February 18, 2016

Cancer Program Focuses on State’s Cancer Disparity Rates

Feb. 18, 2016 | Joseph Su, Ph.D., M.P.H., and Mayumi Nakagawa, M.D., Ph.D., have a big job ahead of them.

As co-directors of the Cancer Prevention and Population Sciences (CPPS) program in UAMS’ Winthrop P. Rockefeller Cancer Institute, they are working to solve the problem of cancer disparity in Arkansas.

According to the Centers for Disease Control and Prevention, Arkansas ranks 30th in overall rates of cancer. But the state’s cancer mortality rate is the sixth highest in the country, Su said, a significant disparity.

Even worse, when you look at the mortality to incidence ratio, Arkansas is third in the country, he said.

“This means that Arkansas isn’t the worst environment in terms of getting cancer, but it falls short in terms of getting people the care they need,” he said.

While programs like the MammoVan and screenings for colorectal cancer and the human papillomavirus (HPV) are an important part of the CPPS, they can’t exist on their own, Su said.

“We can’t screen everybody. We need to identify some factors of which we can really target to eradicate this cancer or reduce the cancer mortality, he said. “It would be too costly to screen everybody. It would be great if we had the money, but obviously, the resources are always limited.”

Nakagawa agreed.

“The research is important because we can’t be doing the same things and still make a dramatic difference in the future,” she said.

The program is focusing on five cancer areas that have the state’s highest health care disparities: cervical, colon, lung, prostate and breast.

“We know that for cervical cancer the screening rate is low, and HPV vaccination rate for teenagers is low,” Nakagawa said, adding that a similar lack of screening is also seen in breast and colon cancers. “So we know that those are the things that are lacking. We have those services, but we have to know, where are the gaps?”

Analyzing the data can reveal surprising things, said Nakagawa. For example, the HPV vaccine, which helps prevent cervical cancer, is covered by Medicaid. However, the reimbursement rate is less than the cost of the vaccine. So every time a physician administers the vaccine to a Medicaid patient, the doctor loses money, leaving no real incentive to increase vaccination rates, she said.

Such information is vital as the CPPS tries to understand and address the state’s cancer disparity, she said.

Su was hired as a co-director of CPPS and as a professor of epidemiology in the Fay W. Boozman College of Public Health in October 2015. He joined UAMS from the Food and Drug Administration where he was the chief of the Epidemiology and Evaluation Research Branch, part of the Office of Surveillance and Biometrics at the Center for Devices and Radiological Health. Prior to that, he had been the program director of the Epidemiology and Genomic Research Program at the National Cancer Institute. He also had worked for 10 years at the Louisiana State University Health Sciences Center in New Orleans.

After six years working in federal government, Su said he was ready to return to academia and thought the position at UAMS looked like a good chance to get back in the classroom and back into community-focused research.

“I thought this was the place where I can really make a public health impact,” Su said.

Nakagawa, who has worked at UAMS since 2004, also joined CPPS last fall. She is a professor of pathology in the UAMS College of Medicine and teaches in the Interdisciplinary Biomedical Sciences program in the Graduate School.

She has been studying HPV since 1992 and has developed a therapeutic vaccine for women who have certain cervical precancerous lesions that were caused by the virus. The preventive vaccines currently on the market are given to children and teenagers before they become sexually active because they do not work after HPV is acquired. Nakagawa’s therapeutic vaccine is in Phase II clinical trials.

Those years of research fit perfectly under the CPPS umbrella, she said, as treating precancerous lesions prevents cancer.