Frontline Cancer: Moving to better serve Hispanic patients

Like California in general, the counties of San Diego and Imperial are “majority-minority,” a demographics term that means the majority of the population is comprised of non-white groups. The largest of these groups is Hispanic/Latino, currently numbering approximately 1.2 million persons in the region, but projected to grow to more than 2.1 million by 2060.

As this population grows, the number and burden of cancer cases is expected to grow as well. But just as cancer impacts individuals differently, so too does it affect different ethnic groups — a fact and challenge that is exacerbated by historical and persistent disparities in research, education and health care delivery.

A longstanding collaboration between Moores Cancer Center at UC San Diego Health and San Diego State University (SDSU) is working to change that unfortunate reality. Since 2008, the SDSU/ UCSD Cancer Center Comprehensive Partnership has pursued an overarching goal of reducing the cancer burden in underserved minority groups in San Diego and Imperial counties.

Recently, the National Cancer Institute (NCI) awarded the partnership a new $13 million grant over the next five years to continue its work. The partnership is one of just 12 funded by the NCI. It will support 30 joint research projects and involve 29 community partners.

In particular, the partnership emphasizes advancing research and improving outreach and education to the largest group: Hispanics. It leverages the distinct but complementary strengths of its two institutions: SDSU is an official Hispanic Serving Institution, a designation of the federal government that means the university is eligible for extra resources to expand educational opportunities for and improve the attainment of Hispanic students. Moores Cancer Center is an NCI-designated comprehensive cancer center, one of just 45 in the nation, capable of conducting both basic research and clinical services at the highest possible levels.

Complex and interrelated factors contribute to how cancer impacts different racial, ethnic and underserved groups of people. Cancer is the leading cause of death among Hispanics, according to a report published in CA: A Cancer Journal for Clinicians. Some cancers are particularly hard-hitting. For example, Hispanics have the highest rates for cancers associated with infection, such as liver (incidence among men doubled from 1992 to 2012; it is overtaking colon cancer as the No. 2 killer of Hispanic men), stomach and cervical. A higher prevalence of infection with human papillomavirus (cervical cancer), hepatitis b virus (liver cancer) and the bacterium Helicobacter pylori (stomach cancer) in immigrant countries of origin contributes to these disparities, but they do not explain the full story. For unknown reasons, Hispanic adults and children also have the highest rates of some types of leukemia.

Although Hispanics are less likely to develop the most common forms of cancers than non-Hispanic whites, such as breast, colon and prostate, they are more likely to be diagnosed with advanced stages of these cancers and less likely to survive after diagnosis. Higher likelihood of advanced stage of cancer at presentation is in part due to lower than average rates of participation in guideline recommended screening. For example, rates of participation in colorectal cancer screening are lower among Hispanics than for other populations.

Part of the work of the U54 partnership includes collaboration with two of San Diego’s largest federally qualified health centers to improve cancer-screening rates among Hispanics. These systems, which include multiple primary care clinics across San Diego County, are charged with providing care to individuals who traditionally have had limited access to primary care, including recommended cancer screenings, and care for large populations of Hispanics. The collaborative work is expected to not only increase cancer screening rates among Hispanics at partner health centers, but also develop novel strategies that will improve screening participation throughout San Diego County and beyond.

The SDSU/UCSD Cancer Center Comprehensive Partnership is led by four investigators, two from each university. At UCSD, Elena Martinez, Ph.D., professor of family medicine and public health and head of the Reducing Cancer Disparities research program at Moores Cancer Center and Sheila Crowe, M.D., professor of medicine and director of research in the Division of Gastroenterology, head the effort. At SDSU, the leaders are Elva Arredondo, Ph.D., associate professor in the Graduate School of Public Health and Mark Sussman, Ph.D., professor of biology in the College of Sciences.

Key research objectives of the partnership are development and support of state-of- the-art projects that advance cancer research capacity at SDSU, enhancement of cancer health disparities research at UCSD and establishment of long-term collaborations between the two institutions.

Beyond that, a major objective is to provide education opportunities in cancer research and cancer disparities for promising undergraduate students from under-represented groups and development of active and sustainable collaborations among community partners to increase participation in recommended cancer screenings and best practices among low-income, underserved populations.