Flora Ukoli

Effects of obesity and height on prostate-specific antigen (PSA) and percentage of free PSA levels among African-American and Caucasian men

Prior studies suggest that obese men have lower prostate‐specific antigen (PSA) levels than leaner men. Caucasian (CA) men also may have lower PSA levels than African‐American (AA) men, but the relevance of body size to racial disparities in PSA levels is unclear. The association between body mass index (BMI) and height on PSA and percentage of free PSA (%fPSA) was investigated within AA and CA men without a prior prostate cancer diagnosis.

Black-White Differences in Hip Geometry

Abstract. Previous studies have demonstrated that reduced thickness of the femoral neck and shaft cortex, a wider intertrochanteric region and a longer hip axis length were predictive of hip fracture among Caucasian women. We hypothesized that racial differences in these features of hip geometry may contribute to explaining the differences in hip fracture incidence between women of African origin and Caucasian women. We measured the cortical thickness and bone widths in 132 African-American women and 43 Nigerian women who were pair-matched on height (± 3 cm), age (± 5 years) and weight (± 3 kg) to 175 Caucasian women. Measures of cortical thickness were greater among women of African origin than Caucasian. Women of African origin had smaller bone widths and a shorter hip axis length than Caucasians. Several of these differences were independent of bone mineral density except for the cortical thickness of the femoral shaft. We conclude that women of African origin have thicker cortical bone of the hip, a shorter hip axis length and smaller intertrochanteric widths than Caucasians. Based on a model developed from hip fractures among Caucasian women, we predict that these observed racial differences could contribute to approximately a 25% decrease risk of hip fracture among blacks.

Multi-institutional prostate cancer study of genetic susceptibility in populations of African descent

Prostate cancer disparities have been reported in men of African descent who show the highest incidence, mortality, compared with other ethnic groups. Few studies have explored the genetic and environmental factors for prostate cancer in men of African ancestry. The glutathione-S-transferases family conjugates carcinogens before their excretion and is expressed in prostate tissue. This study addressed the role of GSTM1 and GSTT1 deletions on prostate cancer risk in populations of African descent. This multi-institutional case-control study gathered data from the Genetic Susceptibility to Environmental Carcinogens (GSEC) database, the African-Caribbean Cancer Consortium (AC3) and Men of African Descent and Carcinoma of the Prostate Consortium (MADCaP). The analysis included 10 studies (1715 cases and 2363 controls), five in African-Americans, three in African-Caribbean and two in African men. Both the GSTM1 and the GSTT1 deletions showed significant inverse associations with prostate cancer [odds ratio (OR): 0.90, 95% confidence interval (CI) 0.83-0.97 and OR 0.88, 95% CI: 0.82-0.96, respectively]. The association was restricted to Caribbean and African populations. A significant positive association was observed between GSTM1 deletion and prostate cancer in smokers in African-American studies (OR: 1.28, 95% CI: 1.01-1.56), whereas a reduced risk was observed in never-smokers (OR: 0.66, 95% CI: 0.46-0.95). The risk of prostate cancer increased across quartiles of pack-years among subjects carrying the deletion of GSTM1 but not among subjects carrying a functional GSTM1. Gene-environment interaction between smoking and GSTM1 may be involved in the etiology of prostate cancer in populations of African descent.

Wilms tumor survival in Kenya

PURPOSE Survival from Wilms Tumor (WT) exceeds 90% at 5 years in developed nations, whereas at last report, 2-year event-free survival (EFS) in Kenya reached only 35%. To clarify factors linked to these poor outcomes in Kenya, we established a comprehensive web-based WT registry, comprised of patients from the four primary hospitals treating childhood cancers. MATERIALS AND METHODS WT patients diagnosed between January 2008 and January 2012 were identified. Files were abstracted for demographic characteristics, treatment regimens, and enrollment in the Kenyan National Hospital Insurance Fund (NHIF). Children under 15 years of age having both a primary kidney tumor on imaging and concordant histology consistent with WT were included. RESULTS Two-year event-free survival (EFS) was 52.7% for all patients (n=133), although loss to follow up (LTFU) was 50%. For the 33 patients who completed all scheduled standard therapy, 2-year EFS was 94%. Patients enrolled in NHIF tended to complete more standard therapy and had a lower hazard of death (Cox 0.192, p < 0.001). CONCLUSION Survival of Kenyan WT patients has increased slightly since last report. Notably, WT patients completing all phases of standard therapy experienced 2-year survival approaching the benchmarks of developed nations. Efforts in Kenya should be made to enhance compliance with WT treatment through NHIF enrollment.

Factors Influencing Prostate Cancer Screening in Low-Income African Americans in Tennessee

This study examined demographic and lifestyle factors that influenced decisions to get screened for prostate cancer in low-income African Americans in three urban Tennessee cities. It also examined obstacles to getting screened. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American men 45 years and older (n=293) were selected from the Meharry CNP community survey database. Participants from Nashville, those who were older, obese, and who had health insurance were more likely to have been screened (p<.05). Additionally, there were associations between obstacles to screening (such as cost and transportation) and geographic region (p<.05). Educational interventions aimed at improving prostate cancer knowledge and screening rates should incorporate information about obstacles to and predictors of screening.

8q24 risk alleles in West African and Caribbean men

Multiple genetic studies have confirmed associations of 8q24 variants with susceptibility to prostate cancer (CaP). However, the magnitude of risk conferred in men living in West Africa is unknown.

A Community-Driven Intervention for Prostate Cancer Screening in African Americans

The purpose of the study was to assess the impact of an educational intervention on prostate cancer screening behavior and knowledge. Participants were 104 African American men, 45 years and older, who had not been screened for prostate cancer with a prostate-specific antigen and/or digital rectal exam within the past year. All participants received an intervention delivered by trained lay community educators using a prostate cancer educational brochure developed in collaboration with the community, with structured interviews preintervention and 3 months postintervention. The main study outcomes included prostate-specific antigen screening rates during the 3-month interval and knowledge, barriers to screenings, and decisional conflict around screening. Compared with the 46 men who did not get screened, the 58 participants who got screened were more likely to have greater than a high school education, annual household incomes ≥

Plasma Lycopene Is Associated with Pizza and Pasta Consumption in Middle-Aged and Older African American and White Adults in the Southeastern USA in a Cross-Sectional Study

25,000, and a family history of non–prostate cancer (p < .05). Average knowledge scores increased, and barriers to screening scores decreased, from preintervention to postintervention only for participants who had been screened (p < .05). The results of this study demonstrate the feasibility and efficacy of an academic institution collaborating with the African American community to develop a successful prostate cancer educational intervention, an approach that can be expanded to other cancers and other chronic diseases.

Precision Medicine: Familiarity, Perceived Health Drivers, and Genetic Testing Considerations Across Health Literacy Levels in a Diverse Sample

Background The role of dietary lycopene in chronic disease prevention is not well known. Methods This study examined intake of lycopene and other antioxidants from lycopene-rich foods (e.g., pizza and pasta) simultaneously with plasma levels of lycopene and other antioxidants in a representative cross-sectional sample (187 Blacks, 182 Whites, 40–79 years old) from the Southern Community Cohort Study (SCCS). The SCCS is an ongoing study conducted in populations at high risk for chronic diseases living in Southeastern United States. Dietary intake was assessed using a validated food frequency questionnaire (FFQ), and plasma levels of lycopene and other antioxidants were measured at baseline (2002–2005). The participants were classified into tertiles according to consumption of pizza and pasta food groups. Results Lycopene dietary intake and plasma lycopene concentrations were significantly higher in the highest (tertile 3) compared to tertiles 1 and 2 (both P < 0.01). Total energy intake ranged from 1964.3 ± 117.1 kcal/day (tertile 1) to 3277.7 ± 115.8 kcal/day (tertile 3) (P<0.0001). After adjusting for age and energy intake, total dietary fat, saturated fatty acids, trans-fatty acids, and sodium intakes were significantly higher in tertile 3 than tertiles 2 and 1 (all P <0.01). Vitamin C intake was significantly lower in tertile 3 than tertiles 1 and 2 (P = 0.003). Except for γ-tocopherol being higher in tertile 3 than tertiles 1 and 2 (P = 0.015), the plasma concentrations of antioxidants were lower in tertile 3 than tertiles 1 and 2 (β-carotene, α-carotene, lutein and zeaxanthin, all P<0.05). Conclusions In the SCCS population, pizza and pasta were the main sources of dietary lycopene and their intake was associated with plasma lycopene concentration. Diets with frequent pizza and pasta consumption were high in energy, saturated fatty acids, trans-fatty acids, sodium and low in other antioxidants. Future studies of lycopene as a protective dietary factor against chronic disease should consider the overall nutritional quality of lycopene-containing foods.

Prostate cancer screening between low-income African-American and Caucasian men☆

A clear awareness of a patient’s knowledge, values, and perspectives is an important component of effective genetic counseling. Advances in precision medicine, however, have outpaced our understanding of patient perceptions of this new approach. Patient views may differ across the three domains of precision medicine (genetics, behavioral, and environmental determinants of health), ethnic/racial groups, and health literacy levels. This study describes and compares group differences in familiarity, perceptions, and preferences for precision medicine in a diverse sample. Between 2016 and 2017, 252 participants completed a 10–15-min survey in three primary care clinics in Florida and Tennessee. The final sample was 42.5% African American/Black, 25.8% Hispanic/Latino, 25.0% White, and 6.7% other ethnicity/race. Less than a quarter of participants reported being familiar with the term “precision medicine,” but were more familiar with basic genetic terms. Participants with higher health literacy reported greater familiarity with terms (p ≤ .003). African Americans/Black participants were more likely to identify ethnicity/race and discrimination as influencing their health (p ≤ .004). When deciding to get a genetic test, individuals across ethnic/racial groups shared similar considerations. Those with higher health literacy, however, gave significantly greater importance to provider trust (p ≤ .008). Given the recent emergence of precision medicine, at present there may be limited differences in patient perceptions across ethnic/racial groups. Culturally sensitive efforts, tailored to health literacy level, may aid equitable precision medicine uptake.