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Hysterectomy-corrected Cervical Cancer Incidence Reveal Larger Racial Disparities in Texas 2012-2014
Full text linkThe purpose of this study was to determine the race specific age-standardized and age-specific annual Texas cervical cancer incidence after correcting for hysterectomy prevalence. A registry-based cross-sectional study design using Texas State level data for the years 2012-2014 was used to evaluate cervical cancer incidence after applying a correction for hysterectomy and examined racial disparities by age and race. We merged into a single database annual age- and race-stratified hysterectomy prevalence, cervical cancer incident case counts, population at-risk denominators and US Census 2000 population weights using the Behavioral Risk Factor Surveillance System (BRFSS) and Texas Cancer Registry (TCR), and used these data to estimate hysterectomy-corrected, age-standardized and age-specific cervical cancer incidence. Significant differences in hysterectomy prevalence by race were seen. For women aged 35-44 years, hysterectomy rates were highest in non-Hispanic whites. Among non-Hispanic blacks and Hispanics, the prevalence of hysterectomy peaked between the ages of 55 and 64 years, but thereafter continued to increase dramatically with age but only in non-Hispanic whites. The largest adjustment between corrected and uncorrected cervical cancer rates (17.1%) was in non-Hispanic white women followed by Hispanics (4.1%) and non-Hispanic blacks (3.6%). Failing to correct reported cervical cancer rates underestimates the true burden of disease. Hysterectomy prevalence in Texas also suggest disparities in access to care based on race. These findings provide further evidence-based information to develop more effective region and ethnic specific cervical cancer prevention programs using unbiased estimates of disease burden.  
Psychosocial Stress, Glucocorticoid Signaling, and Prostate Cancer Health Disparities in African American Men
Full text linkRecent advances in our understanding of racial disparities in prostate cancer (PCa) incidence and mortality have provided important insights into the psychosocial, socioeconomic, environmental, and molecular contributors. There is, however, limited mechanistic knowledge of how the interplay between these determinants influences prostate tumor aggressiveness in African American (AA) men and other men of African Ancestry. Growing evidence indicates that chronic psychosocial stress in AA populations leads to sustained glucocorticoid signaling through the glucocorticoid receptor (GR), with negative physiological and pathological consequences. Compelling evidence indicates that treatment of castration-resistant prostate cancer (CRPC) with anti-androgen therapy activates GR signaling. This enhanced GR signaling bypasses androgen receptor (AR) signaling and transcriptionally activates AR-target genes and GR-target genes, resulting in increased prostate tumor resistance to anti-androgen therapy, chemotherapy, and radiotherapy. Given its enhanced signaling in AA men, GR—together with specific genetic drivers—may promote CRPC progression and exacerbate tumor aggressiveness in this population, potentially contributing to PCa mortality disparities. Ongoing and future CRPC clinical trials that combine standard of care therapies with GR modulators, both agonists and antagonists, should increase the participation of AA patients and carefully assess racial differences in therapy response and clinical outcomes. 
Increasing Pap Testing Uptake and HPVV Knowledge and Acceptability among Black Women
No full textWomen were recruited from two socioeconomically and ethnically similar regions to participate in the intervention. Regions were assigned to one of two conditions: print only or print plus media-based social marketing. Baseline and follow-up data were collected and analyzed using univariate and bivariate statistical approaches. There was a statistically significant relationship between intervention condition and reporting a Pap test at follow up (p = .013). Compared to women in the print only condition, women in the print plus media-based social marketing condition reported significantly increased Pap testing. Across both conditions, intention to receive Pap testing was high. In the print only condition, 37 out of 40 (92.5%) participants reported intention to receive Pap screening within two years, while 47 out of 57 (82.5%) participants in the print and media condition reported intention to have a test within two years. HPVV knowledge increased among all participants with no differences across intervention condition. The print only group reported no change in Pap test completion at follow up. However, the enhanced trial condition showed a 25% increase in Pap testing from baseline to follow-up. Therefore, in both intervention conditions, HPV knowledge and HPVV acceptability significantly increased from baseline to follow-up among all participants. This study suggests a multicomponent media-based social marketing strategy may be useful in promoting Pap testing and knowledge about HPVV among Black women
Racial Disparities in Expression of GDF15 and NFκB in Prostate Cancer and Benign Prostatic Epithelium
Full text linkProstate cancer (PC) outcomes are more adverse for African-American (AA) than white (W) men. Growth differentiation factor 15 (GDF15, PDF, NAG-1) is a stress-induced anti-inflammatory cytokine with immunosuppressive and tumor growth-promoting functions. GDF15 inversely regulates NFκB, a transcription factor enabling pro-inflammatory gene expression and becomes constitutively activated in androgen-independent PC. Tissue microarrays (TMAs), prepared from prostatectomy tissue at three institutions, comprised 688 cases (364 W and 324 AA). Each case included ≥3 tumor punches plus ≥3 non-neoplastic punches. TMAs were stained separately for GDF15 and NFκB and evaluated by two pathologists, using the 0-3+ scale. PC, compared to benign epithelium, had elevated mean GDF15 expression (1.93 vs. 0.99) and also, NFκB (1.18 vs. 0.96, both P<0.0001). Only in AA men did PC show gradewise or stagewise altered expression of these markers. In AA men, GDF15 expression fell as stage rose in PC (P=0.007) and also in benign epithelium (P =0.003). In W men, GDF15 expression in benign epithelium fell as stage (P=0.01) and grade (P=0.01) rose. NFκB expression was higher in AA than W men only in high-grade PC (P =0.01). NFκB expression rose with increasing tumor grade only in AA men (P =0.027) and in the benign prostate component only in W men (P=0.007). Benign and tumor NFκB expression did not vary with stage. PC showed significant alterations in GDF15 and NFκB expression in accord with cancer aggressiveness in AA men only: stagewise decrease in GDF15, and gradewide increase in NFκB. Findings suggest a disparity for immune response by race in prostate carcinogenesis
Enhancing African American Participation in Biospecimens: A Case in Point for Pancreatic Cancer
Full text linkDiseases of the pancreas (i.e. chronic pancreatitis, diabetes and pancreatic cancer) disproportionally affect the African American community. Challenges associated with engaging the African American community in biospecimen research are longstanding. We surveyed a number of pancreas-related biobanks and data repositories for African American representation. While some of the biobanks and databases surveyed contain biospecimens and data from African American donors at levels that reflect minority representation among the general population, others do not. A number of factors have historically contributed to reduced participation of the African Americans community in biospecimen donation including medical mistrust, lack of transparency, fear and a poor knowledge and understanding about the use of biospecimens for research. Suggestions for increasing African American participation in organ and biospecimen donation include educational interventions, particularly in community groups, and providing printed and online recruitment materials to patients, patient advocates and care partners. Increasing awareness of the many benefits of biospecimen donation among African Americans will positively affect health disparities research into pancreatic cancer and other diseases
Overcoming Barriers in Conducting a Transatlantic Prostate Cancer Familial Study in Africa: Best Practice from the CaPTC Cohort Study
Full text linkConducting prostate cancer research, especially prospective data collection in Africa, has numerous challenges. Some of the difficulties stem from socio-cultural factors that consider sensitive topics about men’s health as taboo. Our primary aim was determine how to overcome barriers in conducting a transatlantic prostate cancer familial study in African males.Key research personnel of the CaPTC Transatlantic Prostate Cancer Familial Project were surveyed about their experiences in implementing the study. The data from the survey was analyzed using SPSS version 18. A total of 15 key study personnel responded to the survey. About 73% of the respondents reported that the participants requested a home or office visit rather than visit a data collection center. Eighty percent (80%) of the respondents reported that the participants had no preference for interviewer gender. The majority (80%) of the interviewers agreed that answers to questions about participants’ sexuality were most challenging to obtain, but with an in-depth explanation of the importance of the study and assurance of privacy, the answers were obtained. The best practice for engaging the community for research include community mobilization through sensitization visits and one-on-one talks, use of community ‘gatekeepers’, introduction by relatives, assurance of privacy of health data obtained, the use of incentives and a promise to give feedback on the results of the study both on a personal and community level
NACP: Partnership for Native American Cancer Prevention
Full text linkCancer trends over a two-decade period show a greater reduction in cancer mortality rates for non-Hispanic Whites than for Native Americans. The Partnership for Native American Cancer Prevention (NACP) was established to address cancer health disparities that impact Native Americans. The partners are Northern Arizona University, the University of Arizona Cancer Center and Arizona’s tribal communities. The activities include outreach, research and cancer education. Overall, NACP seeks to expand capacity for culturally-sensitive and community-relevant research on cancer, and to continue developing respectful collaborations that will empower sovereign Native American communities to define, implement, and achieve their goals for cancer health equity
A Genetic Roadmap of Gallbladder Cancer Disparities: A Potential for Development of Targeted Therapies: Gallbladder cancer: from genetics to targeted therapies.
No full textGallbladder cancer (GBC) is an aggressive disease with a dismal prognosis and resistance to chemotherapy. Due to difficulties in early diagnosis of GBC, about 90% of patients are detected at advanced stages with palliative care being the only viable option. While surgery remains the mainstay treatment for early GBC, most patients who undergo surgical resection present with high degrees of recurrence. Unfortunately for many patients, surgical resection is not considered a possibility due to the time at which they are diagnosed. Adjuvant therapies in the form of radiation and/or embolization of the tumor have been probed for the disease with moderate success. While there have been multiple studies (both retrospective and pooled analysis) that suggest an added advantage of combining adjuvant therapy with surgical resection, data from prospective studies is limited. Interestingly, GBC affects women, American Indian, Alaska Native, and black people, and certain Asian ethnic groups in peculiar geographic locations such as Chile, India, China more than other groups elsewhere. These disparities in gender and ethnicities demonstrate the need for better understanding of underlying genetic events of GBC so that molecularly targeted therapies could be developed to provide hope for improving treatment response and better outcome. However, for GBC not much progress has been made mainly due to the lack of understanding of molecular pathogenesis of this disease. This article presents a review of literature focused on molecular and genetic alterations in GBC, and as to how effective targeted therapeutic strategies can be developed with demonstrated survival benefit
Architecture of the Chicago Cancer Health Equity Collaborative – A Partnership Delivering Transformative Cancer Health Equity Research, Education and Community Engagement
Full text linkReducing cancer health inequities requires transformation of longstanding structures, including ways of ‘doing business’ and other deeply rooted traditions that perpetuate social injustice. We posit that moving the needle toward cancer health equity requires the building of large-scale partnerships with the infrastructure and reach to reshape the architecture defining how education, training, and research are conducted. It is with this vision that the Chicago Cancer Health Equity Collaborative (ChicagoCHEC) was conceived in response to a call for proposals by the National Cancer Institute (NCI) in 2015 that sought applications for a partnership across a NCI designated comprehensive cancer center and up to two institutions serving underserved health disparitypopulations and underrepresented students. ChicagoCHEC was conceived as a tri-institutional partnership comprised of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, a NCI-designated Comprehensive Cancer Center which serves a diverse nine county catchment area, Northeastern Illinois University, a minority-serving institution known for its connection to minority students, and the University of Illinois Cancer Center at the University of Illinois at Chicago (UIC), a minority-serving institution and leader in community-focused cancer care and disparities research. Established in 2016, ChicagoCHEC is comprised of four functionally distinct cores that together serve the mission of advancing cancer health equity through meaningful scientific discovery, education, training, and community engagement. The successful functioning of of ChicagoCHEC is evident from the fruits borne by the partnership in research, education, and community engagement toward the goal of eradicating cancer health inequities
Cervical Cancer Outcome by Type of Health Care Facilities: National Cancer Database, 2004-2015
Full text linkThe National Cancer Database from 2004 to 2015 was analyzed to identify cervical cancer outcomes associated with demographic and clinical characteristics measured by types of facility. Chi-Square tests were used to compare proportions and logistic regression to determine factors associated with cervical cancer outcomes. Women treated at Academic/Research Programs (ARPs) were younger at diagnosis, more likely black, less educated and more in Stage 2, lived further away from treatment facilities, had less comorbidities and better 5- year survival, and were more likely to be alive at 30 and 90 days after surgery compared to other programs.
Women treated at Community Cancer Programs were more likely 75 and older at diagnosis, more likely to receive radiation treatment and more in Stage 4, more living in rural areas and less than 10 miles from the facility, and had more comorbidities, and lower 5-year survival compared to other programs.
Women treated at Comprehensive Community Cancer Programs were more likely white and educated, had more private insurance, and underwent surgery. Women treated at Integrated Network Cancer Programs were more likely to live in urban, south region, and in Stage 1B2, had more surgery and one comorbidity, and died fewer than 30 days after surgery. The type of facility and treatment had varied effects on mortality and 5-year survival. Considering the different cervical cancer outcomes from different health care facilities, further research is needed to identify what factors influence women to choose a health care facility for their treatment and how this choice can affect different health outcomes