Elizabeth Blackman

High prevalence of discordant human papillomavirus and p16 oropharyngeal squamous cell carcinomas in an African American cohort

Most studies on human papillomavirus (HPV)‐associated oropharyngeal squamous cell carcinoma (SCC) have been performed on white Americans. Our study examined the incidence of HPV in an African American oropharyngeal SCC cohort and its survival.

Multicenter Study of Human Papillomavirus and the Human Papillomavirus Vaccine: Knowledge and Attitudes among People of African Descent

Objective. To compare knowledge and attitudes of human papillomavirus (HPV) and the vaccine between different cultures of African descent. Methods. A cross-sectional survey of 555 African-Americans and Afro-Caribbeans residing in the US and the Bahamas (BHM) was conducted. Results. General knowledge about HPV and the HPV vaccine differed between the two countries significantly. Bahamian respondents were less likely to have higher numbers of correct knowledge answers when compared to Americans (Adjusted Odds Ratio [Adj. OR] 0.47, 95% Confidence Interval [CI] 0.30–0.75). Older age, regardless of location, was also associated with answering fewer questions correctly (Adj. OR 0.61, 95% CI 0.40–0.92). Attitudes related to HPV vaccination were similar between the US and BHM, but nearly 80% of BHM respondents felt that children should not be able to receive the vaccine without parental consent compared to 57% of American respondents. Conclusions. Grave lack of knowledge, safety and cost concerns, and influence of parental restrictions may negatively impact vaccine uptake among African-American and Afro-Caribbean persons. Interventions to increase the vaccine uptake in the Caribbean must include medical provider and parental involvement. Effective strategies for education and increasing vaccine uptake in BHM are crucial for decreasing cervical cancer burden in the Caribbean.

High-Risk Cervical Human Papillomavirus Infections among Human Immunodeficiency Virus-Positive Women in the Bahamas

Background High-risk (HR) HPV genotypes other than 16 and 18 have been detected in a significant proportion of immunocompromised females. We aim to evaluate the frequency of HR HPV genotypes in a population of HIV-positive Caribbean women. Methods One hundred sixty-seven consecutive, non-pregnant, HIV-positive females ≥18 years were recruited in this study. Each participant received a vaginal examination, PAP smear, and completed a questionnaire. DNA was extracted for HPV testing in 86 patients. Results Mean age was 39.1 years for women positive for HR HPV and 43.1 years for women negative for HR HPV (P value  = 0.040). 78% (130/167) of the women had HR HPV infections; the prevalence of abnormal cervical cytology was 38% among women who were HR HPV-positive compared to women who were HR HPV-negative (22%). Fifty-one percent of the 86 women with available genotype carried infections with HPV 16 and/or HPV 18; genotypes of unknown risk were also frequently observed. Women who had a CD4+ count of ≤200 had 7 times increased odds of carrying HR HPV infection in comparison to women with CD4+>200. Conclusions HR HPV infections in HIV infected females may consist of more than just HPV 16 and 18, but also HPV 52 and 58. Further studies are needed to determine whether HPV 52 and 58 play a significant role in the development of cervical cytological abnormalities in HIV+ women.

The 4th Bi-annual international African-Caribbean Cancer Consortium conference: building capacity to address cancer health disparities in populations of African descent

This is a brief summary of the 4th International Meeting of the African-Caribbean Cancer Consortium (AC3), organized and sponsored by Fox Chase Cancer Center (FCCC), and held on July 21–22, 2012 at the Lincoln University Graduate Center, Lincoln Plaza, Philadelphia, Pennsylvania. AC3 investigators gathered in Philadelphia, PA to present the results of our ongoing collaborative research efforts throughout the African Diaspora. The general theme addressed cancer health disparities and presentations represented all cancer types. However, there was particular emphasis on women’s cancers, related to human papillomavirus (HPV) and human immunodeficiency virus (HIV) infections.

Cancer in populations of African Ancestry: studies of the African Caribbean Cancer Consortium

The AC3 contributors to this Special Issue present scientific achievements and milestones in collaborative cancer research. Articles span topics in areas of screening and cancer control, cancer surveillance (trends in incidence and mortality), treatment outcomes and cancer risk factors in the African Diaspora. As editors, we underscore the undue burden of cancer among peoples of the African Diaspora. People of African Ancestry living in the US and Europe have the highest overall cancer incidence and mortality compared to other racial/ethnic groups16. Similarly people of African ancestry in the Caribbean and Latin American experience some of the highest cancer incidence and mortality worldwide20,21. Additionally, Africans in Africa suffer the greatest cancer-related mortality in the world20,22. Emerging evidence suggest multilevel factors associated with poorer outcomes including genetics, inherited precocious oncogenes, epigenetics, environmental carcinogen, and behavioral factors. Newer studies are now pointing to the oncogenic role of society including poverty, marginalized social status, and healthcare systems and providers including disparate access to and quality of care. Yet, we are hopeful that this Special Issue will attract much needed attention to the cancer plight of peoples of African ancestry. Addressing the African ancestry oncogenic phenomenon—more aggressive with successful metastatic features-- may provide novel keys to the cancer cure for all. Our AC3 leaders have identified practical research opportunities including use of mobile technology, the urgency of primary prevention practices including healthful, plant-based eating, reducing sugars and animal fats, uptake of HBV and HPV vaccines. Many Caribbean and African nations have yet to establish national cancer registries. The dictum that you can’t manage what you can’t measure is the proverbial message in reporting national cancer incidences and mortalities in these regions. The articles in this Special Issue identify the need to document occurrence, treatment and outcomes to provide reliable data and direct targeted interventions; national as opposed to hospital-based cancer registries remains a major hurdle. In some instances, the ethnicity reflect low prevalence and possibly different cancer biology. In low resource countries, prudence is paramount and data accuracy cannot be overemphasized. Clearly more global industry/private, and government/public partnership funding are required. Also critically important, is the training and grooming of researchers who are well prepared with access to adequate facilities to conduct rigorous science, clinicians who provide the best available timely treatments delivered with care, policy makers who will take up the call for population health and quality care, and advocates readied to lead in creating and protecting healthy communities. The disparate cancer landscape of the African Diaspora warrants urgent scientific studies with actionable, translational deliverables into clinical and community practice. This action to solution approach necessitates increased, team science with clinicians, policy makers and advocate engaged collaborations. In the new millennium cancer has emerged as a leading cause of mortality and morbidity in Low Middle Income countries (LMIC), particularly in countries with populations that are predominantly of African descent. The major advances in curbing the disease burden attained through screening, health prevention and promotion, screening, diagnosis and treatment has eluded most LMIC and technological advances. AC3 has embraced the WHO challenge to curb the high cancer burden by closing the health inequity gap through action on pertinent and relevant social determinants of health. Through our collaborative bench research and population-based initiatives, AC3 seeks to define our genetic risk factors, better the awareness and educational programs, and with emphasis on earlier detection and treatment, improve the health experience and outcomes in our populations of African ancestry. In the first ten years of our existence, we defined our values and mission and we established and fortified our linkages. This supplement highlights our accomplishments. Thanks to the funding of the NIH and the partnerships that AC3 has cemented at the national, regional and national levels, we looked forward to advance the health of people of African ancestry in the next decade, and with great optimism.

Integrative genomic analysis identifies ancestry‐related expression quantitative trait loci on DNA polymerase β and supports the association of genetic ancestry with survival disparities in head and neck squamous cell carcinoma

African Americans with head and neck squamous cell carcinoma (HNSCC) have a lower survival rate than whites. This study investigated the functional importance of ancestry‐informative single‐nucleotide polymorphisms (SNPs) in HNSCC and also examined the effect of functionally important genetic elements on racial disparities in HNSCC survival.

Abstract 5289: Assessment of environmental influences, behavioral risk factors and genetic differences among a cohort of 819 African American community members

Objectives: This study was designed to address genetic, environmental and lifestyle risk factors for cancer in populations of African Ancestry. We have established a non-cancer control registry which involves the collection of epidemiological, lifestyle, culture and cancer prevention behaviors (such as cancer screening and diet, etc). Methods: Data was coded and analyzed using Stata from initial study surveys. Results: At analysis, the cohort consisted of 819 participants. The cohort was 65.9% female, ages 18-89 (23.5% within 50-59 age group), 35.9% college graduates, and 17.4% with income level

Abstract B01: Testing a multilevel risk prediction model in high risk men enrolled in a prostate cancer early detection program

20,000-

Abstract C93: Head and neck cancer trends in Trinidad and Tobago

25,000. Two-thirds of the cohort had BMI greater than 25, indicating overweight or obese. When stratified by country of birth, participants born in the US & Territories were more likely to be current smokers (23.3%) and have higher rates of environmental exposure to smoking than any other region of birth analyzed. Participants from US & Territories had the highest access to health care (85.9%). Pap smears were the only screening test with statistically significant difference between the regions, with US & Territories having the highest rates of screening (p Conclusions & Implications: Overall, the cohort and its data provide researchers with a resource to further investigate health disparities in cancer as well as other chronic diseases and tailor culturally relevant education materials to help decrease the rates of cancer in this vulnerable population. Citation Format: Jacquelyn Bucci, Ming Chin Yeh, Khursheed Navder, Joel Erblich, Elizabeth Blackman, Grace X. Ma, Camille Ragin. Assessment of environmental influences, behavioral risk factors and genetic differences among a cohort of 819 African American community members [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5289. doi:10.1158/1538-7445.AM2017-5289

Abstract LB-14: High-risk cervical human papillomavirus infections among human immunodeficiency virus-positive women in the Bahamas.

Background: Health disparities play a major role in prostate cancer (PCa). African American (AA) compared to European American (EA) men are twice as likely to die of and be diagnosed with PCa. Multilevel factors from societal/neighborhood exposures down to genetics likely contribute to racial disparities, but few PCa risk prediction models include multilevel factors and consider race/ethnic differences. Objective: We sought to: 1) develop a multilevel risk prediction model for time to PCa diagnosis, that includes neighborhood variables, individual-level socioeconomic and clinical factors (education, race, digital rectal exam or DRE), and biologic variables (prostate specific antigen or PSA level, and percent West African genetic ancestry) in men at high risk for prostate cancer (defined as AA men and/or men with a PCa family history); 2) compare our multilevel model to a more standard prediction model that includes only age, race, PSA, and DRE (abnormal/normal). Methods: A total of 443 high risk, cancer-free men between 35 and 69 years of age with complete socioeconomic, racial, and genetic ancestry data were identified from the Prostate Risk Assessment Program (PRAP) at Fox Chase Cancer Center. Their data were geocoded and linked to 17 neighborhood variables at the census tract level (from the Year 2000 U.S. Census) that were previously associated with advanced PCa in EA men in a novel neighborhood-wide association study(NWAS) our study team developed. These variables generally represent neighborhood transportation, poverty, income, social support, immigration, renting/owning a house, and employment. Men were followed from time of program (PRAP) entry to PCa diagnosis or censoring, with annual follow-up visits that included PSA and DRE screening. Men with elevated PSA or other indications for PCa were referred to Urology for evaluation and potential biopsy according to PRAP protocols. Univariate analyses of neighborhood variables, and the interaction of each variable with PSA and race, were evaluated in Cox regression models, using robust standard errors to adjust for clustering by census tract, in order to inform the final multivariate, multilevel model. Harrell9s C Index (C Statistic) was used to compare the multilevel risk prediction model to a standard prediction model. Results: With a median follow-up time of 71 months, PCa diagnosis occurred in 69 participants. The final multilevel risk prediction model included 3 neighborhood variables related to transportation, social support, and poverty, along with education, age, race, baseline PSA, baseline DRE, and PCa family history. Significant interactions between the top hit from the NWAS and PSA were noted in the full study population (neighborhood mode of transportation to work X PSA, p-value Conclusion: This study is the first to investigate the role of neighborhood in PCa risk prediction. While risk prediction models show little change, significant neighborhood effects in multilevel models warrant additional study and could inform future health disparity studies. Citation Format: Shannon M. Lynch, Elizabeth Handorf, Elizabeth Blackman, Lisa Bealin, Shiju Daniel, Veda N. Giri, Elias Obeid, Camille Ragin, Mary B. Daly. Testing a multilevel risk prediction model in high risk men enrolled in a prostate cancer early detection program. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr B01.