National Minority Health Month Spotlight: UChicago P20 Planning Grant Team Seeks to Reduce Breast Cancer Disparities, Increase Cancer Research Workforce Diversity
, by CRCHD Staff
In recognition of National Minority Health Month, we at the NCI Center to Reduce Cancer Health Disparities (CRCHD) are recognizing CRCHD scholars on the Center's blog, Dialogue on Disparities. In this blog post, the University of Chicago P20 Planning Grant team describes its efforts to reduce breast cancer disparities and increase workforce diversity within its institution. This blog post was authored by: Olufunmilayo Falusi Olopade, MBBS, OON, Walter L. Palmer Distinguished Service Professor, Director, Center for Global Health, The University of Chicago, Knapp Center for Biomedical Discovery; Dezheng Huo, MD, PhD, Professor, Department of Public Health Sciences, The University of Chicago; and Rita Nanda, MD, Associate Professor of Medicine, Director, Breast Oncology Program, The University of Chicago.
Since 2018, the University of Chicago Interdisciplinary Cancer Health Disparities Specialized Program of Research Excellence (SPORE) in Breast Cancer has been supported by the National Cancer Institute’s (NCI) P20 Planning Grant, with the purpose of finding practical, informative, personalized and productive approaches to reducing the health disparities suffered during a breast cancer experience by Black and other Women of Color across the Diaspora. These efforts further the mission of the NCI’s Center to Reduce Cancer Health Disparities (CRCHD) to eliminate cancer health disparities and diversify the cancer research workforce.
A center for advanced learning and research since its inception in 1892, the University of Chicago is a private, nonprofit institution located in Chicago’s ethnically diverse Southside. The university has a uniquely rich history of fostering cross-disciplinary research, providing a robust foundation for the activities of the UChicago SPORE program. It also has a strong tradition of serving its surrounding community. The translational goals of our SPORE could significantly improve long-term patient outcomes, particularly for the underserved Black populations on the Southside of Chicago, where the breast cancer-specific mortality rate—due to pervasive health care inequities and other reasons still unknown—remains one of the highest mortality rates in the United States. If left unstudied, the mortality rate will only continue to grow.
Reducing Disparities in Breast Cancer Outcomes
To date, the UChicago SPORE program research has had important implications for addressing cancer health disparities:
- One study showed explicitly that Black women with breast cancer experienced worse outcomes in terms of both survival and recurrence compared to White patients, especially for hormone receptor negative (HR−)/HER2 positive (HER2+) and HR+/HER2− patients. These two subtypes of breast cancer can be treated effectively through targeted therapies. While adherence to and completion of guideline-informed targeted therapies have been examined, within-subtype biological differences have never been fully explored. We are studying this within the UChicago SPORE.
- In another recent publication, we reconstructed the evolutionary “life history” of breast tumors and identified a novel genomic subtype in which GATA3 mutations occurred as an early clonal event. This study also discovered an indel signature (labeled as “INDEL-B”) that was quite frequent in Nigerian breast cancers, less common in breast tumors from U.S. Black patients, and almost depleted in U.S. White patients. These findings underscore the need to include more diverse populations in genomic research for better disease classification and development of novel therapies that improve outcomes for all women.
- Additionally, researchers within our program are developing new methods and modeling techniques to analyze images of pathology slides and use these digital pathology features to predict clinical outcomes. The team recently demonstrated that a batch effect in site-specific digital pathology could lead to serious bias in study interpretation. We proposed a method that will eliminate this bias. Because deep learning models are based on widely available pathology slides, our studies have great potential for efforts to develop precision oncology in an equitable and cost-effective manner.
Developing the Next Generation of Diverse Cancer Researchers
Foundational to the UChicago P20 SPORE planning grant is career development support that provides the mentorship, resources, and time to basic, clinical, and population science investigators needed to yield impactful innovations having the potential to reduce cancer health disparities. The program is based on the conviction that translational research is not unidirectional from the bench to the clinic to the population, but rather that it can originate in any of these domains and effectively proceed to the other domains. Expanding diversity, equity, and inclusion is pivotal to fostering the creativity required to develop new approaches in breast cancer care leading to equitable outcomes. Two of our current awardees demonstrate the value of this framework:
Loren Saulsberry, PhD, Assistant Professor in the Department of Public Health Sciences, is a recipient of the one of the SPORE’s pilot project awards to conduct research that will guide genomics and pharmacogenomics in precision oncology toward reducing cancer inequities. Dr. Saulsberry is particularly interested in further developing existing methodologies and practices that can reduce inconsistencies and gaps in the analytic approaches associating genetic variation with disease phenotypes within diverse populations.
Marcia Tan, PhD, MPH, Assistant Professor in Public Health Sciences and Member of the UChicago Comprehensive Cancer Center, is another recipient of one of the SPORE's pilot project awards. The goal of Dr. Tan’s project is to understand how to increase conversations about advanced care planning, or end-of-life care, among Black women with breast cancer, and ways in which community health workers (CHW) can support these discussions. Dr. Tan has experience working with CHWs in both hospital and community-based organization settings to conduct community-based research to design culturally relevant trainings for CHWs. See one of Dr. Tan’s recent papers: Race differences in predictors of weight gain among a community sample of smokers enrolled in a randomized controlled trial of a multiple behavior change intervention.
This SPORE program will remain committed to reducing health disparities by actively recruiting, as awardees, faculty from groups underrepresented in medicine (URM), including women, individuals from disadvantaged backgrounds, LGBTQ, and persons with disabilities, and acting vigorously to retain URM faculty. It is the intention of this program to attract and mentor individuals who will pursue independent careers as investigators and ensure that women and minority scientists are ever better represented as time goes on, in our continuing pursuit of breast cancer research excellence.