Dr. Lucio Miele, director of the UMMC Cancer Institute, and Dr. Mary Ann Van Duyn, program director at the National Cancer Institute's Center to Reduce Cancer Health Disparities, discuss developments during the consortium. The NCI funded the

Dozens of specialists and scientists from nine institutions gathered at the Jackson Medical Mall in Jackson, Miss., for a two-day conference hosted by the University of Mississippi Medical Center (UMMC) Cancer Institute.

The GMaP/BMaP Region 3 conference was held April 23-24 to improve cancer research by designing population studies and drug clinical trials that include minorities and by building tissue banks that better represent the region’s diversity.

The expert consortium included attendees from member universities’ cancer programs at Emory University, Moffitt Cancer Center, Morehouse College, Ponce School of Medicine and Health Sciences, Tulane University, Tuskegee University, University of Alabama at Birmingham, UMMC, and Xavier University. Also in attendance: Mary Ann Van Duyn, PhD, MPH, a program director within the Center to Reduce Cancer Health Disparities (CRCHD) at the National Cancer Institute (NCI), who oversees regional consortiums.

“Overall, we’re working together to study the environmental, cultural, clinical and biological aspects of health disparities in cancer,” said Lucio Miele, MD, director of the UMMC Cancer Institute.

The spring conference marked the group’s fifth meeting since its formation in 2009, with committees reporting a great deal of headway on their goals. Each university is completing or has already done a self-assessment and inventory of what they can bring to the table. Multiple subcommittee cores examine how the universities can work together on various aspects of fighting cancer. Cores include outreach and education, tissue banking, legal and medical ethics, clinical trials and emerging technology. Members of each core teleconference monthly.

The group addressed health disparities in cancer through two main avenues: GMaP – or Geographic Management Program – and BMaP – or Biospecimen Management Program.

GMaP’s purpose is to find ways the institutions can collaborate on population studies and clinical trials. By identifying regional and ethnicity-based differences in cancer outcomes, the consortium can design population research and clinical trials that include statistically significant numbers of minorities.

“There’s no such thing as a single cancer,” said Miele. “Cancers happen in the same place – breast, lung, bones – but there are many different types. Environmental, behavioral, genetic and epi-genetic risk factors affect cancer incidence and outcome, and these are in part influenced by an individual’s ethnicity. A majority of cancer drugs have been developed and approved based on studies that didn’t include a significant number of minorities. So we don’t know if these drugs are optimal for minorities.”

The South has a heavier burden of cancer than other regions in the United States, and minorities are disproportionately affected. But ultimately, the cost of cancer healthcare disparities affects everyone nationwide.

The best way to reduce this burden is to find effective strategies to prevent cancer, to diagnose it earlier and to treat it more effectively. This cannot be accomplished without understanding cancer risk factors and biology in all Americans, irrespective of ethnicity and socioeconomic status, explained Miele.

BMaP is an effort to create a regionally shared bio-repository system that will allow researchers throughout the Mid-South to study novel biomarkers of disease. Understanding differences in cancer subtypes may help explain why certain ethnic groups experience different incidences of cancer and different outcomes in treatment.

“Gene expression and molecular profiling data don’t exist on many minorities’ cancers,” he said. “So we don’t know if we’re dealing with different disease subtypes. It’s why we need biospecimen repositories. We want to ensure we build tissue banks that are as broad and diverse as the U.S. population.”

The GMaP/BMap Region 3 consortium represents five states – Alabama, Florida, Georgia Louisiana, and Mississippi – and Puerto Rico. Those areas share various demographic, cultural and socioeconomic features, including large minority populations, urban and rural poverty, poor education track records, and inadequate access to healthcare. 

African-Americans and Latinos have been just as willing as other races to donate cancer tissue samples and to participate in population studies and clinical trials, Miele pointed out.

“But the infrastructure to do those things has not been strong enough,” he said. “All these things cost money – handling, banking and human costs of tissue storage, and the immense costs of conducting long-term population research. The idea is that between these nine members, we can share each other’s strengths and compensate for each other’s weaknesses. We’re trying to provide the infrastructure so people who haven’t been able to participate in research, tissue specimen banking and clinical trials can participate.”

The GMaP/BMap Region 3 consortium was formed in 2009 with funding from the NCI’s CRCHD. Members meet quarterly and hold monthly teleconferences. The spring gathering marks the consortium’s first meeting in Jackson, Miss.

“For GMaP, we’re planning a joint study on factors hindering or helping diverse participation in regional tissue banking efforts for next year,” said Miele. “For BMaP, we’re working memoranda of understanding among all our institutions to do two things:

1.     Pooling tissue to generate regional tissue microarrays (TMAS) with cancer tissue from patients all over the region, focusing initially on breast, prostate, head and neck, colorectal and kidney cancers. These will be made available to researchers throughout the region on the basis of scientific merit as determined by tissue advisory board with members from all institutions.

2.    Offer each other core facility services at member prices. This way, all the high-technology core facilities available at our nine institutions will be used at capacity and provide cancer researchers with a shared pool of resources. For example, we have unique resources in lipidomics and circulating tumor cells; Moffitt has unique resources in tissue banking with robotics, clinical trials and many other things; UAB has unique resources in behavioral and population sciences; Emory has RNA sequencing; Xavier has proteomics; Tuskegee and Morehouse have tremendous expertise in medical ethics.”

Miele emphasized that shared tissue samples will be de-identified.

“The only allowable way to share actual clinical information is with a properly consented, IRB-approved protocol,” he explained. “Federal law prohibits the release of any identifiable information without patient consent. So, for example, a tissue specimen will be labeled ‘breast cancer, basal type, grade 3, stage IIIa,’ period. So the researchers who’ll analyze this tissue for molecular clues won’t know who it came from unless there’s a specific protocol – for example, to determine how well a certain molecular marker predicts better efficacy of treatment – and in that case, the protocol will have to have informed consent.”

Additionally, Region 3 is forming 2- and 3-way partnerships around health disparity grant applications among members.

“In other words, we’re creating Cancer Team Science all across the South, focusing on the part of the U.S. where cancer incidence and mortality are highest,” said Miele. “All this is in expectation that once the economy gets back on track and the NCI budget is not so restricted, the regional team will receive infrastructure support from the CRCHD so that we can launch region-wide clinical trials, population and prevention studies and biomarker studies for early diagnosis and prognosis, as well as biomarker studies to optimize treatment. Many of these will require tissue to analyze biomarkers or to match biomarkers to treatment.”

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