Metabolic Syndrome (MetS) and Women at Increased Risk for Breast Cancer
Among African-American women, in whom MetS is very prevalent and breast cancer mortality rates are high, it is hypothesized that intervening on MetS to improve the MetS profile may prove to be a means to reduce breast cancer risk. Our project compares two exercise interventions: a supervised facility-based and a home-based exercise intervention to a control group in African-American women with metabolic syndrome who are at increased risk for breast cancer. This study is a 6-month three-arm randomized control trial to assess the impact of the exercise interventions on biomarkers related to obesity, insulin-related pathways, inflammation, and hormones. The specific aim of the proposed study is to compare the impact of a supervised facility-based and a home-based exercise intervention on obesity, metabolic syndrome and known breast cancer biomarkers in postmenopausal African-American women with metabolic syndrome who are at increased risk of breast cancer.
Environmental Exposure and Breast Density
Residents in medically underserved areas of DC have expressed the concern that the high incidence of cancer in their community is due to contaminants in their food and water, including metals. We are working to see if exposure to metals and metalloids increases breast cancer risk by testing the hypothesis that higher lifetime environmental exposure to metals and metalloids with estrogen- and progesterone-like activity is associated with higher mammographic density in women during the menopausal transition due to delays or reductions in the rate of involution of the mammary gland.
Oxidative stress is a complex pathway that has multiple endogenous and exogenous influences. Dietary and other lifestyle factors, such as tobacco use, obesity, and physical activity have been identified as the major modulators of oxidative stress. Chronic oxidative stress is believed to play a role in the pathogenesis of many cancers, such as breast and colorectal cancers. The focus on diet, especially on identifying patterns or components of a pro-oxidant diet, is important because diet is considered the primary exogenous source of oxidative stress, either independently or through its effects on obesity and insulin resistance. Our goal is to measure the systemic oxidative stress burden in African-American women using blood and urine-based proteomic and metabolomic markers, identify dietary pattern(s) related to the biomarker-based oxidative stress burden, and investigate the association of these oxidative stress dietary patterns (OSDP) with cancer risk. The study results will allow us to determine the dietary contributors to oxidative stress and their association with cancer risk among African-American women, and also allows us to compare results from this study with previously published literature among White women.
Oral Health Disparities and HPV
There is a critical need to study the relationship of the oral health condition and oral infectious diseases in oral cancer development to improve the outcomes of oral cancer and oral cancer disparity. Based on the information from DC Cancer Registry, the District of Columbia has the highest incidence and lowest survival rate of oral cancer in the nation. The importance of oral health assessment as an indicator of illness or disease in other parts of the body warrant considerable attention and understanding. The goal of the project is to conduct a community-based assessment of oral health needs, barriers, knowledge, attitudes, and behaviors on oral health disparities in Washington, DC, including disparities in dental carrier, gum disease, oral cancer lesions and oral preventative health. The project is predicated on targeting an understudied, high-risk oral cancer population for interventions. The innovation of this work is to investigate the risk factors of the oral health disparities focusing on the community needs, and the impact of oral health condition and oral infectious diseases (HPV, bacteria and HIV) on oral cancer disparities in DC. HPV has also been found to be associated with oropharyngeal, and other cancers. Progression of HPV infections to cancer is a serious outcome. We seek to investigate the relationship between the oral microbiome, diet, demographics in medically underserved men and women residing in Washington, DC, and to assess the prevalence of oral HPV in low-income populations.
Patient Navigation and Breast Cancer Screening
The DC area has the highest incidence and mortality rates for breast cancer in the US, with incidence rates 20% higher than the national average and mortality rates nearly 40% higher than the national average. We are studying health literacy and breast health comprehension among underserved women regarding the importance of mammography in community settings and public housing. We will provide culturally sensitive tailored educational mammography health sessions and small group discussions to assess the impact on women seeking mammograms.
This application seeks to shift the population focus in current mammography intervention trials to exclusively include minority women who have either never been screened or are non-adherent to their annual screening schedule. Although the barriers and facilitators for mammography uptake and adherence tend to be similar most intervention studies on mammography screening have targeted either uptake or adherence. Additionally, most trials have been conducted among non-Hispanic Whites and women with insurance coverage. We propose to target both mammography uptake and annual adherence in a group of un- and under-insured minority women. We are addressing multiple screenings for both breast and colon cancers.