Cancer disparities in LA's minority communities

My project will look at current research into cancers that disproportionately affect ethnic minorities, specifically Jewish and African-American communities. I will examine medical discoveries and ongoing clinical trials that hope to shed light on breast and ovarian cancer, male breast and prostate cancer, and pancreatic cancer. These stories will include interviews with cancer patients and survivors, doctors, researchers, and advocates. It will require extensive research of the medical literature and media coverage. Multimedia components will include photographs and audio interviews. I plan to use Facebook, Instagram, Twitter, email networks, and the Public Insight Network to gather interview subjects and expert sources, publicize the project and distribute the resulting reports.

BREAST AND OVARIAN CANCER

Twenty years ago, a researcher at UC-Berkeley discovered the hereditary mutations of the BRCA genes, which can lead to the development of breast and ovarian cancer. Individuals of Ashkenazi Jewish ancestry (descendants from Eastern and Central Europe) have a 1 in 40 chance of carrying a BRCA gene mutation, as compared to one out of every 800 members of the general population, according to the Centers for Disease Control. Women who carry mutations in BRCA1 or BRCA2 have up to an 80% risk of developing breast cancer and up to a 45% risk of developing ovarian cancer. Men can also carry and pass these gene mutations on to their family, and also have increased cancer risks.

Although white women have the highest incidence of breast cancer, African-American women have the highest breast cancer death rates of all racial and ethnic groups. They are 40 percent more likely to die of breast cancer than white women. The five-year survival rate for African-American breast cancer patients is 78 percent, compared to 90 percent for white women, according to the American Cancer Society. Many factors contribute to this disparity, including that black women tend to have cancers that are more aggressive and harder to treat. Both black and Latina women face a greater-than-average risk for more serious disease and death from breast cancer, as well as disparities in follow-up care. 

The story will look at the work of Dr. Beth Karlan and her colleagues at the Women’s Cancer Program at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center. The Women’s Cancer Program has also created the Research For Her registry with the goal of enlisting 2,000 participants. Using the resulting pool of data, their goal is to identify cancer risk factors and patients at higher risk for developing cancer. The registry also will help researchers find women who fit the criteria for a particular study or clinical trial.

MALE BREAST AND PROSTATE CANCER

Just as Ashkenazi women have an increased risk of inheriting a mutated BRCA1 and BRCA2 gene from one or both of their parents, so do Ashkenazi men. These mutations result in a higher risk of developing certain types of cancer, including male breast cancer and prostate cancer. Men who inherit an abnormal BRCA1 or BRCA2 gene have approximately a 6 percent risk for developing breast cancer during their lifetime. That risk is 80 percent greater than the lifetime risk of men without an abnormal BRCA1 or BRCA2 gene.

Of the more than 242,000 American men a year who will be diagnosed with prostate cancer and the 28,000 who will die as a result of it, a disproportionate number of African-American men will be represented in each group. The disparity is eye opening: African-American men are nearly 1.6 times more likely to be diagnosed with prostate cancer than white men and 2.4 times more likely to die from the disease.  Studies have shown that African-American men may have reduced access to and quality of care that may result in diagnosis and treatment of prostate cancer at later stages (after the disease has spread outside of the prostate). Other factors may be related to diet, exposures and co-existing medical conditions that influence the severity of the cancer. 

PANCREATIC CANCER

According to the American Cancer Society, pancreatic cancer, though relatively uncommon, is fourth among the leading causes of cancer deaths in 2014, just behind lung, prostate/breast, and colon/rectal cancers. Within a few decades, pancreatic cancer is expected to rise to the second cause of cancer deaths, mostly because an aging population is more likely to be diagnosed. About 1 in 40 Jews in the United States will get pancreatic cancer, compared to 1 in 67 in the overall U.S. population, according to a 2011 study published in the journal Cancer Epidemiology, Biomarkers & Prevention. The reasons for this higher risk are not yet known.

The incidence of pancreatic cancer is 50 to 90 percent higher in African Americans than in any other racial group in the United States. Pancreatic cancer incidence and mortality rates also are higher in men than in women. Studies suggest that environmental and socioeconomic factors may be important. Cigarette smoking, which causes about 25 percent of pancreatic cancer, is more common among African Americans and therefore may partially explain why pancreatic cancer is more common in African Americans. 

Pancreatic cancer runs in families, and approximately 10% of all cases occur in individuals with a genetic predisposition for the disease. BRCA mutations can also increase the risk of pancreatic and prostate cancer, albeit to a lesser degree. People with these mutations have a two- to six-fold increased risk of developing pancreatic cancer over general population estimates, though data is limited.