Why are there racial disparities in cancer?
In the U.S., African Americans males were 1.7 times more likely to be diagnosed with prostate cancer and 2.1 times more likely to die from it than their white counterparts in 2016, according to the Centers for Disease Control and Prevention.
Dr. Rick Kittles is a geneticist and director of the division of health equities at City of Hope, a private hospital, graduate medical school and research center in Duarte, California.
He noted that those rates plaguing the country are mirrored throughout Wisconsin, where racial disparities persist across multiple cancers.
Melinda Stolley, the associate director of prevention and control at the Medical College of Wisconsin’s Cancer Center, said the disparities are not unique.
Racially disparate rates occur all across the country; especially disparate cancer clusters in metro areas typically share the same culprits: hyper-segregation, poverty, lack of health insurance, food deserts, obesity and low health literacy.
Kittles spoke recently at an event hosted by Reggie Jackson, head griot, at America’s Black Holocaust Museum. It was meant to raise that level of literacy.
Jackson encouraged members of the audience to take control of their health care.
“If you go to your doctor and they are not telling you the information you need to have, you need to ask, ‘Well, what about this? What about that?’ ” he said. Kittles agreed.
However, both acknowledged that the history of medicine — slaves being experimented on without anesthesia by pioneers such as physician J. Marion Sims, the Tuskegee syphilis experiments and unauthorized use of Henrietta Lacks’ cells (HeLa cells), for example — presents its own set of challenges to African American communities.
Research mistake
Even feeling discriminated against leads to worse health outcomes: higher blood pressure, heart rates and increased cortisol production, to name a few.
That issue of mistrust crept up again and again at the presentation — especially because, Kittles said, African American participation could lead to better medicine or even a cure, the way HeLa cells were used to create the vaccine that eradicated polio.
And as Kittles discovered, with the exception of HeLa cells, African cell lines are missing from most labs.
The classification of cell lines is based on genography, the study of how early human migration patterns from Africa through Eurasia and ultimately to the Americas produced the cell lines of today.
In his article, “The Genetics of Human Migration,” science writer Philip Hunter described how humans created genetic variants by spreading across the globe and adapting to different environments.
Researchers often use commercial cell lines with varying amounts of West African, European and Native American genetic ancestry in their studies.
Kittles and several researchers pub
lished a study in February that found that researchers had misclassified many cell lines as African American, even though they were actually of mixed ancestry or even majority European ancestry.
And even those studies using cell lines with accurate ancestry lacked diversity; for example, researchers analyzed the breast cancer specimens used in one particular study, and they found that over 71% were European cell lines, whereas only 13% were African American, and one Hispanic and only one East Indian specimen was used.
Why do cell lines matter?
Creating treatments from misclassified cell lines has the potential to compromise “precision medicine,” an increasingly popular approach in oncology that treats individuals based on their genetic makeup, environment and lifestyle.
Moreover, cancer risks are often assessed using cell lines.
“If you had high levels of West African ancestry, your risk of prostate cancer increases,” Kittles pointed out. “What we also found was that high levels of Native American ancestry is protected against prostate cancer.
These cell lines are also used to evaluate detection methods.
PSAs, or prostate-specific antigens, are cancer biomarkers used to detect cancer through the blood; high levels could mean the presence of cancer cells.
Recently, urologists discovered that the antigens behave differently between people of mainly African ancestry and mainly European ancestry.
“The prediction of prostate cancer with PSAs increases with percentages of West African ancestry,” Kittles explained. Race — a factor that Kittles described as a “crude proxy for shared biology and environment” — plays a role at each stage of the cancer process.
Education and inclusion
In recognition of that, researchers at several hospitals, including the Medical College of Wisconsin, have made efforts to diversify their pool of research participants and researchers.
Stolley says it’s all about trust. “You never get anybody to participate in a clinical trial unless you develop trust first,” she said.
Stolley has given presentations to the Milwaukee Public Health and Safety Committee at City Hall describing the results of focus groups conducted by MCW to find out what members of the African American community need to feel safe participating in the process.
Based on the feedback, Stolley and other MCW researchers created a threestep approach that involves building a community partnership, education and efforts to diversity the health care workforce, and community-engaged research.
Essentially, the idea is to make potential patients feel things are being done with them — not to them.
On the research side, Stolley runs Men Moving Forward, a study on how lifestyle, healthy eating and exercise affects African American prostate cancer survivors.
Many were surprised at the invitation to participate in the study.
“Men were saying this is the first time anybody had asked them about their disease and what this was like,” she said. “It’s that kind of work over time that helps people gain trust.”
Resources
Stolley said getting screened, knowing family history and getting second opinions are all ways people can improve their outcomes when it comes to any cancer.
There are also local resources specifically for prostate cancer:
Education: MCW is holding its annual Prostate Health Education Event from 8 a.m. to noon Nov. 2 at Pilgrim Rest Missionary Baptist Church, 3456 N. 38th St. The event is free and free PSA screenings are being offered.
Nationally, the American Cancer Society and United States Preventive Task Force have pages dedicated to prostate cancer detection, diagnosis and treatment on their websites.
Support: Columbia St. Mary’s holds a prostate cancer support group at least once a month at its Cancer Clinic at 2350 N. Lake Drive. The next meeting is 6 to 8 p.m. Oct. 6.
Ascension Southeast Wisconsin Cancer Care holds a prostate cancer survivors support group called Us Too at its Wauwatosa campus, 201 N. Mayfair Road. The next meeting is 5:30 to 7 p.m. Sept. 24.
Clinical trials: African American prostate cancer survivors can also participate in Men Moving Forward, a study on how healthy lifestyle, diet and exercise affect life after cancer. For more information, contact Jermaine Murry at (414) 805-7367 or jmurry@mcw.edu.