Strong association found between prevalence of low white blood count and women of African descent

Dr. Grann is Clinical Professor of Medicine and Epidemiology and Health Policy & Management, College of Physicians & Surgeons and Mailman School of Public Health, Columbia University. A medical oncologist for more than 30 years, in 1977 he received both his M.P.H. degree in Health Policy and Management (Health Outcomes) at Columbia University and a Clinical Research Training Grant from the American Cancer Society (CRTG-98-260-02). His work has focused on quality of life, studies of preferences of breast cancer patients, cost-effectiveness, and decision analysis of heath outcomes related to genetic mutations in breast/ovarian cancer. He also is interested in disparities of care especially in clinical trials. He works in the Women’s Cancer Chemotherapy Clinic at Columbia, where breast cancer patients are evaluated and treated, and is Principal Investigator of the NSABP Study of tamoxifen and raloxifene (STAR) trial for the Cancer Center. Presently he is Director of the Recruitment Core at the Herbert Irving Comprehensive Cancer Center.

Association may affect disparities in disease treatment and outcomes for cancer therapy Researchers from Columbia University Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, have found a strong association between women of African descent from the U.S. and Caribbean, who are otherwise healthy, and the prevalence of neutropenia, or low white blood count. Neutropenia, which is associated with race and ethnicity, has essentially been unexplained and, although thought to be benign, may affect therapy for cancer or other illnesses. Among women of African descent who develop a malignancy, this association may contribute to racial disparities in treatment and outcomes. The study findings are reported online in Blackwell Publishing Ltd. British Journal of Hematology. "The goal of our study was to learn as much as we could about the association between a single nucleotide polymorphism (SNP), which creates a person's unique DNA sequence, and low white blood cell counts (WBC)," said Victor, R. Grann, MD, professor of Epidemiology and Health Policy and Management at Columbia University Mailman School of Public Health, professor of Medicine at the Columbia University College of Physicians & Surgeons, director of Research Recruitment and Minority Outreach of the Herbert Irving Comprehensive Cancer Center (HICCC) , and study lead author. The research compared the data of women from the Caribbean and the United States and is the first to confirm the relationship between these study markers and ethnicity in the absence of disease. In addition to prevalence in African and Afro-Caribbean populations, about 25 percent of all blacks in the United States, including those from other origins, are neutropenic.

Because race/ethnicity is also associated with survival, the authors compared WBC and absolute neutrophil counts (ANC) of 261 healthy American-born women of African descent and European descent, 20 to 70 years of age, and women from the Caribbean islands of Barbados/Trinidad-Tobago, the Dominican Republic, Haiti, and Jamaica. Women from the Dominican Republic were found to have higher median WBC and ANC than all other groups.

In an earlier study the Columbia researchers found that low WBC may delay or prevent the completion of appropriate chemotherapy, especially among women receiving adjuvant treatment or treatment after surgery for breast and colon cancer, and could affect cancer survival.

"We found that women of African descent with early-stage breast cancer had lower baseline WBC and longer duration of adjuvant chemotherapy than non-Hispanic white women," said Dawn Hershman, M.D., Florence Irving Assistant Professor of Medicine and Epidemiology, Columbia University Medical Center, co-director of the Breast Cancer program of the HICCC, and senior author of the study. "Black women were more likely to miss cycles of chemotherapy and had poorer survival than white women which could be related to lower WBC among other factors. These observations raised questions about whether the prevalence of low WBC varied among ethnic subgroups and how WBC might be related to other biomarkers among women without cancer."

This led to other research conducted by the Mailman School scientists and published in Cancer (August 15, 2008) and the present article published online in the British Journal of Hematology, which found that a certain genotype, common among women of African descent, is closely associated with low absolute neutrophil counts or low polymorphonuclear cells, the one's that fight infection, which may affect the timing and intensity of cancer treatments.

The authors anticipate that additional research underway could shed light on the timing and duration of appropriate chemotherapy treatment and its affect on survival. A better understanding of these associations may help to improve cancer outcomes among individuals of African and Caribbean ancestry.

"Unfortunately, we still know very little about the association of neutropenia with genotype in the setting of cancer or any other disease, including sickle cell anemia," noted Dr. Grann. "Further research may help to account for and prevent poor outcomes among persons of African ancestry and lead to interventions that may benefit them as well as all patients." ###

The study was supported by grants from the National Cancer Institute and the National Institutes of Health. To access online: (British Journal of Hematology) www.ncbi.nlm.nih.gov/entrez/query

About the Mailman School of Public Health

The only accredited school of public health in New York City, and among the first in the nation, Columbia University's Mailman School of Public Health provides instruction and research opportunities to more than 1000 graduate students in pursuit of masters and doctoral degrees. Its students and more than 300 multi-disciplinary faculty engage in research and service in the city, nation, and around the world, concentrating on biostatistics, environmental health sciences, epidemiology, health policy and management, population and family health, and sociomedical sciences. www.mailman.columbia.edu

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Established in 1767, Columbia's College of Physicians & Surgeons was the first institution in the country to grant the M.D. degree and is among the most selective medical schools in the country. Columbia University Medical Center is home to the largest medical research enterprise in New York City and state and one of the largest in the United States. For more information, please visit www.cumc.columbia.edu.

Herbert Irving Comprehensive Cancer Center

The Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center and NewYork-Presbyterian Hospital encompasses pre-clinical and clinical research, treatment, prevention and education efforts in cancer. The Cancer Center was initially funded by the NCI in 1972 and became a National Cancer Institute (NCI)–designated comprehensive cancer center in 1979. The designation recognizes the Center's collaborative environment and expertise in harnessing translational research to bridge scientific discovery to clinical delivery, with the ultimate goal of successfully introducing novel diagnostic, therapeutic and preventive approaches to cancer. For more information, visit www.hiccc.columbia.edu.

Contact: Stephanie Berger sb2247@columbia.edu 212-305-4372 Columbia University's Mailman School of Public Health