Cancer Prevention and Control
Taking Disparities Research From the Lab Bench to the Block
Khadijah A. Mitchell, PhD, MS
Assistant Professor, Cancer Prevention and
Control Research Program
We’re in a new age of cancer prevention and control. Thanks to advances in technology and increasing collaboration between disciplines, we are now investigating how biology, behaviors, and environments interact to better determine a person’s cancer risk profile and what their treatment response might be. These interactions are key to reducing cancer disparities and promoting cancer equity.
My research focuses on the causes and consequences of lung cancer disparities, particularly in populations of African descent. Advances in genetics have been central to advancing this field. Twenty-five years ago, we hadn’t finished mapping the human genome, so we hadn’t identified as many driver mutations in lung cancer. Today, we have drugs on the market that target exact genetic changes.
“By taking our research into the community, we can educate the community and be educated by the community. This is how we make progress toward eliminating cancer disparities."
Of course, humans don’t live in a vacuum, we live and work in environments, and our environments interact with our genome to influence our risk of cancer. For instance, everyone knows that smoking causes lung cancer, but so does long-term exposure to radon, a naturally occurring radioactive gas that can be found in the home. With that in mind, my research examines questions like: What kind of genetic changes make you more likely to develop lung cancer if you live in a high-radon area? How can clinicians take steps to determine if a patient’s genetic changes are associated with radon exposure and can influence their drug response?
Over the next 10 years, I want us to think about how challenges that certain communities have faced historically will be compounded in the future due to climate change. For example, what happens to lung cancer risk when temperatures rise and more HVAC systems are turned on, which can draw in more radon-filled air and increase radon levels in the home?
We talk a lot about “bench to bedside” research, but I want us to also take our research from the lab bench to the “block.” By taking our research into the community, we can educate the community and be educated by the community. This is how we make progress toward eliminating cancer disparities.
Nipping Cancer in the Bud: Cancer Detection, Prevention, and Interception
Margie L. Clapper, PhD
Professor and Co-Leader, Cancer Prevention and Control Research Program
Samuel M.V. Hamilton Chair in Cancer Prevention
Cancer prevention has been the focus of my lab during my time at Fox Chase Cancer Center. It comprises two general parts. First, we seek to identify who in the general population is at the highest risk of cancer. Second, we work to develop preventive agents that can be administered long term to individuals who are otherwise healthy. These are tall orders, and relatively new ones at that.
In 1991, I established one of the first research programs in the United States focused on the identification of drugs and natural agents to prevent cancer. At that time, the idea of preventing a disease like cancer was not widely accepted. Since then, the program has grown and continues to receive international recognition for its contribution to the field of cancer prevention.
Over the next decade, I look forward to making substantive progress towards providing high-risk subjects with agents to stop and/or delay cancer development. Thanks to advances in genomic technology and collaborations with researchers and clinicians at Fox Chase, we are rapidly gaining new insight into the genetic alterations that precede the formation of tumors before they ever rear their heads in normal tissue. With these promising new targets in hand, we are well equipped to design agents to intercept cancer initiation and/or progression and bring tumor development to a screeching halt.
“The goal of this program is to establish a pipeline of targeted therapies and vaccines for cancer prevention and interception — disrupting cancer development in its earliest stages — in populations at elevated risk for cancer.”
We have evaluated numerous agents for their ability to decrease the formation of tumors in mice, and the most promising have entered clinical testing at Fox Chase. I have extended this work recently by spearheading the establishment of a Cancer Prevention-Interception Targeted Agent Discovery Program at Fox Chase, which is funded by a $6 million five-year grant from the National Cancer Institute.
The goal of this program is to establish a pipeline of targeted therapies and vaccines for cancer prevention and interception — disrupting cancer development in its earliest stages — in populations at elevated risk for cancer. As pioneers in this initiative, we are better poised than ever to meet the challenges of cancer prevention and prevail.
Addressing Cancer-Related Sexual Problems
Jennifer Barsky Reese, PhD, FSBM
Associate Professor, Cancer Prevention and
Control Research Program
Cancer-related sexual health problems are common, distressing, and persistent for cancer survivors. However, over the last two decades, we have made considerable progress furthering this nascent field of study.
When I started my career back in 2008, many of my senior colleagues doubted the likelihood of securing funding from major organizations like the National Institutes of Health to conduct research focused on the sexual health and functioning of cancer survivors. Yet, over time, we gathered increasing amounts of data to support the importance of this research, including how common and distressing these problems can be for survivors and their intimate partners. Today we are increasingly able to secure funding for our projects.
"Looking ahead, we need to spend the coming years not only identifying programs or treatments that address sexual concerns for cancer patients but getting these programs out to the public."
As an example, one of my areas of research is how cancer patients and their clinicians communicate about sexual health problems. When I started my work on this subject a decade ago, very few researchers were focusing on the issue. By 2022, recognition of its importance had grown to the extent that I was awarded a five-year grant from the National Cancer Institute (NCI) to conduct a trial of video-based education for patients with gynecologic cancer to help them raise sexual health concerns with their clinicians.
Looking ahead, we need to spend the coming years not only identifying programs or treatments that address sexual concerns for cancer patients but getting these programs out to the public. I was recently awarded an NCI grant to develop training for hematology-oncology fellows in how to discuss sexual health with their patients. Currently, this is a two-year grant to develop and pilot test the course with fellows from Fox Chase Cancer Center and the Dana-Farber Cancer Institute.
If we find the intervention effective, the next step will be to apply for a five-year grant to disseminate the course more widely. This is just one example of how research into the sexual health of cancer patients is evolving. As recognition of these issues continues to grow, I hope to see funding increase, the field advance, and cancer patients enjoy better sexual health outcomes, which will have a lasting positive impact on their own well-being and the strength of their partnered relationships.
Closing Gaps in Cancer Care for Asian Americans
Carolyn Y. Fang, PhD
Associate Director for Population Science
Professor, Cancer Prevention and
and Control Research Program
There is a common misperception that Asian Americans do not experience health disparities. This is due in large part to the practice of grouping all Asian Americans into a single category when reporting data, rather than differentiating between subgroups. Over the past 10 years, my colleagues and I and other researchers have been able to chip away at that misperception and increase awareness of how diverse the Asian American population is. However, more remains to be done in this important area.
"We lack data on the biologic, social, and environmental risk factors that underlie cancer development and response to treatment across Asian American subpopulations."
Asian Americans remain highly underrepresented in biomedical research. In particular, we lack detailed data regarding the biologic, social, and environmental risk factors that underlie cancer development and response to treatment across Asian American subpopulations.
Developing ways to gather this granular data is a significant focus of my research. Fox Chase’s partnerships within the community and with Temple Health, along with our top-notch interdisciplinary teams, have been a large part of what makes this research possible.
Recently, the National Institutes of Health invested in building a unique cohort study that is designed to address the dearth of data on Asian American subpopulations. My colleagues and I are participating in this initiative to collect detailed lifestyle data, environmental exposures, clinical exams, and high-quality biospecimens from thousands of Asian Americans across the United States and to monitor the health status of participants over several years.
This comprehensive data resource will enable us and other researchers to investigate the myriad factors underlying cancer risk and other chronic diseases among Asian Americans and, over the next decade, foster new research to identify and eliminate the disparities we uncover.
Reducing Cancer Disparities for Minority Populations
Camille Ragin, PhD, MPH
Associate Director, Diversity, Equity, Inclusion, and Accessibility
Professor, Cancer Prevention and
and Control Research Program
Historically, there have been tremendous hurdles in overcoming cancer disparities for Black populations. One of the biggest, the linchpin underlying everything we see regarding these disparities, is the underrepresentation of minority populations in science and research.
“Many disparities for certain cancers have shrunk, which is a promising sign that what we are doing is working."
This has snowballed into poor outcomes that are not being appropriately addressed because they haven’t been studied. It also contributes to a lack of awareness in these communities about their cancer risk, which ultimately leads to limited access to screening or limited uptake of screening that might be available, all of which leads to higher mortality rates.
My team and I conduct health equity research to address the disparities that impact Black populations in the area that Fox Chase serves and beyond. While the field still has room for improvement, I am encouraged by the increasing focus I see being put on health equity research, especially at Fox Chase. I see efforts being made to increase representation of minority groups in clinical trials. We are also taking steps to ensure we have a more diverse workforce, which is crucial to raising our awareness of the unique needs of specific populations so we can appropriately address them.
Many disparities for certain cancers have shrunk, which is a promising sign that what we are doing is working. For example, there has always been a huge disparity in lung cancer incidence and mortality between Black and White populations. Today, while mortality rates are still higher for Black populations, the incidence gap is closing.
Over the next decade, the key to making further progress will be staying diligent and increasing the momentum we have already created. Our researchers are asking questions relevant to minority populations, and our robust community engagement efforts are only improving. There’s a lot of work left to do, but Fox Chase is aware of the gaps and is prioritizing efforts to close them. There’s a lot of promise in that.
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