ATLANTA — Women with interruptions in health insurance coverage or with low income levels had a significantly increased likelihood of failing to receive breast cancer care that is in concordance with recommended treatment guidelines, according to results presented here at the Sixth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held Dec. 6-9.
Women with a break in their insurance coverage had a 3.5-fold higher likelihood of nonconcordance with National Comprehensive Cancer Network (NCCN) guidelines for radiation therapy and chemotherapy compared with women with uninterrupted coverage.
“We found that women who had no insurance at some point during treatment, women with lower incomes compared with those in the highest income categories, and women who held more debt at the time of diagnosis were less likely to receive all of the recommended breast cancer treatments,” said Jean A. McDougall, Ph.D., M.P.H., a postdoctoral fellow at the Fred Hutchinson Cancer Research Center in Seattle, Wash. “Documenting and understanding these disparities is important for connecting women who are at high risk for not receiving all of their treatment with a patient navigator or social worker ahead of time so that we might increase the likelihood that they will get recommended treatment.”
McDougall and colleagues conducted a population-based cohort study of 1,344 women from the Seattle-Puget Sound area diagnosed with breast cancer between 2004 and 2011. Using data from the cancer registry records, pathology reports, and patient self-reports, the researchers assessed whether or not the treatment received was in concordance with guidelines issued by the NCCN.
The researchers found that women with an annual family income of less than $50,000 were more than twice as likely to have received care that was not in concordance with guidelines for radiation therapy compared with women with an income of greater than $90,000 per year. In addition, they had an almost five times higher likelihood for nonconcordance with chemotherapy guidelines, and an almost four times higher likelihood for nonconcordance with endocrine therapy guidelines.
They also found that women who had consistent financial insecurity or who had debt at the time of cancer diagnosis had an increased likelihood for nonconcordance with American Society of Clinical Oncology/NCCN Quality Measures.
In addition, women who had problems talking to a doctor, women who did not have anyone to accompany them for their hospital visits, and women who did not have anyone to take care of them and their household chores, were less likely to receive NCCN guideline-recommended chemotherapy.
“Surprisingly, we found that education or the facility where a woman was treated was not associated with receipt of guideline-recommended care,” McDougall said. “Our results suggest that further studies are needed to address the root cause of these inequities, and to develop effective interventions.”
This study was funded by the National Cancer Institute’s Center for Population Health and Health Disparities. McDougall has declared no conflicts of interest.
ATLANTA — Diabetes was associated with an increased risk for developing a type of liver cancer called hepatocellular carcinoma, and this association was highest for Latinos, followed by Hawaiians, African-Americans, and Japanese-Americans, according to results presented here at the Sixth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held Dec. 6-9.
“People with diabetes have a two- to threefold higher risk for hepatocellular carcinoma compared with those without diabetes,” said V. Wendy Setiawan, Ph.D., assistant professor in the Department of Preventive Medicine at Keck School of Medicine of the University of Southern California. “We also found that the interethnic differences in the prevalence of diabetes were consistent with the pattern of hepatocellular carcinoma incidence observed across ethnicities: Ethnic groups with a high prevalence of diabetes also have high hepatocellular carcinoma rates, and those with a lower prevalence of diabetes have lower hepatocellular carcinoma rates.”
The number of new cases of hepatocellular carcinoma in the United States tripled in the past three decades, with Latinos and African-Americans experiencing the largest increase in incidence. Prior research has suggested that diabetes may be a risk factor for hepatocellular carcinoma, and its increasing incidence may be contributing to the rising rate of hepatocellular carcinoma.
“People with diabetes should be aware that their condition is associated with a higher risk of developing hepatocellular carcinoma,” Setiawan said. “Maintaining a healthy weight, managing their diabetes, preventing and treating hepatitis infection, and limiting alcohol and tobacco use should be in their priority to-do list.”
In addition, Setiawan said that public health efforts encouraging obesity/diabetes prevention and effective diabetes management should be directed at high-risk populations.
Setiawan and colleagues examined if the association between diabetes and hepatocellular carcinoma differed by race/ethnic group. They analyzed data from more than 150,000 people enrolled in the Multiethnic Cohort Study between 1993 and 1996. During the study follow-up period of about 15 years, 506 cases of hepatocellular carcinoma were reported: 59 cases in non-Hispanic whites, 81 in African-Americans, 33 in Hawaiians, 158 in Japanese-Americans, and 175 in Latinos.
Compared with non-Hispanic whites, Latinos had 2.77 times the risk for being diagnosed with hepatocellular carcinoma, the highest risk identified. Native Hawaiians had 2.48 times the risk; African-Americans, 2.16; and Japanese-Americans, 2.07.
The prevalence of diabetes was consistent with that of hepatocellular carcinoma. Sixteen percent of Hawaiians, 15 percent of Latinos and African-Americans, 10 percent of Japanese-Americans, and 6 percent of non-Hispanic whites had diabetes. Compared with those without diabetes, Latinos with diabetes had 3.3-fold higher risk for hepatocellular carcinoma; Hawaiians, 2.33-fold higher risk; Japanese-Americans, 2.02-fold higher risk; African-Americans, 2.02-fold higher risk; and non-Hispanic whites had 2.17-fold higher risk.
Hepatocellular carcinoma was attributed to diabetes in 26 percent of cases in Latinos, 20 percent of Hawaiians, 13 percent of African-Americans, 12 percent of Japanese-Americans, and 6 percent of non-Hispanic whites, the researchers estimated. According to Setiawan, eliminating diabetes could potentially reduce hepatocellular carcinoma incidence in all racial/ethnic groups, with the largest potential reduction possible in Latinos.
This study was funded by the National Cancer Institute. Setiawan has declared no conflicts of interest.
ATLANTA — Among African-American women with breast cancer, increased levels of the protein HSET were associated with worse breast cancer outcomes, according to results presented here at the Sixth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held Dec. 6-9.
“Our data indicate that HSET represents a potential new biomarker for poor breast cancer outcome among African-American women with the disease,” said Ritu Aneja, Ph.D., associate professor in the Department of Biology at Georgia State University in Atlanta. “Using this biomarker effectively could give oncologists critical new information and potentially save lives by allowing earlier recognition of more aggressive breast cancers in African-American women, with the subsequent use of more customized treatment regimens to better manage disease.”
African-American women are often diagnosed with breast cancer at a younger age than non-Hispanic white women and are more likely to have cancers that spread, recur, or result in death. Identification of biomarkers that can help clinicians predict if African-American women will have aggressive cancer is a high priority, according to Aneja.
Prior research has linked HSET overexpression to lung cancer metastasis to the brain, and has shown that HSET is upregulated in a particularly aggressive form of breast cancer that most commonly occurs in African-American women, triple-negative breast cancer.
To evaluate whether HSET could be a clinical breast cancer biomarker in ethnically distinct populations, Aneja and colleagues analyzed breast tumor samples from 149 African-American women and 44 non-Hispanic white women, looking for levels of HSET.
Breast tumor samples from African-American women were three times more likely to show high levels of HSET in a region of cells called the nucleus when compared with breast tumor samples from non-Hispanic white women. In addition, higher levels of nuclear HSET were linked to poorer outcomes among African-American women, but not non-Hispanic white women. African-American women with the highest levels of HSET were three to four times more likely to have shorter overall survival, progression-free survival, and metastasis-free survival when compared with African-American women with the lowest levels of HSET.
“We were surprised to find that HSET levels appeared to be a better predictor of cancer outcome than other routinely used breast cancer predictors, such as assigning triple negative status,” said Aneja. “We are working around the clock to define ways in which this new biomarker can be used most effectively and as soon as possible in the clinical setting.”
This study was funded by National Cancer Institute at the National Institutes of Health. Aneja has declared no conflicts of interest.
ATLANTA — Researchers have uncovered a potential biological factor that may contribute to disparities in prostate cancer incidence and mortality between African-American and non-Hispanic white men in the United States, according to results presented here at the Sixth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held Dec. 6-9.
In the United States, African-American men are 1.5 times more likely to develop prostate cancer and more than twice as likely to die from the disease compared with non-Hispanic white men.
“The causes of prostate cancer disparities are numerous, complex, often interrelated, and only partially understood,” said David P. Turner, Ph.D., assistant professor in the Department of Pathology and Laboratory Medicine at the Medical University of South Carolina in Charleston. “We have identified a potential relationship between sugar-derived metabolites and cancer that may provide a biological link with socioeconomic and environmental factors known to contribute to prostate cancer disparities.
“As our bodies use the sugars that we consume for energy they generate waste products, or metabolites, including molecules called advanced glycation end products, or AGEs,” Turner explained. “AGEs naturally accumulate in our tissue as we grow older, and they have been implicated in diseases associated with aging such as diabetes, heart disease, and Alzheimer’s disease. They can also cause increased inflammation and the generation of potentially harmful chemicals known as reaction oxygen species, which both promote cancer.
“Critically, a common source of the AGEs that accumulate in our bodies is the foods we eat, which has significant implications for cancer health disparities and our overall health.
“We found that AGE levels were highest in African-American men with prostate cancer,” said Turner. “Because obesity, poor eating habits, and an inactive lifestyle all promote AGE accumulation, and these factors are often more evident in African-Americans, we hypothesize that there is a link between these factors that could help explain why African-American men are more likely to develop prostate cancer and die from the disease.”
Turner and colleagues examined circulating and intratumoral AGE levels in 16 African-American and 16 non-Hispanic white men with prostate cancer. They found that AGE levels were higher in serum from cancer patients compared with individuals without cancer. When analyzing AGE levels in prostate tumor samples, levels were highest in tumor samples from African-American patients. In addition, AGE levels in prostate tumors correlated with levels of a molecule to which AGEs bind to mediate their effects, called receptor for AGE (RAGE).
“We think that the AGE-RAGE signaling pathway promotes prostate cancer and that increased AGE accumulation may represent a biological mechanism promoting prostate cancer disparity,” said Turner.
This study was funded in part by the National Institutes of Health as part of the South Carolina Cancer Disparities Research Center. Turner declares no conflicts of interest.
ATLANTA — Certain genetic alterations to the PAX gene family may be responsible for survival disparities seen between African-American and non-Latino white men with head and neck cancer, according to results presented here at the Sixth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held Dec. 6-9.
“During the last 30 years, the overall five-year relative survival rates for head and neck squamous cell carcinoma (HNSCC) have increased, but despite that, the gap in overall survival rates between non-Latino white patients and African-American patients has remained unchanged,” said Rafael Guerrero-Preston, Dr.P.H., assistant professor at Johns Hopkins University in Baltimore, Md. “This disparity may be due to differences in genetic and epigenetic alterations among African-American patients.”
To test this theory, Guerrero-Preston and colleagues performed a two-stage epigenomic study. In the stage-one discovery phase, the researchers used next-generation sequencing and array-based technologies to evaluate 107 HNSCC samples. In the stage-two validation phase, they validated the findings of the discovery phase and evaluated their effect on survival rates in 279 patient samples from The Cancer Genome Atlas project.
“Our results highlight the differential genomic and epigenomic alterations in PAX, NOTCH, and TP53 pathways between African-American and non-Latino white HNSCC patients, which underlie the complex biology of morphologically similar tumors and explain HNSCC survival disparities,” Guerrero-Preston said. “If further validated in larger cohorts, these discoveries could be used to develop genomic and epigenomic panels that will enable more treatment options, a reduction in treatment cost, and improvement in survival rates for patients with HNSCC.”
The researchers found that African-American HNSCC patients had higher frequencies of p53, FBXW7, and NOTCH1 mutations and no differences in PAX1 or PAX5 methylation across all tumor sites combined. However, when they looked at data based on each tumor site, some differences were discovered.
African-American patients with HNSCC had higher ZIC4, PLCB1, and PAX5 promoter methylation and p53 mutations compared with non-Latino white patients. African-American patients also had no NOTCH1 mutations in nonoropharynx HNSCC. However, in the oropharynx, African-American patients had a higher frequency of combined NOTCH1 mutations and PAX1 methylation.
In contrast, non-Latino white patients with HNSCC had a higher frequency of PAX5 promoter methylation and combined p53 mutation or PAX5 methylation in the oropharynx compared with African-American patients.
All patients with greater PAX5 methylation and p53 mutations had worse overall survival, the researchers found.
This study was funded by the National Cancer Institute, the National Institute of Dental and Craniofacial Research grants, Head and Neck Cancer SPORE, and the Johns Hopkins University Commonwealth Fund. Guerrero-Preston declared no conflicts of interest.
ATLANTA — Knowledge about the efficacy of the human papillomavirus (HPV) vaccine in preventing cervical cancer was lacking in the majority of survey respondents for whom the information would be relevant, according to results presented here at the Sixth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held Dec. 6-9.
“HPV infection can cause cervical cancer as well as other cancers such as anal and vulvar cancers. Recent data indicate the incidence of HPV-related cancers other than cervical cancer is increasing. This trend, coupled with continually low uptake of HPV vaccination and persistent disparities in cervical cancer, suggests we need to reinvigorate efforts to increase HPV vaccination levels,” said Kassandra I. Alcaraz, Ph.D., M.P.H., director of health disparities research at the American Cancer Society.
“We were surprised to find such a high level of uncertainty about the vaccine’s effectiveness among individuals for whom the vaccine is relevant. This uncertainty may influence decision-making about getting vaccinated, and it hinders our ability to reduce cervical cancer incidence and mortality and reduce disparities in cervical cancer,” she said. “Our findings suggest we should encourage health care providers to discuss the effectiveness of the HPV vaccine with patients who are age-eligible for vaccination and parents of vaccine-eligible adolescents.”
Although the HPV vaccine has been available for seven years, uptake remains low, Alcaraz said. For example, only 33 percent of adolescent girls have received the recommended three doses of HPV vaccine. In addition, non-Hispanic black women, Hispanic women, and women with low incomes are less likely than other women to have obtained the HPV vaccine despite having disproportionately higher rates of cervical cancer incidence and mortality.
“The HPV vaccine is a long way from reaching its potential,” Alcaraz added. “Our research suggests efforts should go beyond merely increasing awareness of the availability of the vaccine and focus on making sure people know it is effective.”
Alcaraz and colleagues wanted to examine if people’s perceptions about the efficacy of the HPV vaccine were influencing these trends. Using data from the National Cancer Institute’s Health Information National Trends Survey from 2012 to 2013, the researchers identified 1,417 people who were considered to be HPV vaccine-relevant: an individual or someone with an individual in their immediate family is 9 to 27 years old.
The researchers found that 70 percent of respondents for whom the vaccine was relevant did not 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. Individuals with less than a high school education were even less likely to have talked with a provider about the vaccine. Respondents who had never talked to a health care provider about the HPV vaccine were nearly four times more likely than others to not know about its effectiveness; those who never sought any cancer information from the internet in the past 12 months were twice more likely than others to not know about the effectiveness of the HPV vaccine.
This study was funded by the American Cancer Society. Alcaraz has declared no conflicts of interest.
American Association for Cancer Research Honoring Dr. Beti Thompson With 2013 Distinguished Lectureship on Cancer Health Disparities Sponsored by Susan G. Komen
ATLANTA — The American Association for Cancer Research (AACR) is pleased to announce that Beti Thompson, Ph.D., will present the fourth annual AACR Distinguished Lecture on Cancer Health Disparities, funded by Susan G. Komen.
Thompson, associate program head and associate director for health disparities research in the Cancer Prevention Program of the Public Health Sciences Division of Fred Hutchinson Cancer Research Center in Seattle, Wash., will deliver her lecture, “Eliminating Cancer Health Disparities: Can It Be Done?” Friday, Dec. 6, during the opening plenary session of the Sixth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, 6:30 p.m. ET at the Sheraton Atlanta Hotel in Atlanta, Ga.
Reporters who cannot attend the conference in person can listen to Thompson’s lecture, along with the keynote address given by Otis W. Brawley, M.D., chief medical officer of the American Cancer Society, by dialing in with the following information:
- United States/Canada (toll-free): 866-297-6395
- International (toll): 847-944-7319
Thompson is being recognized for her key role in developing one of the nation’s pre-eminent programs in cancer health disparities, which is based on the overarching goal to discover why disparities exist and build capacity in community-based research to investigate, educate, and treat cancer. Thompson’s research has played a role in the design and implementation of community approaches to reducing cancer health disparities in minority and other underserved populations in the United States and abroad.
In her lecture, Thompson will discuss lack of access to care in terms of cancer prevention behavior among Hispanic populations. She will examine community-based, participatory research initiatives and the effect of such programs on increasing colorectal cancer screenings.
“We are delighted to recognize Dr. Thompson with this distinguished lectureship,” said Margaret Foti, Ph.D., M.D. (h.c.), chief executive officer of the AACR. “While great strides have been made in cancer prevention and treatment, we still see a disproportionately higher burden of cancer falls on racial and ethnic minorities, as well as low-income and elderly populations. Dr. Thompson’s career-long commitment to improving health care for these underserved populations has had a wide-ranging impact on the field of cancer health disparities and on individuals throughout the world.”
Founded in 2010, the AACR Distinguished Lectureship on the Cancer Health Disparities recognizes an investigator whose novel and significant work has had or may have a far-reaching impact on the etiology, detection, diagnosis, treatment, or prevention of cancer health disparities.
“Dr. Thompson shares our commitment to ensure access to breast cancer screening and quality treatment for all women and men, regardless of their socioeconomic status or other barriers to care. We congratulate Dr. Thompson for her important work and for this honor,” said Judy Salerno, M.D., M.S., president and chief executive officer of Susan G. Komen.
Thompson has received numerous other honors in recognition of her achievements in disparities research, including the University of Washington Mentor of the Year Award; the Women of Color Mentor Award; the University of Washington School of Public Health Distinguished Faculty Lecture; the Women of Valor Award, presented by U.S. Sen. Maria Cantwell of Washington; and the American Public Health Association’s Latino Caucus Distinguished Nationally Known Health Professional Award.
Thompson graduated from Grand Valley State University in Allendale, Mich., and received her master’s and doctoral degrees in sociology from Western Michigan University in Kalamazoo.