Dr. Amelie Ramirez: Helping Direct Research of Cancer Disparities Affecting Latinos

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by the National Cancer Institute

As cancer disparities research continues to gain momentum, more attention is being directed to the unique cancer profile and needs of the fast-growing Latino population that has become the largest minority population in the United States.

Dr. Amelie Ramirez, Dr.P.H., MPH is among the leaders in NCI-funded cancer research for the Latino community. She serves as Principal Investigator for Redes En Accn, a Community Networks Program Center funded by the NCI, dedicated to reducing Latino cancer with a national network of community groups, researchers, government health agencies and the public.  Using a community-based participatory research approach, core activities include research, training, and stimulating awareness of cancer and resources in Latino communities. Dr. Ramirez leads the initiative out of the University of Texas Health Science Center at San Antonio, where she is professor and director of the Institute for Health Promotion Research.

Dr. Ramirez has been a leading advocate for reducing chronic disease and cancer health disparities in Latinos for more than 30 years. In a recent interview for “Meet the Researchers,” she discussed her work and how she became interested in a career in the health sciences, more specifically cancer research.

How did you get interested in cancer disparities research?

Growing up in Laredo, Texas, I couldn’t help but see that many residents along the Texas-Mexico border often had inadequate access to high-quality health care.

I quickly decided that I wanted to help Latinos in this region have healthier lives. While working on my master’s degree, I got a job as a community health educator with the Debakey Heart Center at Baylor College of Medicine. This was my first real taste of community outreach, and I took a liking to it. I worked with community clinic patients and tried to educate Houston’s Latino community about the perils of high blood pressure. I also had the opportunity to work with several health communications folks to see how media could inform different communities about health.

From there I was able to launch my own health research career, working in South Texas in the early 1980s. We started one of the first-ever outreach and education programs using a unique mass media plus community educator model to encourage people in communities along the Texas-Mexico border to quit smoking. We had a lot of success, and we’ve used this media model many times over the years to conduct research and promote health among different Latino groups and topics.

How does the Redes En Acción program address cancer disparities in the Hispanic/Latino community?

Redes En Acción is dedicated to reducing Latino cancer with a national network of community groups, researchers, government health agencies, and the public. Core activities include research, training, and stimulating awareness of cancer and resources in Latino communities.

Our infrastructure is strong. We have five national sites led by cancer experts: myself in Texas; Eliseo J. Pérez-Stable, MD, in Northern California; Gregory A. Talavera, MD, MPH, in Southern California; Frank J. Penedo, PhD, in Illinois; and Juan Emilio Carrillo, MD, in New York.

We have had success in each of our core activities. Redes researchers have been awarded more than $200 million in peer-reviewed Latino cancer and chronic disease research grants. Through a variety of activities we have instructed or mentored more than 200 emerging cancer researchers from undergrads to doctoral students to junior faculty, building a national pipeline of Latino researchers and physicians. Redes has reached communities and researchers nationally through more than 2,000 cancer education events, bilingual education materials and informative publications (https://www.redesenaccion.org/publications), and additional efforts.

What is the most important disparities research outcome resulting from the work of Redes En Acción?

Many years ago, we orchestrated the first study of its kind to identify major differences in health knowledge/attitudes/behaviors among different Latino population groups, and we’re the only national group focused solely on cancer in Latinos.

Most recently, our Redes researchers discovered that Latinas endure a lag in definitive breast cancer diagnosis and treatment initiation. We know that time to treatment affects outcomes of breast cancer patients. So the Redes co-investigators and I conducted a randomized controlled trial to test if having access to a patient navigator (someone who could provide women with culturally sensitive help in overcoming a variety of barriers to getting care) would lead to faster diagnosis and treatment among Latinas with abnormal mammogram results. The trial results showed that navigation can lead to faster diagnosis and treatment and increase the proportion of women initiating early treatment.

What is the most challenging aspect of cancer disparities facing the Hispanic/Latino community today?

One challenging aspect remains the education of women about breast cancer.

There are still very critical cultural beliefs that interfere with Latinas’ approach to early detection of cancer. Take for instance, fatalism—even with all the progress against cancer to date, the Latino community still greatly fears cancer, and it’s a primary reason why they put off screening and come in late for diagnosis; mothers take care of others first; cancer is viewed as a death sentence; and not recognizing breast cancer as a disease that in most cases grows slowly enough to be detected and treated.

How important is community-based participatory research to eliminating cancer health disparities?

Getting the community involved with researchers is vital to the uptake of study results into practice in community groups, clinics, etc. Researchers benefit from hearing the community’s needs and being able to adjust interventions to meet those needs, and local residents and groups benefit from having their specific needs addressed while being empowered to put the research to use. It also builds people’s capacity to take leadership roles for change in the future.

What advice do you have for young minority scientists beginning their careers as independent researchers?

Be prepared for new challenges. Luck is where preparation meets opportunity. Choose good mentors. Have a go-to group of professional colleagues who also are friends to bounce off ideas and issues. Remember your roots. Be courteous and kind to everyone you meet, because some day they may be able to open a door for you—or your own children down the road—that otherwise would have been closed. Also volunteer and balance work with family and fun.

NCI leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI web site at www.cancer.gov or call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).