November 11, 2005

Colorectal cancer disparities dissected at conference

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VUMC’s Lisa Signorello, Sc.D., spoke at the conference.
photo by Joe Baker

Colorectal cancer disparities dissected at conference

The Meharry-Vanderbilt Alliance hosted a three-day conference last week aimed at tackling the issue of disparities in treating colorectal cancer and discussing advances in the field.

The conference began with the keynote speech in Light Hall by Harold Freeman, M.D., associate director of the National Cancer Institute (NCI) and director of the Center to Reduce Cancer Health Disparities at the NCI.

“This unequal burden of disease in our society is a challenge to science and a moral and ethical dilemma for our nation,” said Freeman.

Freeman is the leader of the American Cancer Society's initiative on cancer in the poor and is a leading authority on the interrelationships between race, poverty and cancer. He praised the collaboration between Meharry and Vanderbilt-Ingram.

“This kind of alliance should be a model for America,” he said.

Freeman said there is a disconnect in health care between what is discovered and what is delivered.

“When there are people who don't experience the benefits of discovery then we have disparity. The principal reason for disparity is failure to deliver what we know at this time. The huge issue and most important thing we could do in America to change this disparity picture is to apply what we know to all people,” he said.

Freeman noted how Americans move into action to help people in need when natural disasters strike, like the recent devastation from Hurricane Katrina, but he said the same attention should go to those in need of health care in our country.

He closed his speech with some recommendations for working toward eliminating disparities in cancer care.

“We need to have universal access to health care for all American people. At a minimum, if people have cancer, they ought to be treated. I don't think that's asking too much. We should look where people are dying geographically and apply intense education and care in those areas. We should monitor standards of care to make sure it is done for everybody,” Freeman proposed.

The reminder of the conference took place at the Marriott Hotel in Cool Springs, where the Southern Community Cohort Study (SCCS) was highlighted, among many other presentations from national leaders in the field of colorectal cancer.

In the SCCS, Vanderbilt and Meharry Medical College have partnered with the International Epidemiology Institute to identify and assess gaps in population-based cancer research, including colorectal cancer. The Study, funded by the NCI, set a goal to recruit about 70,000 African-Americans and 35,000 non-African-American residents of the southern United States aged 40-79, to try to explain disparities in cancers and care, and help prevent cancer occurrence.

Lisa Signorello, Sc.D., assistant professor of Medicine and a leader in the SCCS, revealed some early progress.

“To date, we've partnered with 48 community health centers in 14 states across the south. So far, we've enrolled 43,000 study participants,” she said.

The early statistics show 76 percent of the enrollees are African-Americans, 24 percent are non-African-Americans, 60 percent are female and 40 percent are male.

Investigators have collected a blood, mouth cell and urine sample whenever possible. “This has allowed us to have DNA from 91 percent of participants to date,” Signorello said.

She said the early results show some staggering health statistics for this population. “The levels of smoking are double the national averages in all groups. They have very high obesity levels. Fifty-eight percent of black women in the study are obese, and this puts the cohort at risk for not only colorectal cancer, but other diseases,” declared Signorello.

Findings to date in the SCCS were also used to examine the role vitamin D plays in colorectal cancer. In the past six months, pilot studies were conducted to look at biomarkers for serum vitamin D among the cohort participants. Signorello said she found higher levels of vitamin D among white enrollees than in blacks.

“Because of their skin pigmentation, blacks don't produce as much vitamin D. The major source for this is sun exposure. So African-Americans are at an increased risk of vitamin D deficiency.

“There is emerging evidence that this deficiency might contribute to health disparities, including excess risk of colorectal, prostate, breast and other cancers.”

Signorello said they will continue to enroll study participants until they meet, if not exceed, their goal.

“We hope moving forward to be assessing risk factors for colorectal cancer, why rates are higher among African-Americans and how to help lower rates.”