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Breast Cancer Incidence and Mortality by Molecular Subtype Statewide Age and Racial/Ethnic Disparities in New Jersey
Full text linkThe objective of this study was to assess breast cancer incidence and mortality rates by molecular subtype for cases diagnosed in New Jersey. Data on all primary, histologically confirmed, invasive breast cancers diagnosed among women between January 1, 2008 and December 31, 2013 were retrieved from the New Jersey State Cancer Registry. Age-adjusted incidence rates were calculated for each subtype, by age, race/ethnicity, and tumor stage. Logistic regression models, Cox proportional hazards models, and Kaplan Meier curves were used to describe the relative risks for breast cancer incidence, mortality, and survival, respectively. In this population-based sample of 32,770 breast cancer cases, non-Hispanic Blacks (NHBs) had the highest triple-negative breast cancer (TNBC) incidence rate (17.8 per 100,000, 95% CI 16.5-19.2) compared to other races/ethnicities. NHBs had also higher odds of TNBC (OR 2.1, 95% CI 1.95-2.36) and higher hazards of death when diagnosed with TNBC (HR 1.28, 95% CI 1.05-1.56), luminal A (HR 1.64, 95% CI 1.41-1.91), or luminal B (HR 1.54, 95% CI 1.10-2.15) than non-Hispanic Whites (NHWs). Younger women (20-39 years) had higher odds of TNBC (OR 1.77, 95% CI 1.54-2.02) and luminal B (OR 1.56, 95% CI 1.35-1.80) compared to women 50-64 years; minority women had higher odds of non-luminal HER2-expressing and lower odds of luminal A than NHWs. TNBC was associated with the poorest survival rates. These findings highlight a need for enhanced screening to promote earlier diagnosis and improve breast cancer outcomes, particularly in minorities and younger women, which will be essential for achieving health equity
Looking at Cancer Health Disparities without the Colored Lenses
Full text linkCancer health disparities (CHDs), defined as the adverse differences in cancer incidence and mortality, are prevalent in certain racial and ethnic groups. Underlying causes of CHDs are multi-factorial and debatable. While low socioeconomic status, geographical location, lifestyle and behavioral factors are mostly believed to contribute to CHDs, regardless of ethnic and racial background, significant data now also exist to support a genetic basis of such disparities as well. Clearly, CHDs could best be understood by studying the interplay of multiple (genetic and non-genetic) factors and then translating the resulting knowledge into effective approaches for reducing the existing disparity gaps. This review article highlights these aspects in brief and calls the people of different expertise to work together to make an impact and tackle the challenges associated with CHDs
Improving First Nations Cancer Journeys: Current Policy Perspectives and Approaches in British Columbia, Canada
Full text linkThe process of reconciliation in Canada has created a new climate for discussions about systemic racism and a lack of cultural safety as a root cause of health outcome disparities for First Nations people. In British Columbia, quality improvement efforts to improve First Nations cancer outcomes and experiences are now formalized through an Indigenous Cancer Strategy that incorporates BC First Nations perspectives on health and wellness. By leveraging the unique First Nations health governance structure in the province, health system and community partners are now leveraging the current climate for change to improve First Nations cancer journeys, and are leading the way to improving culturally safe health services for all British Columbians
Cortisol and Health-Related Quality of Life as Prognostic Indicators for Prostate Cancer Risk in West African Black Men in Nigeria, Cameroon and the USA: The CaPTC Cohort Study
Full text linkPoor understanding of the clinicopathological features of prostate cancer (CaP) in Black men (BM) is one of the major challenges implicated in the management and prevention of the disease. The development of CaP involves an accumulation of multiple oncogenic events with associated increase in prostate specific antigen (PSA) and stress related hormones such as Cortisol. This data aim to examine the role of Cortisol and health-related quality of life (HRQoL) in CaP development. Data was collected as part of a large CaPTC Familial CaP Cohort Study. The HRQoL indicators were measured and salivary Cortisol levels evaluated by enzyme immunoassay. CaP tissue expression patterns of cortisol and Annexin V were also studied by immunohistochemistry. The HRQoL indicators showed a significant difference between participants with and without physical activity (P = 0.025), stress (P = 0.008) and self-care (P = 0.005). There was significant increase in salivary cortisol levels in the CaP patients compared to CaP-free participants (P = 0.003). The salivary cortisol level for the CaP patients ranged from 1.029 µg/dL to 0.037 µg/dL while the range for the CaP-free participants was from 0.139 µg/dL to 0.026 µg/dL. In addition, we found increased expression of the cortisol protein in CaP patients with Gleason score 8 compared to those with lower scores and the CaP tissues showed overexpression of Annexin V protein. Salivary and tissue cortisol levels with an accompanying Annexin V expression may serve as important biomarkers for prostate cancer diagnosis and prognosis in West African Black men.  
Community-Clinical Linkage Intervention to Improve Colorectal Cancer Screening Among Underserved Korean Americans
Full text linkBackground: Korean Americans report thae lowest and declined rates of colorectal cancer (CRC) screening, compared to general population in the United States. The present study aimed to evaluate the efficacy of a community-based multifaceted intervention designed to improve CRC screening among Korean Americans. Methods: A cluster-randomized trial involving 30 Korean church-based community organizations (n = 925) was conducted. Fifteen churches were assigned to intervention (n=470) and the other 15 to control (n = 455) groups. Main components of the intervention included interactive group education, patient navigation, physician engagement, and provision of fecal immunochemical test (FIT) kit. CRC screening rates were assessed at a 12-month follow-up. Results: Participants in the intervention group were significantly more likely to receive CRC screening (69.3%) as compared with those in the control group (16%). The intervention was particularly effective in promoting FIT among the more disadvantaged individuals in the Korean American community. Regression analysis revealed that controlling for the intervention effect, male gender, high school education, annual income of $20,000–40,000 were significantly associated with increased screening by FIT, whereas English inefficiency was significantly and lack of health insurance was marginally significantly associated with decreased screening by colonoscopy/sigmoidoscopy. Conclusion: Culturally and linguistically appropriate multifaceted intervention combining FIT provision with community-clinical linkage has a potential to be a cost-effective and practical approach to effectively targeting hard-to-reach disadvantaged minority populations and enhance CRC screening to reduce cancer disparities. 
Notch as an Immunologic Basis of Cancer Disparities
Full text linkTherapeutic modalities including surgery, radiation, chemotherapy and targeted therapies have had an impact on standard of care for cancer patients; however, they do not change the mortality statistics. Also, de novo and acquired resistance are major issues with all known targeted therapies. In addition, induction of tumor immunity and memory is critical for durable remission following conventional or pathway-directed cancer therapies. Immune responses also shape cancer heterogeneity, a hallmark feature aiding clonal survival, therapy resistance and dissemination of cancer. Moreover, inter-individual differences due to racial/ethnic backgrounds may alter host immunity responsible for the cancer immunosurveillance and elimination, leading to immune suppression and cancer escape. One basis of disparity in tumor incidence, progression, or therapeutic outcomes could lie in the components of Notch intercellular communication system which provide instructive signals for a variety of pathways regulating cell commitment and differentiation including context-dependent lymphocyte polarization in tumor microenvironment. Notably, Notch signaling in hematopoietic cells is perturbed by tumor growth for its advantage, and there are indications that differences in Notch components could underlie poor cancer prognosis in certain populations. Here, we discuss the oncogenic and immunogenic aspects of Notch which can inform on cancer health disparities and therapeutic outcomes
MicroRNA 204 mediated negative regulation of the IGF2R promotes breast cancer progression and is a potential mechanism driving breast cancer disparity
Full text linkIn the US, African American women have a significantly higher rate of mortality due to breast cancer compared to Caucasian American women. Molecular differences in tumor biology exist between racial groups; however, their contribution to cancer disparity is not well understood. Our studies have identified a race-specific, mechanistic link between microRNA-204 and the IGF2R. The IGF2R is a tumor suppressor gene in several cancers including breast cancer and IGF2R levels are found at significantly lower levels in African American women with breast cancer when compared to their Caucasian counterparts. We observed elevated levels of miR-204 in serum of African American women with breast cancer when compared to Caucasian American women and identified IGF2R as a direct target of miR-204. We show mechanistically that miR-204 mediated inhibition of IGF2R leads to activation of the IGF1R signaling pathway resulting in increased proliferation, migration and invasion, processes that are required for tumor progression. We developed a unique doxycycline-inducible miR-204 transgenic mouse model to define in vivo the oncogenic potential of miR-204 and the mechanism and functional consequences of IGF2R loss. We observed a significant increase in tumor growth and increased metastasis in these animals when compared to non-transgenic controls. This is the first characterization of miR-204 in an in vivo model. These data support a mechanism whereby miR-204 promotes tumor aggression through the IGF2-mediated hyperactivation of the IGF1R signaling pathway in response to direct negative regulation of the tumor suppressor IGF2R and that this could be a potential mechanism promoting breast cancer disparity
Prevalence of the UGT1A1*28 Promoter Polymorphism and Breast Cancer Risk Among African American Women in Memphis, TN
Full text linkInherited variations in UDP-glucuronosyltransferase 1A1 (UGT1A1) are associated with an increased breast cancer risk in women of African ancestry. The UGT1A1*28 promoter polymorphism is characterized by the presence of 7 TA repeats in the TATA box sequence and results in reduced UGT1A1 gene expression and enzymatic activity. In this study, we investigated associations between the UGT1A1*28 polymorphism and breast cancer risk among African American (AA) women in Memphis, Tennessee, a city with increased breast cancer mortality rates among AA women. Saliva was collected from 352 AA women, including breast cancer cases (n=82) and controls (n=270) between June 2016 to June 2017. DNA was isolated and sequenced for the UGT1A1*28 polymorphism. The odds ratio for cases with the low UGT1A1 activity alleles (TA)7/8 repeat genotypes versus 5/5, 5/6, and 6/6 genotypes was 1.46 [95% CI, 0.65-3.31; P = 0.36] in premenopausal women and 1.10 (95% CI, 0.52-2.38; P = 0.79) in postmenopausal women. Further analysis of TCGA RNA-seq data showed that UGT1A1 mRNA was significantly lower among estrogen receptor (ER)-negative breast cancers from AA as compared to non-Hispanic white women with ER-negative breast cancer. Larger epidemiological studies are needed to determine the functional consequence of the UGT1A1*28 polymorphism on breast cancer risk in AA women
Commercial Tobacco Exposure in First Nations, Inuit and Métis in Ontario: Results from Population-Based Health Surveys and Implications for Cancer Control
Full text linkThe lack of comprehensive health data is a significant barrier to better understanding and reducing the risk of chronic diseases among First Nations, Inuit and Métis people in Ontario. This study estimates commercial tobacco exposure (cigarette smoking and second-hand smoke) in First Nations (on- and off-reserve), Inuit and Métis in comparison to non-Aboriginal Ontarians using three health surveys. We measured age-standardized prevalence estimates using the First Nations Regional Health Survey Phase 2 (for First Nations on-reserve), Canadian Community Health Survey (for First Nations off-reserve, Métis and non-Aboriginal Ontarians) and the Aboriginal Peoples Survey (for Inuit). A higher proportion of First Nation men, women and adolescents on- and off-reserve smoked compared to their non-Aboriginal counterparts. Métis adults and adolescents were more likely to smoke than non-Aboriginal adults and adolescents. Métis adolescents were more likely to be regularly exposed to second-hand than non-Aboriginal adolescents, both at home and in public places. Inuit adults had a higher prevalence of current smoking and a higher prevalence of regular second-hand smoke exposure at home. The high prevalence of cigarette smoking and second-hand smoke exposure suggests that First Nations, Inuit and Métis people may experience a greater future burden of cancer and other chronic diseases related to smoking. Differences in survey questions and methodology, and the lack of ethnic identifiers in most Canadian health databases limit our understanding of cancer burden and other health outcomes in these populations. Knowledge-sharing and relationship building between First Nations, Inuit and Métis organizations, researchers and data custodians are essential to ensure appropriate data governance, meet health needs and further cancer control activities, including prevention
Health Disparities, Cancer among the Haudenosaunee, New York State
No full textIdentifying health status and disparities for Indigenous populations is the first logical step toward better health. We compare the mortality profile of the American Indian and Alaska Native (AI/AN) population with that of non-Hispanic whites in the Haudenosaunee Nations in New York State, the Indian Health Service (IHS) East region (Nashville Area) and the United States. Data from the linkage of IHS registration records with decedents from the National Death Index (1990-2009) were used to identify AI/AN deaths misclassified as non-AI/AN. Analyses were limited to persons of non-Hispanic origin. We analyzed trends for 1990-2009 and compared AI/AN and white persons in the Haudenosaunee Nations in New York State, IHS East region and the United States. All-cause death rates over the past two decades for Haudenosaunee men declined at a greater percentage per year than for AI/AN men in the East region and United States. This decrease was not observed for Haudenosaunee women with all-cause death rates appearing to be stable over the past two decades. Haudenosaunee all-cause death rates were 16% greater than that for whites in the Haudenosaunee Nations. The most prominent disparities between Haudenosaunee and whites are concentrated in the 25-44 year age group (Risk Ratio=1.85). Chronic liver disease, diabetes, unintentional injury, and kidney disease death rates were higher in Haudenosaunee than in whites in the Haudenosaunee Nations. The Haudenosaunee cancer death rate (180.8 per 100,000) was higher than that reported for AI/AN in the East (161.5 per 100,000). Haudenosaunee experienced higher rates for the majority of the leading causes of death than East AI/AN. These results highlight the importance of Haudenosaunee-specific data to target prevention efforts to address health disparities and inequalities in health