MUSC and SCSU join forces to address health disparities

Marvella Ford missed out on a fundamental part of childhood: having grandparents to spoil and take care of her. They all died before she was born. "That's a tremendous loss that you can never overcome. I grew up not having met or seen pictures of any of my grandparents," she said.

She couldn't even find out how they died. "I was told that no one knew their causes of death. This lack of information about something so important made me decide to enter the field of health disparities research, to try to better understand the reasons behind the racial and ethnic health disparities in this country."

Ford is now leading the effort to establish the South Carolina Cancer Disparities Research Center, designed to do exactly that. It's funded by a $12.5 million grant from the National Cancer Institute. Half of the money goes to the Medical University of South Carolina Hollings Cancer Center, the other half to South Carolina State University.

Ford is the glue that brings the two universities together in her roles as a professor in the MUSC College of Medicine's Department of Public Health Sciences, a senior leader at the MUSC Hollings Cancer Center and the SmartState endowed chair in prostate cancer disparities at SCSU. She's leading the project with Judith Salley-Guydon, chairwoman of the Department of Biological and Physical Sciences at SCSU.

When it comes to cancer, "Our state has glaring cancer disparities geographically, socioeconomically, and in terms of race," Ford said. "With prostate cancer, the death rate is three times higher for black men than it is for white men. The story is the same for women in South Carolina with breast cancer. The mortality rate is much higher for black women than for white women."

The South Carolina Cancer Disparities Research Center, also known as SC CADRE, will be guided by the belief that race and circumstances should not keep people from enjoying as long and healthy a life as possible. SC CADRE's goals include increasing SCSU's ability to do cancer research, conducting cutting-edge cancer disparities research, inspiring a new generation of researchers to focus on cancer disparities and getting the general public more involved in cancer research.

Laying the Groundwork

"This grant will help us build tremendous infrastructure. The first piece is, we're developing a new biostatistics and quantitative methods shared resource at SCSU," Ford said.

"Shared resource" is a common term in research. In this case, it means a group of people who are experts in statistics and research methods who can help cancer researchers with data and computation. MUSC already has multiple shared resources at the Hollings Cancer Center, but SCSU hasn't had one -- until now.

"This is specific to cancer research center grants," Ford said. Having the shared resource will give SCSU a much better shot at getting the federal government and other funding sources to pay for its cancer research. That, she said, benefits both SCSU and MUSC. "It really allows MUSC investigators to partner with SCSU faculty, because they have access to funding resources we don't have, and vice-versa, so multidirectional partnering can take place."

Increasing Focus on the Health of Black South Carolinians

The researchers will need good material to work with, and the grant is designed to give them that. "We're establishing a new biorepository at South Carolina State and a clinical trials office in the Regional Medical Center in Orangeburg, where 62 percent of the patients are African-American," Ford said.

Tissue samples taken from patients in the Regional Medical Center's Mabry Center for Cancer Care will be taken to SCSU, cataloged and made available to scientists. "We anticipate this new biorepository is going to be one of the most racially and ethnically diverse biorepositories in the country," Ford said. "It should be in very high demand by other researchers and private industries."

One of the SC CADRE biorepository's most important roles will be helping researchers identify differences in the biological pathways involved in diseases such as triple negative breast cancer, which has a poorer prognosis than hormone-receptor positive breast cancer. "We know that triple negative breast cancer is more prevalent in African-American women, but we need to understand more about why," Ford said.

SC CADRE will also help researchers study nuances within the black community, including the health of the Gullah living on the Sea Islands of South Carolina. "We've done some very preliminary work with 90 breast cancer survivors in South Carolina. Our work shows that the prevalence of triple negative breast cancer seems to be lower in Sea Islanders than in blacks without Sea Island ancestry. We're looking at biological contributors to breast cancer outcomes. That's the kind of study we'll be able to do."

Finding the answers to such questions may benefit people statewide, Ford said. "This is a cancer disparities grant, but sometimes we forget disparities refer not only to racial and ethnic disparities but also to geographic and socioeconomic disparities. Our studies will include multiple racial and ethnic groups with different levels of education and income. We really want to improve cancer outcomes for everyone in South Carolina."

Lowering AGE Levels

A third piece of the SC CADRE grant focuses on lowering the levels of AGEs, or advanced glycation end products, in prostate cancer survivors. A big part of that may involve changing their diets, shifting away from cooked meat to more fruits and vegetables. Researchers will also look at whether exercise and medications can lower AGE levels and improve people's health.

"There is a big difference in levels of AGEs between blacks and whites," Ford said. "Blacks actually have higher levels of ages even before cancer diagnosis. They're linked with poorer prognosis and worse outcomes in prostate cancer. The idea is, if we can drive down the level of AGEs, we can make more equitable health outcomes for blacks and whites, and it may help reduce disparity in prostate cancer survival rates."

Buy-In from the Public

Ford said all of her team's work is guided by input from the public. "We have community input at every step. Even in putting the grant together we went to our advisory board at the cancer center to get their input in how to proceed with developing the grant."

The SC CADRE researchers created a community engagement panel. "It's important to have the input of the public, especially when we're designing clinical trials. They can tell us about how the trial might be perceived in the community. And when it comes to the end points that we think are most important, they may have other ideas we can learn from."

Part of getting that community input involves letting people know that the researchers understand where they're coming from, in terms of the burden of cancer in local communities. "We hear the pain. We feel the pain," Ford said. "I want people to know we are doing everything we can to conduct research to reduce disparities in South Carolina."