After spending last week focusing on cancer awareness among minorities, I

read the archives at http://cancer-carnival.blogspot.com

decided to submit one of those articles to the Cancer Research Blog Carnival. It was accepted. (Yeeesssss!)  It’s been five quiet months of blogging and now I just might be starting to make a friend or two out there. Each month Cancer Research presents what’s new and now from cancer biology, cancer genetics, cancer therapeutics to cancer diagnostics and patient care. Head on over to Highlight HEALTH and check out the 21st edition of this blog carnival which is the standard for all things cancer. Be sure to read all the articles, the Health Advocate is in such excellent company.

human metastatic breast cancer cells (from abcam.com)

Two recently published cancer studies reveal differences in the severity of cancer (specifically breast and colorectal) between black Americans and other racial or ethnic populations are based in genetic variations.  I think we should pause a moment and recognize that today is National Day, an observance popular in K-12 education to recognize the day that the research scientists at NIH completed sequencing of the human genome.  The knowledge gained from that tremendous endeavor has informed the physicians and scientists is countless labs since and the current findings in the disparities between the burden of illness suffered by blacks with breast or colorectal cancer tumors is no different.

Dr. Carol Rosenberg and her colleges at Boston University School of Medicine have discovered that cancer tumors lacking genetic expression for estrogen receptors, progesterone receptors and HER-2 (human epidermal growth factor), so called “triple-negative” tumors were more common among black women.  Specifically, their study of 415 women (36% non-Hispanic white, 43% black, 10% Hispanic, and 10% other) revealed that black women have a three times greater risk of having triple-negative breast cancer tumors as compared to non-Hispanic whites.  Triple-negative phenotype tumors (which make up 15% of all invasive breast cancers) have been associated with poor prognosis and low 5-year survival rates.  The implications are significant to understanding the prevalence of an increased burden of illness and death suffered by black women developing breast cancer.

“The reasons explaining this finding are not certain, but it is possible that black women may be at intrinsically greater risk of these more aggressive tumors,” observed Dr. Rosenberg.

The proportion of black women suffering from triple-negative breast cancer tumors was the same when comparing women under or exactly fifty years of age to those over fifty, as well as women who were obese to those who we not obese.  The findings of this study were release late last month in the Journal of Breast Cancer Research.

Earlier this month, Upender Manne, PhD and his colleges at University of Alabama at Birmingham released the results of their investigation of colorectal cancer in Clinical Cancer Research.  Scientists have thoroughly documented he p53 gene and its association with colon cancer in the literature.  In the current study, statistically significant differences in colorectal cancer tumors where identified and described.  Dr. Manne and his team reviewed 373 patients (63% non-Hispanic white and 37% black surgically treated between 1985 and 1995 at the anatomical, cellular and genetic level.  The codon 72 of the p53 protein can contain the amino acid (a protein building block) proline (Pro) or arginine (Arg).  As a result, there are three different phenotypes of p53 protein Arg/Arg, Arg/Pro or Pro/Pro.  In previous studies, researchers have found the Arg/Arg phenotype of the p53 protein to have a higher potential for inducing apoptosis (or programmed death of cancer cells).  On the other hand, the Pro/Pro phenotype of the protein has been found to accompany a greater proliferation of cancer cells.  In general, mutations that disrupted or inactivated the p53 protein have been associated with progression of the cancer.

The racial difference in the prevalence of these phenotypes of p53 protein associated with the colon cancer tumors was statistically significant.  Nineteen (19%) percent of colorectal cancer tumors in blacks had the Arg/Arg phenotype protein compared to 36% of the tumors in whites; 64% of tumors in blacks had the Arg/Pro phenotype protein compared to 57% of the tumors in whites; and 17% of tumors in black had the Pro/Pro phenotype protein compared to 7% of whites.  The implication of the numbers is this:

blacks had a higher prevalence of the p53 protein phenotype (Pro/Pro) which is associated with more aggressive tumors and progression of the cancer.

Specifically, this Pro/Pro phenotype was 2.5 times more likely to be associated with death in black patients than those with the other phenotypes.  In stark contrast, these Pro/Pro phenotye p53 proteins were only 1.6 times more likely to be associated with death in white patients than those with the other phenotypes.  As Dr. Manne stated,

“African-Americans, but not Caucasians, with the Pro/Pro phenotype had significantly higher mortality…and risk of death due to [colorectal cancer].”

This particular study, also identified additional, statistically significant

April 2009 issue

differences between tumors in blacks and non-Hispanic whites that create future opportunities to examine and disaggregate what Manne referred to as the “confounding from other lifestyle factors of the aggressiveness of the disease.”

Medscape Oncology contacted an independent physician, Dr. Hemant Roy of the Feinberg School of Medicine at Northwestern University to comment on the clinical significance of colorectal cancer study.  “Risk assessment is complex, and this and other genetic polymorphisms are an important piece of the puzzle…While this observation may not necessarily represent a stand-alone future test, it takes us closer to understanding risk and hence targeting screening.”  I think this observation speaks to the value of the molecular and genetic characterizations that come from health disparities research such as the two studies I discussed here, they decipher a piece of the entire puzzle that determine risk factors and help health care providers target and personalize the screening process.

Sources:

Stead LA, Lash TL, Sobieraj JE, Chi DD, Westrup JL, Charlot M, Blanchard RA, Lee JC, King TC, Rosenberg CL. Triple-negative breast cancers are increased in black women regardless of age or body mass index. Breast Cancer Res. 2009 Mar 25;11(2):R18.

Beals JK. New Polymorphisms Affect Colorectal Cancer Risk, Progression in
Blacks.  In Medscape Medical News.  Cited April 24, 2009.  Available at <http://www.medscape.com/viewarticle/590604>

Katkoori VR, Jia X, Shanmugam C, Wan W, Meleth S, Bumpers H, Grizzle WE, Manne U.  Prognostic significance of p53 codon 72 polymorphism differs with race in colorectal adenocarcinoma. Clin Cancer Res. 2009 Apr 1;15(7):2406-16.

by Steve Kelley, originally uploaded by the Health Advocate.

It is simply undeniable, our diets really do affect our health and overall risk for disease. This week, cartoonist Steve Kelley reminds us.

The prevalence for different types of cancer varies greatly according to the race and ethnicity of the population in question.  For example:

• While the gap (as compared to non-Hispanic whites has narrowed since 1991) black Americans are more likely to develop and die from cancer than any other racial or ethnic group. The most common cancers among men in 2009 are projected to be prostate (34%), lung (16%), and colorectal (10%) cancer, and among women, breast (25%), lung (12%), and colorectal (11%) cancer. For all cancer types, blacks are far more likely to be diagnosed in advanced stages of disease, when the cancer is less treatable.  Blacks are also less likely than whites to survive 5 years after a diagnosis, regardless of cancer type and stage of diagnosis.
• Cancers associated with viral infection are the most common caners in Hispanics/Latinos. Women have the second highest number of cases of cervical cancer (which is often caused by human papillomavirus) while cases of liver cancer (which is often caused by the hepatitis virus) are twice as high in Hispanic men and women as in non-Hispanic whites.
• Asian Americans/Pacific Islanders are more likely to develop and die from both liver and stomach cancers than all other racial or ethnic groups (except in the case of stomach cancer where their prevalence and death rates are second to those of blacks).

Racial and ethnic minorities have less access to cancer screening

Medical researchers focusing on areas of health care disparities continue investigations to elucidate these figures. The interrelationship between multiple factors continues to yield reasons that are complex.

“Rates are driven by social and economic factors,” says Ahmedin Jemal, PhD, ACS Department of Epidemiology and Surveillance Research. “In the African American population, there’s far less utilization of screening. For example, in 2005, 44% of African Americans were screened for colorectal cancer, compared to 51% of whites.”

Other research reveals this failure to access care through regular recommended screening is true across all racial/ethnic minority groups. Surveys show that about a third of Hispanic/Latinos and 20% of blacks have no coverage at all. The consequences are significant as people who don’t get mammograms, colon exams, and Pap tests on schedule are more likely to be diagnosed with a cancer at a later stage in the disease, when survival rates are lower.

“Having health insurance coverage is the single greatest determinant of access to health care services,” explained Eve Nagler, ACS Director of Special Populations.

Access Resources:

Use this CDC interactive map to locate National Breast and Cervical Cancer Early Detection Program low-cost and free screening resources near you.

Sources:

Cancer’s Racial Gap Narrowing yet Challenges Persist. In ACS News Center. American Cancer Society.  Cited April 22, 2009. Available at <http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Cancers_Racial_Gap_Narrowing_Yet_Challenges_Persist.asp>

Cancer Is A Burden, Finding Help Should Be. In In the Spotlight.  American Cancer Society. Cited April 22, 2009.  Available at <http://www.cancer.org/docroot/SPC/content/SPC_1_Cancer_Is_a_Burden_Finding_Help_Shouldnt_Be.asp>

Bridging the Disparity Gap.  In In the Spotlight.  American Cancer Society. Cited April 22, 2009.  Available at <http://www.cancer.org/docroot/SPC/SPC_0.0.asp>

Racial and ethnic minority populations continue to grow such that by mid-century, Latino, black and Asian populations are expected to represent the majority of people living in the US, according to the Census Bureau.  This is already the case for the nation’s largest metropolitan areas and it is increasingly becoming the case in smaller communities fueled by the growing Latino population.  In light of this fact, minority health and health disparities among racial and ethnic minorities is not a issue for special populations but rather an issue that concerns us all especially as we examine the health status of the population as a whole.  Nevertheless, the third week in April (19-25) is set aside as National Cancer Minority Awareness Week.

Do race and ethnicity affect cancer risk?

Each year, cancer statistics continue to show that minority groups are more likely than the general population to develop and/or die from certain types of cancer.  As researchers continue to unravel the multiple contributing factors to this issue there are things that individuals can do for themselves.

About fifty percent of cancer deaths can be prevented through regularly scheduled screenings, healthy eating, regular physical activity and quitting tobacco use. However, minorities continue to have lower screening rates than whites; report less leisure-time activity than recommended – less than the recommended 30 minutes of moderate-to-vigorous physical activity above usual activities on five or more days per week; and consume less fruits, vegetables and whole grains. The American Cancer Society recommends eating five or more servings of fruits and vegetables each day, choosing whole grains in preference to processed grains and limiting consumption of processed and red meats.

(click through the image link)

Despite  health disparities, race and ethnicity are only two among several factors that contribute to cancer risk.  This personal cancer risk profile tool (developed by the University of Texas MD Andersen Cancer Center) can help you begin to assess your own risk for cancer. This questionnaire will determine specific actions you can take to reduce your risks for developing cancer and/or to make sure that you identify the disease in the earliest, most treatable phase.

Learn More at The American Cancer Society website and MD Andersen Cancer Center website

Featured Health Observance.  April is Cancer Control Month. Since 1938, this annual proclamation has given Americans an opportunity to focus on advances against cancer, as well as, rededicate themselves to fighting the disease both through research and prevention.  President Obama observed:

“As researchers work daily to better understand this disease, Americans can take steps to decrease their risk of developing cancer. Individuals of all ages should seek regular and appropriate check-ups. These check-ups should include [Common Screening Tests], such as mammograms, the Pap test, and tests for colorectal cancer, all of which can help detect cancer during its early stages.  Healthy personal habits can also reduce the risk of cancer. Smoking accounts for thousands of cancer deaths every year, and quitting — even after many years — can greatly reduce the risk of cancer. Physical inactivity and obesity may cause a substantial proportion of colon, breast, endometrial, kidney, and esophageal cancers in the United States, so maintaining physical activity and a healthy diet can help prevent cancer, among other diseases. Finally, moderating alcohol intake and sun exposure can help protect Americans.”

In keeping with the broader concept of primary prevention and leading lives filled with health promoting activities, enBloom will also feature the following health observances this month so keep an eye out for ways to take part and educate yourself around these issues.

• April  1-30.  National Donate Life Month (This month’s first Friday feature is a continuation of the February discussion of National Donor Day and March discussion of World Kidney Day.)
• April 16.  National Healthcare Decision Day
• April 19-25.  National Minority Cancer Awareness Week

Source: National Cancer Control Month, 2009. In The White House Blog. Available at<http://www.whitehouse.gov/the_press_office/Presidential-Proclamation-Marking-National-Cancer-Control-Month/>

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Today’s post was inspired by a Denise Grady article I read in the New York Times Second Opinion column and the peer-reviewed article it summarized (see link below). Our main purpose at enBloom is to increase your literacy in health and medical issues and to empower you with tools to help you have productive conversations with your doctors and health care providers. Before you receive any major procedure in the hospital or even on an out-patient basis you are required to sign consent forms. These are legal documents that indicate you understand the procedure you are about to undergo and the regular risks of complications associated with that procedure. When teaching students health care ethics, I always impress upon them the fact that unless the patient truly understands the procedure and the risk, their job is not done. That is to say, you cannot have consent unless it is informed.

One of the reasons, we began to see the rise of centers of excellence in the last decades of the 20th century is because physicians recognized they could significantly decrease risk by increasing the volume of highly specialized procedures. Patients and health care consumers should also be aware of the fact that time and location of physician training has lead to variations in the way specific physicians treat specific conditions, a phenomenon referred to as practice patterns. This is one of the reasons why it is so important to seek a second opinion when you receive a serious diagnosis or you’ve been recommended to undergo serious treatment.

The peer-reviewed article, Should Informed Consent for Cancer Treatment Include a Discussion about Hospital Outcome Disparities from the Public Library of Science website discusses these very issues. It raises a controversial ethical question around which two groups of experts debate. Since a physician is obligated to do no harm to their patients as well as actively work to remove or reduce disease, pain, and suffering does it then follow that they are obligated to tell their patients if the best care available is indeed at another hospital or medical center? The discussion in the article was extremely provocative. Yet, it led me to another slightly related question. Now that we have documented evidence in the disparities of care among the various ethnic groups, do we take those into account when reporting risk for informed consent? If we currently do not, shouldn’t we do so if the consent is truly to be informed?

Learn more:

PLoS Medicine – Should Informed Consent for Cancer Treatment Include a Discussion about Hospital Outcome Disparities?.

Should Patients Be Told of Better Care Elsewhere?