The National Cancer Institute (NCI) has awarded a five-year, U.S. $ 16 million grant to establish a cancer health equity center at the University of Florida and partner institutions, inducing, Florida A&M University and the University of Southern California.
Combined, Florida and California have the highest cancer incidence and mortality in the United States and the new center is designed to create a bi-coastal minority cancer research and training center. Florida and California also have uniquely rich and heterogeneous populations of blacks and Latinos, who are the focus of this study.
The center is directed and administered by multiple principal investigators from each of the participating institution.
Complexity of Disparities
Over the past several decades there has been substantial progress in cancer treatment, screening, diagnosis, and prevention, addressing cancer health disparities, including as cancer death rates, less frequent use of proven screening tests, and higher rates of advanced cancer diagnoses. However, in a number of populations progress has not kept pace.
In the United States, for example, the differences of cancer health between whites, and African-Americans or Latinos are particularly stark.
According to the National Cancer Institute, the death rate for all cancers combined is, for example, for African-Americans 25% higher than for whites. Statistics also show that Latinos have the highest rates for cancers associated with infection, such as liver, stomach and cervical cancers.
Other documented differences include:
- A higher incidence of triple-negative breast cancer (TNBC), a particularly aggressive form of the disease among African American women;
- A substantially higher rate of prostate cancer among African American men;
- A higher rates of kidney cancer among American Indian and Alaska Natives
- higher rates of liver cancer among Asian and Pacific Islanders 
To understand understand why some people may be more or less likely to develop cancer, experience cancer-related health problems, or die from cancer than other groups of people, additional research is needed.
Access to healthcare
In addition, access to healthcare, which may be related to socioeconomic and policy-level issues, may also be a factor. In some cases this may include lack of access to health care facilities, state and federal policies on health insurance, and hospital and physician payment rules.
All-in-all, disparities in cancer health is based on a complex mix of factors that can be difficult to tease apart – an may lead to differences in disease outcomes among different racial and ethnic groups—including environmental (e.g., exposure to secondhand smoke), behavioral (e.g., higher rates of alcohol use and physical inactivity), cultural (e.g., mistrust of the health care system and fatalistic attitudes about cancer), and biological factors.
Led at University of Florida by program directors Folakemi T. Odedina, PhD. and Diana Wilkie, PhD, RN, FAAN, the new Health Equity Center, called the Florida-California Cancer Research, Education and Engagement or CaRE,2, will bring together researchers from Florida and California.
Both Odedina and Wilkie have extensive experience in leading multidisciplinary center grants and cancer disparities research.
The Leading the University of Southern California’s component are John D. Carpten, PhD, professor and chair of the University of Southern California Translational Genomics, and Mariana Carla Stern, PhD, a professor of preventive medicine and urology at the Keck School of Medicine of University of Southern California.
“We are thrilled about this new grant and center under Carpten’s and Stern’s leadership. It is a rare opportunity to bring together world-class science and community engagement in a way that will also develop the next generation of scientists who come from the communities we serve,” noted Laura Mosqueda, MD, FAAFP, AGSF, dean of the Keck School of Medicine who is a widely respected authority on geriatric and family medicine, elder abuse, and care of the elderly and underserved populations.
“We are so proud that Keck’s researchers, students and staff will be leading the way nationally toward advancing cancer health equity.”
Tears and agonies
“Behind every cancer statistic are the tears and agonies of cancer patients, survivors, family members and friends,” noted University of Florida’s Odedina.
“I take the fight against cancer personally because I am simply tired of seeing unnecessary cancer deaths in minority and underserved populations globally,” she added.
In her roles as principal investigator at the University of Florida’s Florida Minority Cancer Research and Training, or MiCaRT, Odedina’s primary goal has been to transform the exploratory cancer center into a comprehensive health equity center.
Culture and background
The center will allow researchers to better understand the culture and background of these minority populations and those diagnosed with cancer.
“We have done a lot to reduce cancer mortality and morbidity in general, but research for Blacks and Latinos have not kept pace with the majority population,” Wilkie said.
“With the CaRE2 Health Equity Center, we are focusing on the biological and human experience that can be altered from one’s cultural background to improve cancer outcomes for blacks and Latinos. We want to better understand how one’s biology, beliefs and attitudes affect engagement with care and survivorship,” she added.
Adding to this, University of Southern California’s John Carpten said that an important aspect of the bicoastal center is the unique opportunity to look at the genetics of cancer health disparities across its highly diverse communities in Florida and Southern California. These include American-born, African-born and Caribbean-born blacks, and Mexican-Americans, Caribbean Latinos, and Central and South Americans.
Highly integrated research
Within each institution there are six CaRE2 center cores designed to be highly integrated into the research platform and to support the overall mission. These cores are led by researchers at their respective institutions and include the administrative core, the research education core, the outreach core, the planning and evaluation core, the shared resources core, the tissue modeling core, and the bioinformatics, statistical and methodological core.
At University of Florida, researchers come from across multiple campuses. This includes researchers from the colleges of Medicine, Pharmacy, Nursing and Education, University of Florida Research and Academic Center Lake Nona, University of Florida Health Jacksonville as well as from University of Florida Health Shands Hospital. The team includes researchers with expertise across the spectrum, from molecular biology and bioinformatics to community outreach and clinical interventions.
For the first phase of the center, two full research projects and one pilot project will be conducted that are focused on prostate and pancreatic cancers, two cancers with noted disparities among Blacks and little-known information among Latinos.
Each project has a team at each of the partnering institutions.
The first full research project, led by Li-Ming Su, M.D., chair of the University of Florida College of Medicine’s department of urology, will aim to understand the contribution of novel mitochondrial-derived peptides to racial differences in prostate cancer development.
The second research project, led by Jose Trevino, M.D., an assistant professor in the University of Florida College of Medicine’s department of surgery, aims to reduce disparities in efficacy of a chemotherapy treatment by using molecular profiles of patients to predict their sensitivity to this treatment, taking into account various factors related to racial and ethnic differences.
A pilot project focusing on identifying the genetic basis of racial disparities in pancreatic cancer will be led by Thomas Schmittgen, Ph.D., chair of the University of Florida College of Pharmacy’s department of pharmaceutics. Schmittgen team will be examining early events that lead to the cancer formation, using human samples in vitro.
Ethnically diverse faculty
One of Florida A&M’s contributions will be its ethnically diverse faculty and focus on health disparities research, Carpten said. University of Florida and Florida A&M have worked closely together addressing this issue for the past four years.
“When you have minorities doing research to serve communities to which they belong, it moves faster,” Keck School of Medicine of USC’s Mariana Stern explained. “Studies show that when you don’t have enough minority scientists engaged in research, you introduce more disparities.”
Another goal of the center is to provide research training opportunities for underrepresented minority trainees and early-stage investigators that fosters their individual career development.
“This center really ‘takes a village’ to address cancer health disparities,” Odedina noted.
“Our strength is in our diversity, with the center being led by five underrepresented minority scientists and four women,” she added.
NCI-designated Cancer Center
“Not only will the center advance health disparities research in Black and Latino populations and provide opportunities for underrepresented minority researchers, it will also aid in the University of Florida’s application to become an NCI-designated Cancer Center,” explained David R. Nelson, M.D., interim senior vice president for health affairs at University of Florida and president of University of Florida Health.
The center will also be supported by the University of Florida Health Cancer Center. Jonathan Licht, M.D., director of the University of Florida Health Cancer Center, said he is proud of the role that the Cancer Center has played in supporting the aspirations of this team and all they will accomplish.
“This center will also expand our reach beyond North Central Florida to more urban Orlando and Jacksonville areas and bring University of Florida expertise to study the challenges in underserved and underrepresented cancer populations,” Licht said.
“The goal of our Cancer Center is to bring the best minds and the most impactful resources to work on behalf of our community to solve the challenges of cancer,” Licht added.
The center is backed by the unique contributions of its researchers who are passionate about addressing knowledge gaps in cancer disparities research among subpopulations of Blacks and Latinos.
“While the center is a win-win situation for [the participating institutions], the real winners are cancer patients, especially Blacks and Latinos in Florida and California,” Odedina concluded.
American Association for Cancer Research
Unrelated to the establishment of the Florida-California Cancer Research, Education and Engagement or CaRE2, the issue of cancer health disparities has become a main focal point for cancer research.
In an interview with The Onco’Zine Brief on PRX (Public Radio Exchange), an interview and discussion program covering a broad range of topics and timely news updates with information from all oncology disciplines and sub-specialties, Michael A. Caligiuri, MD, the 2017 president of the American Association for Cancer Research | AACR discussed his concern.
Health disparities are now commonly discussed. And in early November 2018 AACR’s Science of Cancer Health Disparities conferences is expected to help advance the understanding of, and ultimately help to eliminate, the disparities along the cancer continuum that represent a major public health problem in our country.
This conference is designed to reflecting a transdisciplinary field with professionals from academia, industry, government, and the community and bring them together to promote the exchange of novel ideas, discuss the latest findings in the field, and stimulate the development of new research on health disparities.
 Cancer Health Disparities Research. Why Research on Cancer Health Disparities Is Critical to Progress against the Disease. National Cancer Institute. Online. Last accessed October 25, 2018.
 Disparities in Cancer Care Represent a Major Public Health Problem – The OncoZine Brief (Length: 25:02) [Radio Program]
Last Editorial Review: October 25, 2018
Featured Image: Worried Patient. Courtesy: © 2018 Fotolia. Used with permission. Photo 1.0: Folakemi T. Odedina, Ph.D., serves a dual appointment as a professor in the colleges of Pharmacy and Medicine, part of University of Florida Health. She is also the principal investigator and program director of the University of Florida’s Florida Minority Cancer Research and Training, or MiCaRT. This center was established in 2014 through a grant from the NCI, part of the National Institutes of Health, and supported by the University of Florida Health Cancer Center. Courtesy: © 2010 – 2018 UF Health | University of Florida Health Science Center | University of Florida. Used with permission. Photo 2.0: Diana Wilkie, PhD, RB, FAAN, is the Prairieview Trust-Earl and Margo Powers Endowed Professor at the College of Nursing and director of the Center for Palliative Care Research and Education. She is also co-program leader of the University of Florida’s Health Cancer Center’s Cancer Population Sciences research program. Courtesy: © 2010 – 2018 UF Health | University of Florida Health Science Center | University of Florida. Used with permission. Photo 3.0: Mariana Stern and John Carpten have received a grant to create a cancer health equity center at USC and partner organizations. Courtesy: © 2010 – 2018 USC University of Southern California | USC Photo | Gus Ruelas. Used with permission.
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