that HPV was present in approximately 42% of CRC tumors and in 20% of patients with normal colonic mucosa. "We observed that in individuals with HPV infected cancer tumors, the virus was integrated at the genomic level in most cases," she said. "We also examined mRNA expression of viral oncogenes E6 and E7 in those HPV+ tumors. The HPV genome was integrated in all HPV-16 positive colorectal cancer cases, and the expression of the E6 gene was universally observed."

This is an ongoing study funded under an NCI/CRCHD R21 grant. Working alongside Cruz-Correa are Raul Bernabe, Ph.D. and Professor Yasuhiro Yamamura from the Ponce School of Medicine and Health Sciences.

Cruz-Correa currently heads the Gastrointestinal Oncology Program at the UPR Cancer Center, where a multidisciplinary team comprising clinicians, basic and clinical scientists, and epidemiologists collaborate to treat CRC. She is also Associate Professor of Medicine, Biochemistry and Surgery at UPR, Visiting Assistant Professor of Medicine at Johns Hopkins University (JHU) in Maryland, and Adjunct Associate Professor of Surgical Oncology at the M.D. Anderson Cancer Center.

The focus of the Gastrointestinal Oncology Program is to uncover genetic and epigenetic pathways for colorectal carcinogenesis among Hispanic patients with hereditary cancer syndromes. Cruz-Correa and her research team developed the first population-based, familial colorectal cancer registry in Puerto Rico, which currently has more than 500 CRC patients enrolled.

Cruz-Correa is co-leading an NCI R01 clinical trial evaluating the role of bioflavinoids (curcumin) as a chemopreventive agent in adult patients with familial adenomatous polyposis (FAP). Bioflavinoids are natural products that have potent anti-inflammatory and anti-oxidant qualities. Curcumin, the main chemical in the popular South Asian spice turmeric, is a natural bioflavinoid that comes from the root Curcuma Longa, and has been shown to inhibit inflammation.

"In this study, we are conducting a randomized, double blind, placebo-controlled, clinical trial to evaluate the efficacy of oral curcumin as a chemopreventive agent in patients with FAP," Cruz-Correa said. Individuals with FAP have a genetic mutation that causes the development of colorectal adenomas and cancer if left untreated. "Our goal is to determine if using high-dose oral curcumin is associated with a reduction in colorectal polyps and/or prevention of new polyps in this population," she said.

Cruz-Correa is also a co-investigator evaluating the use of celecoxib in pediatric patients with FAP.

On Feb. 24, 2011, President Barack Obama appointed Cruz-Correa to the National Cancer Advisory Board (NCAB), a position she will hold until 2016. NCAB comprises 18 members appointed by the President of the United States. The board advises and assists the Director of NCI, Harold Varmus, M.D., with the National Cancer Program.

"Ever since I was a child, I had an interest in science, and owned a variety of microscopes and a stethoscope," she said. But, it was her professors during her post-graduate training, Francis Michael Giardiello, M.D. and Andrew P. Feinberg, M.D., MPH, both at JHU, and Gloria Petersen, Ph.D., at the Mayo Clinic, who strongly influenced the scientific direction she is taking now.

Cruz-Correa completed her B.S. in Biology at UPR and her medical degree at the UPR Medical School. She completed her training in internal medicine at the UPR Hospital, and subsequently did a fellowship in gastroenterology and hepatology at JHU. Cruz-Correa completed a doctorate degree in clinical investigation and genetic epidemiology at the JHU Bloomberg School of Public Health.

Cruz-Correa has published more than 50 original papers, and is a reviewer for numerous medical journals, including Gastroenterology and Cancer Research. She is a member of numerous medical societies, including the American Gastroenterology Association and the American Society for Gastrointestinal Endoscopy, is past-President of the Puerto Rico Gastroenterology Association, and President of the Puerto Rico Colorectal Cancer Coalition. Cruz-Correa also sits on several NCI special review panels.

Updated: 03/14/14