RACIALIZED MEDICINE U$A
Study demonstrates benefit of precision medicine based on race/ethnicity
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A NEW STUDY, LED BY HIROSHI YAMADA, PH.D. AT THE UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE AT OU HEALTH SCIENCES, HIGHLIGHTS RACIAL DISPARITIES IN A SUBSET OF CANCER PATIENTS AND PROVIDES EVIDENCE FOR THOSE DIFFERENCES AT THE MOLECULAR LEVEL.
view moreCREDIT: PHOTO PROVIDED BY THE UNIVERSITY OF OKLAHOMA HEALTH SCIENCES
“Precision medicine,” an emerging approach to health care in which a patient’s genetics, diseased tissue and other factors guide clinicians to personalize treatment strategies, can dramatically improve health outcomes for people with various diseases, notably cancer.
Years of analysis of cancer specimens makes such targeted treatment possible, yet the samples being studied in the United States and Europe overwhelmingly come from people who are white. That reality means innovative new cancer treatments may have missed genetic predispositions toward cancer that are pronounced in people from non-white races and ethnicities.
A new study published by researchers at the University of Oklahoma College of Medicine at OU Health Sciences highlights racial disparities in a subset of cancer patients and, using advanced biomedical research technology, provides evidence for those differences at the molecular level. The collaborative study among researchers in Oklahoma and Alabama was led by Hiroshi Yamada, Ph.D., and Chinthalapally V. Rao, Ph.D., assistant professor of research and professor in the Department of Medicine, Section of Hematology-Oncology, as well as Upender Manne, Ph.D., professor of anatomic pathology at the University of Alabama in Birmingham. The study was published in NPJ Precision Oncology, a Nature journal publication, and the research was funded by multiple grants from the National Institutes of Health.
“People from various races, regions and communities face differences in the prevalence of cancer and survival rates from cancer,” Yamada said. “Poor cancer outcomes have reasons. But the reasons have not been understood at the molecular level. Unlike social factors such as poverty or access to advanced cancer care, molecular differences in cancer can be addressed by a drug or other personalized treatment. But because molecular analyses on cancers historically have focused on samples from white people, that has created a blind spot in treatment development.”
To investigate whether cancer racial disparities can be identified at the molecular level, Yamada and his team analyzed colon cancer specimens from American Indian patients in Oklahoma. In addition, researchers at the University of Alabama provided cancer specimens from African American patients in Alabama. For many years, statistics have shown that non-white populations often face cancer at a higher rate and have worse health outcomes than people who are white. Advancements in technology now allow researchers to find evidence for those disparities at the molecular level.
Yamada and his team indeed discovered differences in American Indians and African Americans, as compared to white Americans, in two important areas: gene expression (instructions in the DNA that tell cells what to do) and cytokines (proteins that play a role in how cells interact and communicate with each other). Because of what researchers know about those differences, some of the colon cancer drugs under development — mostly based on data from cancer samples of white patients — may be less effective for American Indians or African Americans, Yamada said.
“This study highlights potential targets for colon cancer prevention and treatment in American Indians and African Americans, which is information that would not be available through the analysis of cancer specimens from white populations alone,” Yamada said.
Yamada said that racial/ethnic groups share biological “patterning” that occurs because of social constructs (not unchangeable characteristics), as well as dietary habits, geographic locations, and other cultural practices and lifestyles. It is essentially impossible to separate these elements that make up biological patterning, he said, but from the standpoint of research, race is an important trait to consider.
Yamada said he hopes his study raises awareness about the shortage of cancer specimens from non-white populations and bolsters the effort to diversify samples for research. He also plans to continue his research in this area by investigating the function of genes that could be influencing colon cancer development and treatment outcomes in American Indians and African Americans. In the United States, colon cancer is the third most common cancer diagnosed in both men and women and, in 2022, was the second most common cause of cancer death.
“Molecular analysis is a new research tool in the field of cancer disparities,” said Yamada, who is among the early adopters of the approach. “Molecular analysis according to race, or any population vulnerable to cancer, will help to identify specific cancer traits, which can be used in the development of precision medicine. This approach will improve poor health outcomes in minorities who have cancer.”
The study is titled “Molecular disparities in colorectal cancers of White Americans, Alabama African Americans, and Oklahoma American Indians” and can be found here. Yamada also wrote a “Behind the Paper” article at communities.springernature.com.
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About the OU College of Medicine
Founded in 1910, the OU College of Medicine at the University of Oklahoma Health Sciences trains the next generation of health care professionals. The OU Health Sciences is the academic partner of OU Health, the state’s only comprehensive academic health system of hospitals, clinics and centers of excellence. With campuses in Oklahoma City and Tulsa, the College of Medicine offers the state’s only Doctor of Medicine degree program and a nationally competitive Physician Assistant program. For more information, visit medicine.ouhsc.edu.
The University of Oklahoma Health Sciences
The University of Oklahoma Health Sciences is one of the nation’s few academic health centers with all health professions colleges — Allied Health, Dentistry, Medicine, Nursing, Pharmacy, Public Health, Graduate Studies and School of Community Medicine. OU Health Sciences serves approximately 4,000 students in more than 70 undergraduate and graduate degree programs on campuses in Oklahoma City and Tulsa and is the academic and research partner of OU Health, the state’s only comprehensive academic healthcare system. OU Health Sciences is ranked 108 out of over 2,900 institutions in funding received from the National Institutes of Health, according to the Blue Ridge Institute for Medical Research. For more information, visit ouhsc.edu.
About the University of Oklahoma
Founded in 1890, the University of Oklahoma is a public research university located in Norman, Oklahoma. As the state’s flagship university, OU serves the educational, cultural, economic and health care needs of the state, region and nation. OU was named the state’s highest-ranking university in U.S. News & World Report’s most recent Best Colleges list. For more information about the university, visit www.ou.edu.
JOURNAL
npj Precision Oncology
ARTICLE TITLE
Molecular disparities in colorectal cancers of White Americans, Alabama African Americans, and Oklahoma American Indians
How do controllable risk factors for dementia vary by race, ethnicity?
MINNEAPOLIS – Approximately 23% of people diagnosed with Alzheimer’s disease or another related dementia in their 60s and later have cases that can be explained by controllable risk factors such as high blood pressure, diabetes, physical inactivity, and too little or too much sleep, and that percentage varies depending on race and ethnicity, according to a new study published in the January 17, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology. When including APOE ε4, a gene variant associated with the strongest genetic risk for late-age Alzheimer’s disease, the study found about a third of cases could be explained by these known risk factors altogether.
“There is no cure for Alzheimer’s disease, so preventing or delaying this disease and other related forms of dementia by reducing controllable risk factors is an urgent public health priority,” said study author Unhee Lim, PhD, of the University of Hawaii at Manoa in Honolulu. “Our study found not only does the percentage of cases linked to controllable risk factors vary by race and ethnicity, so do the most prevalent risk factors for each group.”
The study involved 91,881 participants of the larger Multiethnic Cohort Study with an average age of 59 who did not have dementia at the start of the study. Of participants, 34% were Japanese American, 28% were white, 19% were Latino, 12% were Black and 7% were Native Hawaiian.
Participants completed questionnaires about disease history and medications. They were asked about physical inactivity, defined as less than 30 minutes of moderate or vigorous activity per day, 12 years or less of education, and sleeping an average of less than five hours or more than nine hours a day. Participants also completed a food questionnaire to determine if they had a low-quality diet, such as a diet high in saturated fat. Researchers used the residential addresses of each participant to determine the socioeconomic conditions of their neighborhoods, including income, employment and housing quality.
After an average follow-up period of nine years, 16,507 people were diagnosed with Alzheimer’s disease or related dementia at age 60 or older. Lim noted that disproportionately higher percentages were Black, 24%, or Native Hawaiian, 14%.
“The disparity for Black people has been reported by previous studies,” Lim said. “However, our study also discovered a disparity for Native Hawaiians, who we analyzed separately from Asian Americans. Native Hawaiians are often grouped with Asian Americans in research. However, studies have consistently shown Asian Americans have the lowest risk for Alzheimer’s disease and related dementia.”
Researchers then determined what percentage of cases could be attributed to known risk factors including the gene variant APOE ε4 as well as 12 risk factors that can be controlled or changed: low physical activity; less education; low socioeconomic status; a history of high blood pressure, heart disease, stroke or diabetes; not being married as a proxy for low social contact; current smoking; too short or too long sleep; obesity; and low-quality diet.
Researchers found 31% of all cases could be attributed to these known risk factors.
Looking only at controllable risk factors, researchers found the percentage of cases was similar among all female participants at 23% and all male participants at 24%.
However, when looking across racial and ethnic groups, the percentages varied. Researchers found controllable risk factors accounted for 33% of cases among Latinos, 29% among Native Hawaiians, 28% among Black people, 22% among white people and 14% of cases among Japanese Americans.
Researchers also examined top risk factors. Among female participants, low socioeconomic status accounted for 4% of cases followed by less education at 3%. Among male participants, the top risk factors were less education at 4% of cases followed by low socioeconomic status at 3%.
Top risk factors varied by race and ethnicity. For Latinos, diabetes was the top risk factor, accounting for 7% of cases. Among Black, Native Hawaiian and white people, low socioeconomic status was the top risk factor accounting for 6%, 5% and 4% of cases, respectively. For Japanese Americans, physical inactivity led risk factors at 4%.
“Our findings confirm that less education, low socioeconomic status, and other risk factors in middle age account for substantial but varying proportions of dementia cases later in life across racial and ethnic populations,” said Lim. “Our findings call out the need for tailored interventions for various racial and ethnic groups, specific to more prevalent risk factors. Our findings also highlight the importance of discovering other risk factors in racial and ethnic groups whose cases are not as well explained by known risk factors.”
A limitation of the study was that there was not enough data to examine additional risk factors such as hearing impairment, depression, a history of traumatic brain injury or exposure to air pollution.
The study was funded by the National Cancer Institute and the National Institute on Aging at the National Institutes of Health.
Learn more about dementia at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, X and Instagram.
When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.
The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.
For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, X, Instagram, LinkedIn and YouTube.
JOURNAL
Neurology
Black people face strokes at higher rates, younger ages than white people
MINNEAPOLIS – Black people consistently had a higher rate of stroke than white people over a recent 22-year period, according to a study published in the January 10, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study also found that the average age of Black people experiencing stroke was nearly 10 years younger than that of white people, another inequity that grew over time.
“We found that the rate of stroke is decreasing over time in both Black and white people—a very encouraging trend for U.S. prevention efforts,” said study author Tracy E. Madsen, MD, PhD, of Brown University in Providence, Rhode Island. “But there was an inequity from the beginning of the study, with the rate of stroke always being higher for Black people than their white counterparts. The disparity did not decrease in 22 years, especially among younger and middle-aged adults.”
Researchers evaluated stroke trends over time using data from hospitals in southern Ohio and northern Kentucky from 1993 to 2015. Stroke cases were recorded across a full year every five years—about 1,950 cases per year for a total of 9,728. Using U.S. Census data, they were able to calculate stroke incidence rates per 100,000 people.
The overall rate of stroke decreased from 230 cases per 100,000 people in 1993 to 188 cases per 100,000 people in 2015. For Black people, the rates went from 349 to 311 and for white people they declined from 215 to 170.
The rate of stroke among Black people continued to be 50 to 80% higher than the rate among white people across the 22 years, even after adjusting for age and sex—a disparity that was particularly stark in younger and middle-aged Black adults. The disparity shrank in older age groups, a difference the researchers say may be due to different survival rates in Black and white people.
While the rate of stroke was decreasing, the study found that strokes were occurring at younger ages over time, and this change was larger in Black people, exacerbating an existing disparity. Strokes struck Black people at an average age of 66 at the beginning of the study and at age 62 by the end of the study. For white people, the average age was 72 at the beginning of the study and 71 two decades later.
“These disparities present a major ongoing public health concern,” Madsen said. “More work is clearly needed to address systemic and policy problems, as well as factors at the provider and patient levels. These findings are a clear, urgent call for concrete efforts to build more equitable means of stroke prevention and care.”
Madsen noted a limitation of the study was that while race was the primary focus of the study, the key social factors that contribute to racial inequities like systemic racism and access to preventative care were not measured.
The study was supported by the National Institute of Neurological Disorders and Stroke.
Learn more about stroke at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, X and Instagram.
When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.
The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.
For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, X, Instagram, LinkedIn and YouTube.
JOURNAL
Neurology
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