Genomic insights could boost equity in global cancer care

There are well-documented inequalities in cancer outcomes based on race. In the US, Black people have the highest death rates and shortest survival rates from most cancers, of any racial group — a clinical reality with which Sophia George has personal experience.

George, originally from the Commonwealth of Dominica and now a researcher at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, has lost family and friends to cancer and seen first-hand its devastating impact. It’s among the motivators for her and other experts at Sylvester who dedicate their careers to preventing other people, families and communities from experiencing the same loss, wherever they are.

“I wanted to leverage my skills and the opportunity I have earned to help my community get better cancer care in Miami and across the globe,” she says.

George’s work seeks to discover why young Black women are more likely to develop rare and aggressive triple-negative breast cancer, and why Black men risk developing aggressive prostate cancer and at a much younger age than other groups. She and her colleagues are determined to help solve these mysteries, and more.

“We feel that our research can provide many of these answers,” George says.

Underserved communities

People of African descent are traditionally underrepresented in cancer studies. The result is a lack of biological knowledge about how and why tumours develop as they do. It also means medical facilities are less able to optimize cancer care for Black patients.

George aims to address both issues in her research at Sylvester. She leads a new international effort to decode Black genomes and investigate the genetic drivers behind breast, ovarian and prostate cancer. Backed with US$1.65 million from the Chan Zuckerberg Initiative, the project — called the African-Caribbean Single-Cell Network — will assess what goes wrong when cancer develops by first collating evidence of what goes right in the disease-free state.

The network will build a single-cell atlas of healthy breast, fallopian tube (where most ovarian cancers originate) and prostate cells from people in Kenya, Nigeria, the Bahamas, Haiti, Jamaica and people in the US of African ancestry. It will combine single-cell and genotyping data with information on health and lifestyle factors, such as diet and behaviour, to better understand what constitutes ‘normal’ tissue in men and women of all ages, and hopefully to decipher how cells become cancerous.

“We don’t know the spectrum of ‘normal’ in these populations because they have historically not been represented in biomedical research,” George says.

There are many reasons for this disparity. One is structural racism in science and medicine, George says, based on an assumption that Black people are less willing to participate in studies. In some cases, Black people are underrepresented in clinical trials because of unintentional bias in exclusion criteria, which often rule out people with co-morbidities — such as hypertension — that are more common in minoritized populations.

Another factor, according to Stephen D. Nimer, director of Sylvester Comprehensive Cancer Center and executive dean for research at the Miller School, is that some communities have less access to medical facilities. This can leave people with a lack of awareness or understanding of trials, or even a mistrust of medical professionals.

Outreach and education

To address these disparities, Sylvester runs several outreach programmes, including what it calls ‘Game Changer vehicles’ — RVs driven by health workers to areas that traditionally have poorer access to healthcare, to provide health education and screening.

While results from research can take time to improve the situation on the ground, these vehicles are visible signs of Sylvester’s outreach programmes making an impact now. By developing better relationships with local communities, Nimer says the cancer centre can more readily disseminate knowledge from research findings, such as screening for a gene linked to cancer.

And the flow of information goes both ways. Sylvester recently launched a lecture series for staff and students on partnerships and collaboration, delivered by the people carrying out research and collecting data in local communities. “Our vision is one of inclusion,” Nimer says. “This attracts great researchers and students to Sylvester and is guiding and developing a changing workforce.”

Education is another important part of the African-Caribbean Single Cell Network. As part of that effort, George and her Sylvester colleague Matthew Schlumbrecht, a researcher and clinician, recently visited the Lagos University Teaching Hospital and other sites in Nigeria.

“We want to train researchers and clinicians in Nigeria, and in other countries, to give them the research skills and experience necessary to answer the questions relevant to their own communities,” Schlumbrecht says. For example, the birth rate in Nigeria is 5.6 children per woman, compared with 2.6 in the US, and this can alter the risk of some cancers. As part of the programme, Nigerian colleagues have the opportunity to carry out three months of clinical observations and six-month research fellowships at Sylvester.

The full spectrum

In a related project, George is leading a new cancer genome cohort study to characterize the genetic and molecular drivers of breast cancer across the African diaspora.

The work is being done as part of the African-Caribbean Cancer Consortium (AC3), an international network that conducts studies of cancer risk and outcomes among populations of African ancestry. “We want to understand the full spectrum of who we are,” George says.

Schlumbrecht’s research focuses on endometrial cancer. While Black and white women in the US are diagnosed with the disease at similar rates, Black women are almost twice as likely to die from the cancer because they are at greater risk for aggressive types that metastasize early. “We know that there are both genetic and environmental triggers at play,” Schlumbrecht says. “Socioeconomic status can have a profound impact on disease development and progression.”

There is no screening test for endometrial cancer, which puts minority women — those at higher risk for aggressive types — at most risk for worse outcomes. One goal of Schlumbrecht’s research is to develop a way to screen for the condition — perhaps by identifying genetic clues, or by looking at the characteristics of the vaginal microbiome. Earlier diagnosis and treatment could have a huge impact on the lives of Schlumbrecht’s patients, and women in the wider community. Like George, Schlumbrecht’s research and educational work is driven by a personal passion from his own clinical experiences.

“I see women with advanced-stage endometrial cancer every day who need better options,” he says. “At the most basic level I really hope the result of our work is the direct delivery of improved patient care and outcomes by preventing disease and improving treatments.”