Dr. Eugene Manley is LUNGevity's Director of STEM Workforce Initiatives.
Maisha Standifer, PhD, MPH, LUNGevity’s Community Scholar-in-Residence, and I attended the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved in Philadelphia from September 16-19, 2022.
This is one of the largest meetings in cancer disparities and had 700 attendees from 11 countries. If one can attend only one cancer disparities meeting during a year, it should be this meeting – where researchers and healthcare practitioners get together to share learning and solutions toward reducing disparities impacting minority and underserved populations.
Many of the sessions covered social determinants of health, bias, racism, access, survivorship, race and ancestry, and community engagement. I will highlight four of the many takeaways from this meeting.
Lung Cancer
Disparities in lung cancer span basic research, clinical trials, biomarker testing, and lung cancer screening. The 2022 Distinguished Lectureship on the Science of Cancer Disparities given by Dr. Loic Le Marchand from the University of Hawaii Cancer Center, titled “Translating Multiethnic Epidemiological Research Into Innovative Interventions,” provided valuable insight into the multitude of factors that impact people diagnosed with lung cancer. His work with the Multiethnic Cohort study tracked lifestyle, diet, environment, genetics, and multilevel factors in Whites, Japanese Americans, Native Hawaiians, African Americans, and Latinos in Hawaii and Los Angeles. This work showed certain groups have increased risk of lung cancer, metabolize nicotine differently, and have different rates of smoking intensity, and that certain groups of people will require different interventions. His work was the precursor to many new studies that combine structural and social determinants of health, with the biology of the disease.
I also learned that there are very few lung cancer cell lines derived from African Americans. NCI-H23 and NCI-H1373 are the only two adenocarcinoma cell lines derived from African Americans.1 As many drugs are developed through preclinical research followed by clinical trials, it is essential to test them in a range of cell lines that at least reflect the population based on demographics or relative lung cancer rates or mortality. There can be differences in genetics, metabolism, and therapeutic effectiveness in different racial and ethnic groups, and if these are identified early in drug development, then it will be a better driver of precision medicine and reduce some of these disparities. In recent times, Asian and Hispanic populations, respectively, have often been looped together as one race. However, there are many different ethnicities among these groups, including different income, education, diet, genetics, and how they interact with the healthcare system. It may be beneficial to identify cell lines across these populations to facilitate additional targeted therapies.
Implementation of Mentoring, Training, and Other Programs to Increase Workforce Diversity
There were several talks that discussed NIH programs currently running or in development that will increase training of minority scholars.
- NIH UNITE is focused on racial and ethnic minorities, increasing diversity and inclusion in science, and ending structural racism across the NIH.
- NIH DEIA (Diversity, Equity, Inclusion and Accessibility) is an expansion of UNITE and includes LGBTQIA, people with disabilities, women, and other groups.
- Other NIH programs to increase diversity in the cancer research workforces include the Intramural Continuing Umbrella of Research Experiences (ICURE), CURE Shing Stars Seminar, and the Cancer Moonshot Scholars program.2
In addition to NIH initiatives, the United Negro College Fund (UNCF) has several programs
to help minority scholars in STEM careers.
- UNCF Computer Science (CS) Academy connects undergraduates at historically Black colleges and universities (HBCUs) with Silicon Valley and provides them with entrepreneurship as well as technical and professional skills.
- UNCF Ernest E Just Life Sciences Initiative connects HBCU students to summer internships with Boston-based pharma and biotech.
- UNCF TechVentures Tech-Entrepreneurship (E*ship) increases opportunities for African American students from HBCUs to launch pre-accelerator programs on their campuses to aid in the launch of student-led ventures.
Race vs. Ancestry and Disease Risk
Several presentations discussed the use of race vs. genetic ancestry in models to predict cancer risk. Some say that race is a social construct and can predict disease risk. Others believe that genetic ancestry is a better indicator of where someone is from, and a better predictor of disease risk. Several studies showed that prediction models using ancestry alone were not sufficient to accurately capture the societal and environmental factors that may impact biology and disease risk.
Many of the large genomic databases overrepresent European populations and thus are difficult to use to identify mutations and gene variants that may drive disease in diverse populations. Work was shown in several cancer models that there are some genetic differences between Black individuals in the US, across the Caribbean, and in different countries in Africa. Similarly, there are differences between Asian subpopulations and Hispanic subpopulations; however, they are also often grouped together. This suggests that more work needs to be done to build samples from these various groups to more completely understand disease risk and to increase group-specific interventions and outcomes.
Community Engagement, Participation, and Advocacy
Dr. Nadine Barrett at Duke Cancer Center talked about the need to integrate people starting at the community level to address disparities. Her analogy, modified from the Saporta Report, really drove home the point. Visualize a tree where there are leaves, branches, a trunk, roots, and underlying water. External influences (i.e., COVID) can shake the leaves. The leaves are also where many programs are created; however, these address surface issues and do not impact the core structural problems. To foster growth, one must go down the branches and trunk and into the roots to develop an ecosystem where the community is engaged. They are able to participate in the research, they offer input, and they uplift each other. As the roots grow, structural and societal systems (i.e., the water) start to be disrupted and allow people to thrive. She reinforced the need for “1) transparent and equitable partnerships, 2) committed and open leadership and teams, and 3) honest and actionable assessments” to work toward anti-racism, anti-bias, and equity in cancer research and care.
A great example of a community-driven project is the All of Us Research Program, which is trying to get data from 1,000,000 patients to build a database that can be used to asked relevant health care questions that can be specific to underserved populations across multiple diseases. It can account for demographics, identify who benefits from treatments, Medicare or insurance usage, age, environment, and clinical trials.
This meeting shows that for all of the progress that we have made, there is still a lot of work that needs to be done to ensure all patients can survive.
To learn more about the AACR meeting and work, be sure to check out the 2nd annual AACR Cancer Disparities Progress Report 2022.3
References
1. Kessler MD, Bateman NW, Conrads TP, Maxwell GL, Hotopp JCD, O’Connor TD. Ancestral characterization of 1018 cancer cell lines highlights disparities and reveals gene expression and mutational differences. Cancer. 2019;125 (12): 2076-2088.
2. National Cancer Institute Center to Reduce Cancer Health Disparities (CRCHD). www.cancer.gov/crchd
3. AACR Cancer Disparities Progress Report 2022: Achieving the bold vision of health equity for racial and ethnic minorities and other underserved populations. Philadelphia: American Association for Cancer Research; 2022. Accessed September 2022.