Health disparities: genetics plays an important role in cancer detection, prognosis among minorities

Sorting the samples according to race, they found the differences in gene expression. Of significance was over-expression of indoleamine-2,3-dioxygenase, an immune system modulating enzyme that tumors use to subvert immune-system surveillance, and the “self” antigens HLA-E and HLA-G that additionally inhibit immune responses through different mechanisms.

“These genes are well-known contributors of immunologic tolerance in tumors,” she said. Additionally, there was a distinctive interferon signature in gene over-expression in the African-American patients, which is associated with an immune system response against foreign invaders such as viruses.

One puzzling finding: genes that activate the immune system and genes that suppress it were both more highly expressed in the African-American patients. Wallace says this suggests the immune system is fighting the cause of the cancer, which could be a pathogenic invader. Alternatively, the discovered gene signature may reflect merely the presence of a chronic low-level inflammation that is more prevalent in the tumors of the African-American patients, she says. It could also mean that prostate tumors in these men have ways of suppressing the immune system, which explains why their tumors are more aggressive, she adds.

“Something is different in the tumor microenvironment between the group of patients we studied and it has to do with tumor immunobiology,” Wallace said. “We are intrigued with these findings, which we are continuing to research.”

A tracking and feedback registry to reduce disparities in breast cancer care: Abstract 3836

A tracking and feedback registry following breast cancer surgery reduces racial disparities in follow-up treatment and may ultimately affect clinical outcomes, researchers report.

Following surgery, women with breast cancer have numerous subsequent treatment options, but minority women are less likely to obtain further treatment than white women, previous studies have found.

Nina Bickell, M.D., M.P.H., an associate professor of health policy at Mount Sinai School of Medicine, suspected this was partly because referring surgeons had no way of keeping track of their patients in order to encourage follow-up care. So Bickell, Kruti Mohan, M.P.H., a senior project manager at Mount Sinai, and colleagues set up a tracking and feedback registry whereby surgeons at six medical centers were notified by phone and letter whether or not their patients subsequently visited an oncologist. By the end of the study, there was an increase in oncology consultations and a decrease in underutilization of adjuvant treatment.