Why are African-Americans less likely to survive certain cancers?

It's not due soley to poverty or inferior health care, study finds

MAYWOOD, Il. - African Americans are more likely than other races to die from breast, prostate and ovarian cancers, but this disparity is not due to poverty or inferior healthcare, a first-of-its-kind study has found.

Researchers followed more than 19,000 patients who were enrolled in cancer clinical trials conducted by the Southwest Oncology Group, a National Cancer Institute-funded clinical trials national cooperative. Patients of all races received the same advanced treatments by the same doctors.

"It was a level playing field for everyone, with the same quality care," said lead author Dr. Kathy Albain. "So our findings cast doubt on a prevailing theory that African Americans have lower cancer survival rates because of poverty, poor access to quality care or other socioeconomic factors." Albain is a breast and lung cancer specialist at Loyola University Health System's Cardinal Bernardin Cancer Center.

If poverty or other socioeconomic factors were to blame, then the survival gap should exist for all cancers.

But the study, published in the Journal of the National Cancer Institute, found there was no statistically significant association between race and survival for lung and colon cancers, leukemia, lymphoma or myeloma.

"The good news for African Americans is that for most common cancers, they have the same survival rates as all other races," Albain said.

The cancers that did show survival gaps -- breast, prostate and ovarian -- are gender-related. The findings therefore suggest that the survival gap is due to a complex interaction of biologic factors in the tumor and inherited variations in common genes that control metabolism of drugs and hormones, Albain said. People with different patterns of these genes metabolize cancer drugs and their own hormones differently, and experience different side effects.

"We are actively conducting new research based on these findings to explore interactions among tumor biology, treatment, sex, race, inherited genes and survival," Albain said.

Dr. Patrick Stiff, director of the Cardinal Bernardin Cancer Center, said: "This groundbreaking study will provide investigators with a road map for future research that will improve outcomes of patients of all races and socioeconomic status."

Researchers identified 19,457 adult cancer patients enrolled in 35 Southwest Oncology Group clinical trials who were followed for at least 10 years after treatment. Twelve percent of the patients were African American. During the course of the study, African Americans were 49 percent more likely than other races to die from early-stage, postmenopausal breast cancer; 41 percent more likely to die from early stage, premenopausal breast cancer; 61 percent more likely to die from advanced-stage ovarian cancer and 21 percent more likely to die from advanced-stage prostate cancer. ###

Albain is a professor in the Department of Medicine, Division of Hematology/Oncology, Loyola University Chicago Stritch School of Medicine. Her co-authors are Joseph Unger and John Crowley of the Southwest Oncology Group Statistical Center, Dr.Charles Coltman of the University of Texas Health Science Center and Dr. Dawn Hershman of Columbia University College of Physicians and Surgeons.

The study was funded by the National Cancer Institute.

Based in the western suburbs of Chicago, Loyola University Health System is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and 28 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 561-licensed bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 264-bed community hospital, the Gottlieb Center for Fitness and the Marjorie G. Weinberg Cancer Care Center.

Contact: Jim Ritter jritter@lumc.edu 708-216-2445 Loyola University Health System

Physician trust, early screening reduces disparities for prostate cancer

Men who have a regular, ongoing relationship with a health care provider are more likely to receive prostate cancer screening and less likely to be diagnosed with advanced prostate cancer, regardless of their race, according to a University of North Carolina study published in the current issue of the journal Cancer.

The study compared the experiences of black and white men over age 50 and newly diagnosed with prostate cancer in North Carolina and Louisiana. The goal was to find underlying reasons why African-American men have a higher incidence of prostate cancer and a higher rate of death from the disease than their white counterparts.

"We found that Caucasian (white) men tended to be seen regularly by the same physician, which appears to be associated with greater trust in their doctors and in physicians in general," said study author William R. Carpenter, Ph.D., research assistant professor of health policy and management in the UNC Gillings School of Global Public Health and a member of UNC Lineberger Comprehensive Cancer Center. "They were also more likely than their African-American counterparts to get regular prostate cancer screenings, and to get all their medical care at a physician's office."

William R. Carpenter, PhD. Research Assistant Professor Health Policy and Management

The study enrolled 1,031 black and white men, age 50 and older, within weeks of their prostate cancer diagnosis. A study nurse conducted a structured survey and acquired biological specimens in a home visit and obtained other medical information from each patient's medical records. In this study, the stage of prostate cancer at diagnosis was similar between races, but the mean Gleason scores, an indication of the aggressiveness of the disease, were higher for blacks than for whites.

Blacks were less likely than whites to report participation in prostate cancer screening prior to diagnosis. Men without a prior history of screening were more likely to be diagnosed with advanced disease and/or more aggressive forms of prostate cancer. However, when men of either race had established relationships with a health care provider, the differences in prostate cancer stage at diagnosis went away.

"This evidence leads us to think that encouraging African-Americans to establish an ongoing relationship with a regular care provider may encourage more appropriate use of prostate cancer screening, and thus reduce racial disparities in prostate cancer diagnosis and treatment, which, by extension, may reduce disparities in prostate cancer deaths," Carpenter said.

James Mohler, M.D., chair of the department of urology at Roswell Park Cancer Institute in Buffalo, N.Y., and principal investigator of the study, said, "The goal of the study was to gain a deeper understanding of the role of racial disparities in prostate cancer outcomes. These findings suggest that differences in screening result from inconsistent or poorer quality interaction between an African-American man and the American health care system. If the interaction is poor, the care giver may not 'get around' to discussing or offering preventive health care, such as prostate cancer screening. Improving the interaction between all men, and especially African-American men, and their primary care givers should reduce prostate cancer deaths in all men and decrease the racial disparity in prostate deaths in African-American men." Mohler is a member of UNC Lineberger Comprehensive Cancer Center.

Carpenter added, "Factors in health care systems, including setting and continuity of care, may hinder the development of physician-patient relationships, and possibly preclude discussions beyond the immediate medical issue at hand, including discussions of preventive health and preferences in use of early detection. These factors and relationships can influence whether there are discussions beyond the immediate medical issue at hand, including discussions of preventive health and preferences in use of health care services such as prostate cancer screening." ###

Other UNC authors include Paul Godley, M.D., Jeannette Bensen, Ph.D., Merle Mishel, Ph.D., and Timothy Finnegan, M.D. Other authors include the study's co-principal investigator, Elizabeth Fontham, Ph.D., from the Louisiana State University Health Science Center in New Orleans.

The research was supported by the U.S. Department of Defense and the National Cancer Institute.

Contact: Dianne Shaw dgs@med.unc.edu 919-966-5905 University of North Carolina School of Medicine

Researchers uncover genetic variants linked to blood pressure in African-Americans

Findings may point to new avenues for treatment, prevention

A team led by researchers from the National Institutes of Health today reported the discovery of five genetic variants related to blood pressure in African-Americans, findings that may provide new clues to treating and preventing hypertension. The effort marks the first time that a relatively new research approach, called a genome-wide association study, has focused on blood pressure and hypertension in an African-American population.

Hypertension, or chronic high blood pressure, underlies an array of life-threatening conditions, including heart disease, stroke and kidney disease. Diet, physical activity and obesity all contribute to risk of hypertension, but researchers also think genetics plays an important role.

Eric D. Green, M.D., Ph.D. Caption: Dr. Eric D. Green, Scientific Director, Division of Intramural Research, NHGRI. Credit: Maggie Bartlett, NHGRI Date Created: November 12, 2002

About one-third of U.S. adults suffer from hypertension. The burden is considerably greater in the African-American community, in which the condition affects 39 percent of men and 43 percent of women. "This work underscores the value of using genomic tools to untangle the complex genetic factors that influence the risk for hypertension and other common diseases," said Eric Green, M.D., Ph.D., scientific director for the National Human Genome Research Institute (NHGRI), part of NIH. "We hope these findings eventually will translate into better ways of helping the millions of African-Americans at risk for hypertension, as well as improved treatment options for other populations."

In addition to NHGRI researchers, scientists from the Coriell Institute for Medical Research in Camden, N.J.; Boston University; and Howard University, in Washington, D.C., collaborated on the study, which was published in the July 17 online issue of PLoS Genetics.

To produce their findings, researchers analyzed DNA samples from 1,017 participants in the Howard University Family Study, a multigenerational study of families from the Washington, D.C., metropolitan area who identified themselves as African-American. Half of the volunteers had hypertension and half did not. To see if there were any genetic differences between the two groups, researchers scanned the volunteers' DNA, or genomes, analyzing more than 800,000 genetic markers called single-nucleotide polymorphisms (SNPs).

The researchers found five genetic variants significantly more often in people with hypertension than in those without the condition. The variants were associated with high systolic blood pressure, but not with diastolic blood pressure or combined systolic/diastolic blood pressure.

Blood pressure is measured in millimeters of mercury (mm Hg), and expressed with two numbers; for example, 120/80 mm Hg. The first number (systolic pressure) is the pressure when the heart beats while pumping blood. The second number (diastolic pressure) is the pressure in large arteries when the heart is at rest between beats.

"This is the first genome-wide association study for hypertension and blood pressure solely focused on a population with majority African ancestry," said the study's senior author, Charles Rotimi, Ph.D., NHGRI senior investigator and director of the trans-NIH Center for Research on Genomics and Global Health (CRGGH). "Although the effect of each individual genetic variant was modest, our findings extend the scope of what is known generally about the genetics of human hypertension."

In a genome-wide association study, researchers identify strategically selected markers of genetic variation. If disease status differs for individuals with certain genetic variants, this indicates that something in that chromosomal neighborhood likely influences the disease. Variants detected using this approach can accurately point to the region of the genome involved, but may not themselves directly influence the trait.

In May, two major international studies used the genome-wide association approach to identify 13 genetic variants associated with blood pressure and hypertension in people with primarily European and South Asian ancestry. While each variant was associated with only a slight increase in blood pressure, that work found that the more variants an individual had, the greater his or her risk of hypertension. Two genes identified by one of those studies were also associated with blood pressure in the new study.

In their pioneering study of African-Americans, Dr. Rotimi and his colleagues found that all of the five genetic variants associated with blood pressure were located in or near genes that code for proteins thought to be biologically important in hypertension and blood pressure. Previous research had implicated two of those genes in blood pressure regulation, and additional analyses by Dr. Rotimi's group revealed that all of the variants are likely involved in biological pathways and networks related to blood pressure and hypertension.

An existing class of anti-hypertension drugs, called calcium channel blockers, already targets one of the genes, CACNA1H. However, the additional genes may point to new avenues for treatment and prevention.

To follow up and expand upon their findings in African-Americans, the researchers scanned DNA from 980 West Africans with and without hypertension. The work confirmed that some of the genetic variants detected in African-Americans were also associated with blood pressure in West Africans. "The Western African population is of particular significance since it is the ancestral population of many African-Americans," said lead author Adebowale Adeyemo, M.D., CRGGH staff scientist. ###

This study was supported by the NHGRI, CRGGH, and the National Institute of General Medical Sciences, all part of NIH; and by a W.W. Smith Foundation grant to the Coriell Institute. The Howard University General Clinical Research Center carried out the enrollment of study participants.

For more information about hypertension, visit www.nhlbi.nih.gov/health/.

To learn more about the genome-wide association approach, visit www.genome.gov/.

NHGRI is one of the 27 institutes and centers at the NIH, an agency of the Department of Health and Human Services. The NHGRI Division of Intramural Research develops and implements technology to understand, diagnose and treat genomic and genetic diseases. Additional information about NHGRI can be found at its Web site, www.genome.gov.

The National Institutes of Health — "The Nation's Medical Research Agency" — includes 27 institutes and centers, and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases. For more, visit www.nih.gov.

Contact: Raymond MacDougall macdougallr@mail.nih.gov 301-402-0911 NIH/National Human Genome Research Institute

'Go to the doctor? Only if I'm really sick...'

Black men's notion of masculinity leads to avoidance of health-related behaviors

African American men could be putting their health at risk by avoiding disease screening, in the belief that the results might threaten their masculinity. Because they prove their masculinity through their sexuality and sexual performance, seeking medical advice including HIV/AIDS testing goes against their notion of masculinity. Waverly Duck, a Post Doctoral Associate from the Department of Sociology at Yale University in the US, argues that current leading theories of gender and masculinity and health behavior models are not relevant enough to African American men and their distinctive notion of masculinity. His results (1) are published online in Springer's Journal of African American Studies.

Waverly Duck

Duck studied how African American men conceptualize masculinity and how it relates to their health behaviors. Through a combination of focus groups and in-depth interviews, he asked African American men about their own understanding of their gender identity and examined how that identity, as well as how it is achieved and maintained, relates to their health. The study found that being sexually active is an important component of African American men's notion of masculinity.

Two-thirds of the participants described masculinity based on patriarchy, heterosexuality, subordination of others, economic security and physical dominance – also known as hegemonic masculinity – as the standard. However, when they are economically marginalized, sexuality and sexual performance become the means by which they prove their masculinity. Health seeking behaviors, including going to the doctor and HIV/AIDS testing, go against their notion of masculinity by potentially interfering with the freedom of their sexual activities. However, they considered it acceptable to get screened for health conditions they perceived as curable, if the cure allowed them to resume normal sexual relations.

Dr. Waverly Duck's work challenges conventional approaches to black masculinity and attempts to lay the foundation for a more nuanced way of looking at it. He argues that a new health behavior model for Black men should be developed - one that explores the link between their history and how it affects health promoting and health avoidance behaviors.

He concludes: "If men use avoiding going to the doctor to exhibit masculinity, then new strategies of health intervention should be promoted to this population. Voluntary health screening procedures for conditions such as prostate cancer, heart disease and HIV/AIDS tests should be available and conducted in hospital emergency rooms, settings where African American men frequently have contact with the medical profession." ###

Reference
1. Duck W (2009). Black male sexual politics: avoidance of HIV/AIDS testing as a masculine health practice. Journal of African American Studies DOI 10.1007/s12111-009-9097-2

Contact: Joan Robinson joan.robinson@springer.com 49-622-148-78130 Springer

New book explores post-emancipation education of blacks in Mississippi

CHAMPAIGN, Ill. – In the years immediately following the Civil War, the question of education for newly emancipated slaves in Mississippi centered on whether schools should seek to educate blacks as citizens or train them as subsistence laborers. While many whites favored the laborer option, those who had been freed wanted schools established by and for themselves as a means of achieving independence, equality and political empowerment – in essence, full citizenship, says Christopher M. Span, a professor of educational policy studies at the University of Illinois.

The story of the politics and policies of public education for newly freed slaves in post-bellum Mississippi is the subject of Span's new book, "From Cotton Field to Schoolhouse: African American Education in Mississippi, 1862-1875" (The University of North Carolina Press).

Caption: Christopher M. Span, a professor of educational policy studies at Illinois, has written a new book, "From Cotton Field to Schoolhouse: African-American Education in Missisippi, 1862-1875," that explores the question of education for newly emancipated slaves in post-bellum Mississippi. Credit: L. Brian Stauffer. Usage Restrictions: None.

Other books have traced the challenges of education in the South during the Reconstruction Era, but Span's book appears to be the first significant piece of contemporary scholarship to tell the story of the public education of formerly enslaved black Mississippians. "I wanted to know what value knowledge and literacy had in the slave community, and how people who were once enslaved became literate," Span said. "I always knew that African-Americans valued education, even though that runs counter to popular consensus."

"There's an idea today that African-Americans devalue school," he said. "But if you look at the historical record, you would see it's anything but that."

Even though they lived in a country that had sanctioned their slavery and bondage for generations, Span said newly free black Mississippians still had "a fundamental belief in all of the things that makes America so great."

"Freedpeople were willing to risk their own lives to ensure that, if they couldn't have it – whether it's democracy, schooling, equality or land ownership – their children could."

In fact, the children of former slaves in Mississippi were going to school in record numbers. But despite the explosion of educational opportunities for blacks in the state, the type of schools they were attending didn't match with what they thought formal schooling would do for them – namely, become full-fledged citizens of society.

"The schools barely went beyond the elementary grades, and there were very few secondary schooling opportunities for them," Span said. "They may have had an opportunity to get, at best, what we would think of today as an eighth grade education. An overwhelming number of schools educated them to have a rudimentary understanding of literacy and mathematics and numeracy, but not very much beyond that. And there were very few opportunities for them to advance their education once they left school."

Although the newly freed made heroic efforts to get the most out of their educational opportunities, schooling was most often used to redirect their ambitions.

"Should freedpeople be educated as a full-fledged citizen or as a cheap source of labor? – that was the big question during that time," Span said. "You had northerners who would go south convinced that freedpeople needed help in their transition from slave to free. And then you had southern whites, particularly those in Mississippi, who thought that if anything they should be taught how to be laborers, and should continue to labor the land for those who enslaved them prior to the Civil War. And then you had the freedpeople themselves, who really desired to be equals."

"That's really how you began to see how those ideological strands play out in the schools and the type of curriculum and opportunity African-American school children would receive," Span said.

The pedagogy played out the way Mississippi's political economy existed before the Civil War – around the cotton cycle, and around the demand for having a steady, cheap and near-permanent labor force to work the fields.

But that ran contrary to what former slaves wanted in Mississippi, Span said.

"If they envisioned working the lands, it would be lands they owned and possessed themselves, and not for someone else's profit," he said.

Span said Mississippi was an interesting case study for black education in the South because it could be thought of as ground zero for the recalcitrance of ruling-class southern whites during Reconstruction.

"What happened was a significant minority of whites in Mississippi who would go to great lengths to ensure that the state was for whites only," Span said. "And you would see an equal number of African-Americans who wanted to be equals at the table. It wasn't just a call for equality for people who had been enslaved, it really was a call for equality for everybody, regardless of race, class or previous condition of servitude. It was really a call for universal access to education for everyone, including poor, dispossessed whites."

The history from that period of time reflects on the present in that "we should never doubt one's thirst for knowledge and education," Span said.

"Those values haven't been lost in the African-American community. I just think the most sensational acts and aspects of culture seem to have taken precedence over the things that are still at the foundation of ordinary, everyday people who live out their lives and attempt to do the best they can, and want to see something better for their children the next day. The quest for knowledge and for schools and for one to have something better is still there." ###

Contact: Phil Ciciora pciciora@illinois.edu 217-333-2177 University of Illinois at Urbana-Champaign

No race disparities in risk of AIDS and death in HIV patients in Kaiser Permanente system

Surprising trend toward better outcomes for Hispanics

OAKLAND, Calif., July 20, 2009 – Kaiser Permanente researchers found no disparities by race or ethnicity in risk of AIDS and death among HIV-infected patients in a setting of similar access to care. This is despite lower Anti-Retroviral Therapy adherence among Hispanics and African-Americans compared to whites. Researchers also saw a trend toward better outcomes for Hispanics.

The study, which appears online in The Journal of General Internal Medicine, is one of the largest to date to evaluate racial and ethnic differences in clinical outcomes among HIV-infected patients.

Michael J. Silverberg, PhD, MPH, has been a research scientist at the Division of Research (DOR), Kaiser Permanente Northern California since 2004. He received his doctorate in epidemiology from the Johns Hopkins University, Bloomberg School of Public Health in 2001; and his masters in public health in epidemiology from the School of Public Health, University of California, Los Angeles in 1999.

"When it comes to HIV among Kaiser Permanente members, it appears that access to care is the key to eliminating racial and ethnic disparities," said the study's lead author Michael Silverberg, a researcher at the Kaiser Permanente Division of Research. He explained that equal access may likely improve prevention and also encourage early treatment. Kaiser Permanente is the largest private provider of HIV care in the United States. Dr. Silverberg said that certain aspects of Kaiser Permanente care may reduce differences in outcomes among racial/ethnic groups in that most patients have medical insurance coverage and their HIV care is guided by the principles of integrated, chronic condition management and multi-disciplinary HIV specialty care. Another advantage of this setting is Kaiser Permanente's large HIV registry, which has historical data on more than 17,000 patients, including a substantial number of racial/ethnic minorities. This study is among the first to include a large number of Hispanic patients and comprehensively account for other factors -- such as socioeconomic status, HIV disease stage and ART adherence -- that may contribute to racial/ethnic disparities, according to the investigators.

Hispanics had a statistically significant 34 percent survival benefit compared with whites and a 42 percent survival benefit compared with blacks. However, no statistically significant differences for racial/ethnic groups were observed after adjustment for demographics, socioeconomic status and clinical factors.

The study was a retrospective observational cohort study from 1996 to 2005 in Kaiser Permanente, an integrated delivery system with more than 3 million members in Northern California. Researchers studied 3,106 whites, 919 Blacks and 661 Hispanics infected with HIV and looked at differences in ART adherence, new AIDS events and all-cause mortality.

"This observation of reduced mortality in HIV-infected Hispanics is somewhat surprising giving the observed lower adherence rates, reduced immunological responses and lower census-based socioeconomic status compared to whites," said Silverberg. Hispanics had particularly low numbers of cardiovascular and cancer-related deaths. He explained that this phenomenon, also called the Hispanic Paradox, may occur because of differences in diet, genetics and extended family support.

This study is part of Kaiser Permanente's larger ongoing work to end health disparities by providing equitable access and care to its 8.6 million members, by targeting resources to areas in need in communities across the United States, by investing in disparities research, and by implementing strategies that support equity in health nationwide, including universal health coverage. ###

Additional investigators on the study include Wendy Leyden, MPH, Charles P. Quesenberry, Jr., Ph.D., and Michael A. Horberg, MD, MAS, all affiliated with the Kaiser Permanente Division of Research in Oakland, Calif. The research was funded by a Community Benefit grant from Kaiser Permanente Northern California, and a career development award from the National Institute for Allergy and Infectious Diseases, part of the National Institutes of Health.

About the Kaiser Permanente Division of Research (http://www.dor.kaiser.org/)

The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR's 400-plus staff is working on more than 250 epidemiological and health services research projects.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers.

Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go: www.kp.org/newscenter.

Contact: Emily Schwartz eschwartz@golinharris.com 415-274-7926 Golin/Harris International

Why do blacks fare worse with cancer? Access, economics not the whole story

An analysis of clinical trial data from a U-M based group implicates biological factors behind worse outcomes for African-Americans with breast, ovarian, or prostate cancer.

ANN ARBOR, Mich. - An analysis of almost 20,000 patient records from the Southwest Oncology Group’s database of clinical trials finds, for the first time, that African-American breast, ovarian, and prostate cancer patients tend to die earlier than patients of other races even when they get identical medical treatment and other confounding socioeconomic factors are controlled for. The finding points to biological or host genetic factors as the potential source of the survival gap.

Based at U-M, the Southwest Oncology Group conducts cancer clinical trials through a network of more than 500 affiliated institutions.

“When you look at the dialogue about the issue of race and cancer survival that’s gone on over the years,” says the paper’s lead author, Kathy Albain, M.D., a breast and lung cancer specialist at Loyola University’s Cardinal Bernardin Cancer Center,

“it always seems to come down to general conclusions that African-Americans may in part have poorer access to quality treatment, may be diagnosed in later stages, and may not have the same standard of care delivered as Caucasian patients, leading to a disparity in survival.”

The study, published in the Journal of the National Cancer Institute (JNCI), found that when treatment was uniform and differences in tumor prognostic factors, demographics, and socioeconomic status were controlled, there was in fact no statistically significant difference in survival based on race for a number of other cancers — lung, colon, lymphoma, leukemia, and multiple myeloma.

“The good news is that for most common cancers,” Albain says, “if you get good treatment, your survival is the same regardless of race. But this is not the case for breast, ovarian, and prostate cancers.”

Even with good treatment by the same doctors, African-American patients with one of these three cancers faced a significantly higher risk of death than did other patients, ranging from a 21% higher risk for those with prostate cancer to a 61% higher risk for ovarian cancer patients.

The elimination of treatment and socioeconomic factors as the cause of this higher mortality “implicates biology,” says study co-author Dawn L. Hershman, M.D., of the Columbia University College of Physicians and Surgeons.

“There may be differences in genetic factors by race that alter the metabolism of chemotherapy drugs or that make cancers more resistant or more aggressive,” she adds.

Hershman published a smaller study last month that found that, at least with breast cancer, disparities in survival based on race persist even after adjusting for differences in treatment. That study, published in the Journal of Clinical Oncology, analyzed data on 634 breast cancer patients.

“Our study of multiple cancers is distinguished from others that have looked at race-based disparities by its size and by the source of its data,” says Joseph Unger of the Southwest Oncology Group’s Statistical Center, who was statistician and co-author on the new JNCI study.

The study analyzed records from 35 clinical trials — going back as far as 1974 — that had been conducted by the Southwest Oncology Group, an NCI-sponsored cooperative group headquartered at the University of Michigan. Using data from clinical trials, which are already controlled for a range of potentially confounding factors such as differences in diagnosis, treatment, and follow-up, helps throw the remaining factors into sharper relief, according to Frank L. Meyskens, Jr., M.D.

“It’s because of the similar way that people are treated on clinical trials that these differences are even detectable,” he says. Meyskens is associate chair for Cancer Control and Prevention for the Southwest Oncology Group and director of the University of California-Irvine’s Chao Family Comprehensive Cancer Center.

The urgency of addressing the reasons for racial disparities in outcomes — both sociological and biological — is amplified by another recent study in the Journal of Clinical Oncology. It predicts the cancer incidence among minorities will nearly double in the coming decades, increasing 99% by 2030 compared to an expected 31% increase among whites.

And the American Society of Clinical Oncology, the field’s premier professional organization, recently issued a “Disparities in Cancer Care” policy statement that recommends a set of strategies for improving outcomes for minority cancer patients.

“The elimination of socioeconomic and healthcare access disparities must be a priority in the United States,” says Lisa Newman, M.D., director of the Breast Care Center at the University of Michigan Comprehensive Cancer Center. “However, Dr. Albain’s landmark study demonstrates that further investigation of race- or ethnicity-associated differences in primary tumor biology is also important.”

Additional Authors
John Crowley, Ph.D., of the Southwest Oncology Group Statistical Center and Charles A. Coltman, M.D., of the University of Texas Health Science Center

Funding
National Cancer Institute

About the Southwest Oncology Group
Headquartered at the University of Michigan, the Southwest Oncology Group is one of the largest cancer clinical trials cooperative groups in the United States. Funded primarily by the National Cancer Institute, the group designs and conducts clinical trials to advance the science of cancer prevention and treatment and to improve the quality of life for cancer survivors. The almost 5,000 physician-researchers in the Group’s network practice at more than 500 institutions, including 19 of the National Cancer Institute-designated cancer centers. The Group is headquartered at the University of Michigan in Ann Arbor, Mich. (734-998-7140). The Group has an operations office in San Antonio, Texas and a statistical center in Seattle, Wash.

Contact: Frank DeSanto fdesanto@umich.edu 734-998-0114 University of Michigan Health System

Genetic factors implicated in survival gap for breast, ovarian or prostate cancer

NEW YORK – A new finding reveals that African-American patients with breast, ovarian, and prostate cancer tend to die earlier than patients of other races with these cancers, even when they receive identical medical treatment and when socioeconomic factors are controlled for. The finding, an analysis of almost 20,000 patient records from 35 clinical trials, points to biological or genetic factors as the potential source of the survival gap. Dawn Hershman, M.D, M.S., a Columbia University Medical Center oncologist whose research is dedicated to examining racial and ethnic disparities in cancer outcome and in cancer survivorship, was the senior author of the research published online by the Journal of the National Cancer Institute (JNCI).

Dawn Hershman, M.D, M.S

The study analyzed patient records from clinical trials – going back as far as 1974 – conducted by the Southwest Oncology Group (SWOG). The investigators conducted an analysis that controlled for comparable treatment, disparities in tumor prognosis, demographics, and socioeconomic status, and found no statistically significant difference in survival based on race for a number of cancers – including lung, colon, lymphoma, leukemia and multiple myeloma.

However, African-American patients with breast, ovarian, or prostate cancers – the gender specific tumors – were found to face a significantly higher risk of death than did other patients, ranging from 21 percent higher for those with prostate cancer to 61 percent higher for ovarian cancer patients.

The poorer outcome for African-American cancer patients was supported by separate data published last month in the Journal of Clinical Oncology (JCO), which found that disparities in breast cancer survival based on race persisted even after adjusting for differences in treatment. That analysis of data from 634 breast cancer patients who participated in two SWOG-conducted trials was led by first author Dr. Hershman. Findings revealed that African-American women received similar dose intensity and cumulative dose as the Caucasian breast cancer patients, but were more likely to discontinue treatment early or experience treatment delay. In addition, African-American women had lower white blood counts, but no increase in infections complications. While Dr. Hershman and her team adjusted for these specific treatment related factors and other known predictors of outcome, such as age, hormone receptor status, stage, and treatment, African-American women still faced a lower rate of survival.

"The findings from these two studies are important as they suggest a possible role for biologic factors such as genetics, hormonal factors, comorbid conditions and tumor biology in cancer disparities. A better understanding of all the factors that contribute are critical, so that continued progress can be made toward reducing cancer mortality for patients of all races and ethnicities," says Dr. Hershman, assistant professor of medicine and epidemiology at Columbia University Medical Center and co-director of the breast cancer program at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center. "There may be differences in genetic factors by race that alter the metabolism of chemotherapy drugs or that make cancers more resistant or more aggressive. We are now starting research to determine the role of these factors in this disparity."

"When you look at the dialogue about the issue of race and cancer survival that has gone on over the years, it always seems to come down to general conclusions that African-Americans in part have poorer access to quality treatment, may be diagnosed in later stages and may not have the same standard of care delivered as Caucasian patients, leading to a disparity in survival," says Kathy Albain, M.D., of Loyola University's Cardinal Bernardin Cancer Center, lead, and senior author of the JNCI and JCO papers, respectively. "The good news is that for most common cancers, your survival is the same regardless of race. But this is not the case for breast, ovarian, and prostate cancers."

"The need to address the racial disparities in cancer survival outcomes – both sociological and biological – has never been more urgent," says Dr. Hershman. "With the incidence of cancer among minorities predicted to double in the next two decades – while comparable incidence among whites is only expected to rise 31 percent – this is a crucially important public health issue to understand all the factors that alter survival outcomes." ###

The Southwest Oncology Group is one of the largest cancer clinical trials cooperative groups in the United States. Funded primarily by the National Cancer Institute, the group designs and conducts clinical trials to advance the science of cancer prevention and treatment and to improve the quality of life for cancer survivors. The almost 5,000 physician-researchers in the Group's network practice at more than 500 institutions, including 19 of the National Cancer Institute-designated cancer centers. For more information, please visit www.swog.org.

Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions.

Established in 1767, Columbia's College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the most comprehensive medical research enterprise in New York City and state and one of the largest in the United States. Columbia University Medical Center is affiliated with NewYork-Presbyterian Hospital, the nation's largest not-for-profit hospital provider. For more information, please visit www.cumc.columbia.edu.

Contact: Elizabeth Streich eas2125@columbia.edu 212-305-6535 Columbia University Medical Center

Online computer games could encourage children to eat healthy foods

Children who play an online game promoting healthy foods and beverages appear more likely to choose nutritious snacks than those who play a game promoting unhealthy products, according to a report in the July issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Obesity rates among U.S. children and youth have tripled during the past 40 years, according to background information in the article. "One potential contributor to the rise in obesity is media exposure, primarily because television advertising markets high-calorie foods and beverages that have little nutritional value," the authors write. "We know far less about how newer media influence children's food preferences, but Internet use is a very popular activity among youth aged 8 to 18 years. Marketers have taken notice of this online revenue-generating opportunity in which exposure to products costs less than traditional television advertisements and legal restrictions and regulations are virtually non-existent."

Food Guide Pyramid

Advergames—online computer games developed specifically to promote a brand, often featuring logos and characters—are present on many food and beverage Web sites. Tiffany A. Pempek, Ph.D., and Sandra L. Calvert, Ph.D., of Georgetown University, Washington, D.C., conducted a study involving 30 low-income, African American children age 9 to 10 years.

One group played a game, based on Pac-Man, that rewarded them for having their computer character choose bananas, orange juice and other healthy foods and beverages. A second group played a different version of the same game that instead rewarded consumption of soda, candy bars, cookies and bags of potato chips.

These two groups were instructed to select a snack from among options featured in the game after playing, whereas a third, control group selected a snack and beverage before playing the healthy version of the game. The children reported liking both versions of the game and played for an average of 9 minutes and 32 seconds.

Children who played the healthy version before selecting a snack were significantly more likely than those playing the unhealthy version to choose a banana and orange juice instead of soda and potato chips. "With only 10 minutes of exposure, our results revealed that children selected and ate whatever snacks were being marketed by the advergame, healthy or not," the authors write.

The findings suggest that public concerns about online games that market unhealthy foods are justified, the authors note, but also that the technology could be used to promote nutritious foods. "Eating patterns established during childhood affect health throughout the lifespan. Thus, it is important that we find ways to promote a healthy lifestyle for our children from an early age, particularly those who come from low-income neighborhoods where the risk of obesity is greatest," the authors write.

Despite concerns that low-income children do not have Internet access, children in the study reported being online daily or at least several times per week. "Overall, our results suggest that reaching low-income African American children via the Internet is feasible and that the use of advergames is a potential way to alter their eating habits in favor of more nutritious foods," the authors conclude. ###

Editor's Note: This study was supported by a Reflective Engagement in the Public Interest grant from Georgetown University. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Contact: Rachel Pugh rmp47@georgetown.edu 202-687-4328 JAMA and Archives Journals

Why African-Americans are at greater risk of hypertension and kidney disease

Study finds growth factor higher in blacks compared to whites

NEW YORK (July 13, 2009) -- Physician-scientists from NewYork-Presbyterian Hospital/Weill Cornell Medical Center believe that a heightened level a certain growth factor in the blood may explain why blacks have a greater prevalence of hypertension and kidney disease compared to whites. Results from a new study are the first to show that an elevated level of a protein, called transforming growth factor B1 (TGF-B1), raises the risk of hypertension and renal disease in humans.

African Americans constitute about 32 percent of all patients treated for kidney failure in the U.S. and are four times more likely to develop renal disease than whites, according to the National Institutes of Health's U.S. Renal Data System. The researchers' findings, published in this month's issue of the journal Kidney International, may someday lead to the development of a new class of anti-hypertensive and kidney disease drugs that target the TGF-B1 protein.

Manikkam Suthanthiran, M.B.,B.S

"I believe we may now understand a great puzzle: why the black population has a greater prevalence of hypertension and kidney disease," says Dr. Manikkam Suthanthiran, first author of the study and attending physician at NewYork-Presbyterian/Weill Cornell, Stanton Griffis Distinguished Professor of Medicine, Professor of Biochemistry and Professor of Medicine in Surgery at Weill Cornell Medical College.

Results from the study revealed that the TGF-B1 protein was significantly higher in 186 black study participants compared with 147 white participants.

After controlling for race, sex and age, TGF-B1 protein levels were highest in hypertensive blacks (46 ng/ml). Non-hypertensive blacks also had higher levels (42 ng/ml) compared to hypertensive whites (40 ng/ml) and non-hypertensive whites (39 ng/ml), demonstrating that even healthy black patients may be at higher risk for future hypertension and renal disease compared to healthy and hypertensive whites.

"Many black patients may have a disadvantage from the start -- having a higher baseline level of TGF-B1," says Dr. Phyllis August, senior author and attending physician in the division of hypertension at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, Ralph A. Baer Professor of Medical Research and professor of medicine atWeill Cornell Medical College.

While the exact mechanisms of TGF-B1 require further study, the authors believe that in black patients, higher levels of the growth factor are correlated with lower renin activity -- an enzyme that constricts blood vessels and raises blood pressure. High blood pressure is the leading risk factor for end-stage kidney disease.

The authors believe it may be possible that higher levels of TGF-B1 boost retention of sodium salt within the kidneys, leading to higher blood pressure in the kidney and also lower levels of renin.

Greater levels of TGF-B1 in blacks were also positively associated with body mass index (BMI) -- indicator of body fatness compared to height -- and metabolic syndrome -- a group of abnormalities that is associated with atherosclerotic vascular disease and diabetes.

"Future clinical studies must be done so we may fully understand the specific role of TGF-1 in how the kidney handles sodium, blood pressure and kidney disease." Says Dr. August. ###

NewYork-Presbyterian Hospital/Weill Cornell Medical Center

NewYork-Presbyterian Hospital/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and Weill Cornell Medical College, the medical school of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, education, research and community service.

Weill Cornell physician-scientists have been responsible for many medical advances -- including the development of the Pap test for cervical cancer; the synthesis of penicillin; the first successful embryo-biopsy pregnancy and birth in the U.S.; the first clinical trial for gene therapy for Parkinson's disease; the first indication of bone marrow's critical role in tumor growth; and, most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient.

NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, NewYork-Presbyterian Hospital/Westchester Division and NewYork-Presbyterian Hospital/The Allen Pavilion. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report.

Weill Cornell Medical College is the first U.S. medical college to offer a medical degree overseas and maintains a strong global presence in Austria, Brazil, Haiti, Tanzania, Turkey and Qatar. For more information, visit www.nyp.org and www.med.cornell.edu.

Office of Public Affairs, Weill Cornell Medical College, 525 East 68th Street, Box 144. New York, NY 10065. tel: 212.821.0560, fax: 212.821.0576. email: pr@nyp.org

Contact: Limda Kamateh lib9027@med.cornell.edu 212-821-0560 New York- Presbyterian Hospital/Columbia University Medical Center

Teens who believe they'll die young are more likely to engage in risky behavior, University of Minnesota research finds

MINNEAPOLIS / ST. PAUL — University of Minnesota Medical School researcher Iris Borowsky, M.D., Ph.D., and colleagues found that one in seven adolescents believe that it is highly likely that they will die before age 35, and this belief predicted that the adolescents' would engage in risky behaviors.

Borowsky and colleagues analyzed data collected by the National Longitudinal Study of Adolescent Health, a nationally representative sample of more than 20,000 youth in grades 7 through 12 during three separate study years. In the first set of interviews, nearly 15 percent of adolescents predicted they had a 50/50 chance or less of living to age 35. Those who engaged in risky behaviors such as illicit drug use, suicide attempts, fighting, or unsafe sexual activity in the first year were more likely in subsequent years to believe they would die at a young age. Vice versa, those who predicted that they'd die young during the first interview were more likely in later years to begin engaging in these same risky behaviors and have poor health outcomes. Notably, these teens were significantly more likely to be diagnosed with HIV/AIDS just six years later, regardless of their sexual preference.

Four black children in yard Library of Congress Prints and Photographs Division Washington, D.C. 20540 USA

"While conventional wisdom says that teens engage in risky behaviors because they feel invulnerable to harm, this study suggests that in some cases, teens take risks because they overestimate their vulnerability, specifically their risk of dying," Borowsky said. "These youth may take risks because they feel hopeless and figure that not much is at stake."

Nearly 25 percent of youth living in households that receive public assistance and more than 29 percent of American-Indian, 26 percent of African-American, 21 percent of Hispanic, and 15 percent of Asian youth reported believing they would die young—compared to just 10 percent of their Caucasian peers.

"Our findings reinforce the importance of instilling a sense of hope and optimism in youth," Borowsky said. "Strong connections with parents, families, and schools, as well as positive media messages, are likely important factors in developing an optimistic outlook for young people."

She also notes that study findings support physician screening of adolescents for this perceived risk of early death. "This unusually common pessimistic view of the future is a powerful marker for high-risk status and thus deserves attention."

There was no significant relationship between perceived risk of dying before age 35 and actual death from all causes during the six year study period. ###

The study "Health Status and Behavioral Outcomes for Youth Who Anticipate a High Likelihood of Early Death," will be published in the July issue of Pediatrics.

The study was funded by a grant from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies.

Dedicated to excellence, diversity and service, the University of Minnesota Medical School educates the next generation of physicians, advances patient care, and discovers breakthroughs in biomedical research that enhance health in Minnesota and beyond. Its commitment to transform medical education, Rural Physician Associate Program, and success in training Native American physicians are well-known. More than 1,500 Medical School physicians and scientists provide world-class care and carry out nearly $200 million in research, which informs the treatments and care that patients receive. For more information, go to www.med.umn.edu.

Contact: Laura Stroup stro0481@umn.edu 612-624-5680 University of Minnesota

Race origins and health disparites

Today's racial categories evolved from negative assumptions made hundreds of years ago to justify slavery.

Much is often said about the glaring statistics showing that some racial and ethnic minorities face greater risks than whites when it comes to health.

Nina T. Harawa, an Assistant Professor and researcher at Charles Drew University, says today's disparities are linked to many factors, including economics, access to health care and the impact of living in a race conscious society.

But in the recent issue of Ethnicity and Disease, she writes that the concept of race is often misunderstood or inconsistently used when examining differences (or "disparities") in health outcomes.

Caption: Nina T. Harawa, MPH, PhD is a researcher at Charles Drew University. Credit: Charles Drew University. Usage Restrictions: None.

"There is no gold standard for the use of race in health research," said Harawa, who co-wrote the article with Assistant Professor Chandra L. Ford, PhD, of the UCLA School of Public Health. Harawa said there are no readily agreed-upon standards for measuring someone's race, as in the case of gauging someone's age. Nevertheless, race has been used to categorize people since before the country's founding.

Efforts to simplify the complexities of race— including genetic, cultural and socioeconomic variations—have made race-related research "a minefield of often premature and ultimately wrong conclusions," she said.

To understand health disparities in the various population groups, she said, researchers need to understand how today's racial categories evolved from the negative assumptions made hundreds of years ago to justify slavery.

"Advancing our ability to address racial/ethnic disparities in health requires a historically informed understanding of these issues, including how the notion of fixed and distinct races became fixed in the American mind," she wrote.

A report, titled "Health Disparities: A Case for Closing the Gap", recently released by the U.S. Health and Human Services, shows significant disparities:

* 48 percent of all African American adults suffer from a chronic disease compared to 39 percent of the general population.
* Eight percent of White Americans develop diabetes while 15 percent of African Americans, and 14 percent of Hispanics and 18 percent of American Indians develop diabetes.
* African Americans are 15 percent more likely to be obese than Whites.

"Minorities and low income Americans are more likely to be sick and less likely to get the care they need," said Health and Human Services Secretary Kathleen Sebelius after the release of her report earlier this month. However, Dr. Harawa points out there are also exceptions, such as first generation Latino immigrants who have health advantages in many areas despite high levels of poverty and generally low levels of education. Further, Black immigrants frequently experience much better health outcomes than do other Black populations in the US.

Unfortunately, today's race and ethnic categories often fail to make these distinctions. ###

Nina T. Harawa, MPH, PhD, is an epidemiologist. Her research involves both documenting and understanding trends in the distribution of HIV infections and developing effective HIV prevention interventions. She has conducted and led numerous studies examining the prevalence of HIV infection and risky behaviors in a variety of high-risk populations.

"Race Origins and Health Disparities" by Nina Harawa, MPH, PhD, and Chandra Ford, PhD, can be found here in PDF format: Race Origins and Health Disparities

Contact: John L. Mitchell johnmitchell@cdrewu.edu 323-563-4981 Charles Drew University of Medicine and Science

2 studies shed light on racial disparities in cancer survival

Black women diagnosed with breast cancer have a greater chance of dying from the disease than white women, according to a new study published online July 7 in the Journal of the National Cancer Institute.

Age-standardized breast cancer mortality rates in the U.S. have remained higher and declined more slowly among black women. This study was undertaken because the underlying causes of this disparity were unclear.

To explore this, Idan Menashe, Ph.D., of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, in Rockville, Md., and colleagues used the Surveillance, Epidemiology, and End Results program to investigate almost 250,000 women diagnosed with breast cancer from January 1990 through December 2003. Researchers calculated black-to-white ratios of mortality, incidence, hazard of breast cancer death (probability of dying from the disease), and incidence-based mortality, with some analyses stratified by estrogen receptor (ER) status and age.

Idan Menashe

The researchers found a statistically significantly higher hazard of death in black women diagnosed with breast cancer compared to whites, especially in the first few years after diagnosis. Hazard rates of breast cancer death declined substantially for ER-positive tumors and modestly for ER-negative tumors but were persistently higher for blacks than whites.

"These differences in hazard may reflect racial differences in response and access to innovations in breast cancer treatment, as well as other biological and non-biological factors," the authors write. "Hence, greater emphasis should be placed on identifying the reasons for these increased hazards among black women and on developing new therapeutic approaches to address the disparity."

In another study, also published in this issue, Kathy S. Albain, M.D., of Loyola University Medical Center in Maywood, Ill., found that even when African American patients received the same care as all other patients, their survival rates were lower for breast, prostate and ovarian cancers, but were equivalent for all other major cancers.

Albain and colleagues analyzed records of more than 19,000 patients who participated in phase III cancer clinical trials conducted by the Southwest Oncology Group.

"Patients of all races had the same doctors and received the same state-of-the-art treatments," Albain said. "It was a level playing field for everyone. So our findings cast doubt on a widely accepted theory that African Americans' lower survival rates for certain cancers are solely due to such factors as poverty and poor access to quality health care."

Albain's study found no statistically significant association between race and survival for lung cancer, colon cancer, lymphoma, leukemia, or myeloma.

The cancers that did show survival gaps -- breast, prostate and ovarian -- are gender-related and the survival disparity persisted after adjustment for treatment factors, tumor variables, and socioeconomic status. The findings therefore suggest that the survival gap for these cancers is most likely due to an interaction of tumor biologic factors, hormonal environment, and inherited variations genes that control metabolism of drugs, toxins and hormones, Albain said.

In an accompanying editorial, Otis W. Brawley, M.D., of the American Cancer Society, said results of the Albain et al. study provide evidence that racial differences in the U.S. for certain cancers can be attributed to unequal care. He points out that blacks are less likely to have disease detected early and less likely to receive adequate treatment when it is detected.

The Menashe et al. study, according to Brawley, showed clear differences in mortality by race.

"Taken together, the two studies and others do not suggest that blacks have a different kind of breast cancer, but rather that there are multiple kinds of breast cancer and a higher proportion of black breast cancer patients have the worse kinds," the editorialist writes. "No race has a monopoly on the good kind, nor the bad kind of breast cancer, but the prevalences differ." ###

Contacts:

• Menashe et al. study: NCI Press Officers, ncipressofficers@mail.nih.gov, (301)496-6641
• Albain et al. study: Frank DeSanto, fdesanto@med.umich.edu, (734) 998-0114
• Jim Ritter, Loyola University Health System, jritter@lumc.edu, 708-216-2445
• Editorial: David Sampson, David.Sampson@cancer.org, 213.368.8523

Citations:

• Article: Menashe et al. Underlying Causes of the Black – White Racial Disparity in Breast Cancer Mortality: A Population-Based Analysis. J Natl Cancer Inst 2009, 101: 993-1000.
• Article: Albain et al. Racial Disparities in Cancer Survival Among Randomized Clinical Trials of the Southwest Oncology Group. J Natl Cancer Inst 2009, 101: 984-992.
• Editorial: Brawley O. Is Race Really a Negative Prognostic Factor for Cancer? J Natl Cancer Inst 2009, 101: 970-971.

Contact: Steve Graff jncimedia@oxfordjournals.org 301-841-1285. Journal of the National Cancer Institute

Did Bush's court appointments emphasized ideology over diversity?

CORVALLIS, Ore. – The judicial appointments of former president George W. Bush suggests that his motivation for appointing nontraditional judges was driven more by ideology and strategy than concerns for diversity, a new analysis shows.

The examination of all the federal judicial appointments over the two terms of the Bush presidency show that while he did make a number of diverse appointments, especially with Hispanics, overall the federal courts did not gain in the number of minority judges during Bush's tenure.

The analysis appears in an article in the current issue of Judicature and was written by Jennifer Segal Diascro, an assistant professor in the Department of Government at American University, and Rorie Spill Solberg, an associate professor in the Department of Political Science at Oregon State University.

Rorie Spill Solberg, Associate Professor. Contact Information Office: 310 Gilkey Hall Address: Department of Political Science Oregon State University Corvallis, OR 97331-5303. Phone: (541) 737-2811. Fax: (541) 737-2289. Email: Rorie Spill Solberg

"The key is to look at the replacement patterns," said Spill Solberg. "Bush did appoint many minorities, but in order to have a gain in diversity, you have to replace more seats with diverse judges than you started with or else it doesn't equate with a diverse bench." Diascro and Solberg relied on statements from President Bush and members of his administration to determine that ideology played a role in his appointments, and relied on statistical analyses by Carp et al. (published in the same issue of Judicature) that reveal that his appointees to the lower courts were indeed conservative. To assess the relative ideology of Judge Sonia Sotomayor and other women on Obama's short list, Diascro and Solberg utilized the Judicial Common Space scores developed by Lee Epstein and colleagues.

The empirical measurements used to assess ideology are all reliable and valid measures employed by political scientists.

According to the article, when compared with all presidents since Jimmy Carter, Bush maintained the status quo in appointing nontraditional judges to the bench. He appointed more men (78 percent overall) then women (22 percent) and more whites (82 percent) than minorities (18 percent), but as Spill Solberg points out, that pattern was true for Bush's predecessors.

When comparing total appointments, Bush appointed more white females (50) than Carter (32), Ronald Reagan (27) or George H.W. Bush (31), but less than Bill Clinton (83). He appointed more Hispanic females (12) than Clinton (5), but fewer African American females (8 compared to 15) than Clinton, so the overall diversity representation is about the same, or in some cases less than during Clinton's presidency.

In particular, Spill Solberg said, African-American judges did not see a significant increase under the Bush administration. "At the end of eight years in office, African Americans held 8.5 percent of the seats on the court of appeals, an increase of only half a percent from the end of the Clinton administration," the study points out.

Spill Solberg said that like Carter, Reagan and George H.W. Bush, George W. Bush often appointed minorities to seats for political gain or for ideological purposes.

"There is a tendency, and we see this across the political spectrum, to use bench appointments to gain clout with certain voters," she said. "The Bush administration was actively courting the Hispanic vote, so it isn't surprising that he made more appointments of Hispanic judges than African Americans, but it was often also based on judicial philosophy."

In contrast, the study shows that Clinton often stressed diversity and representation over ideology. He often picked moderate and conservative minority and female judges even though they did not necessarily reflect his own political philosophies. Diascro said Democrats have had an easier time appointing a diverse bench that also serves their political and ideological goals as nontraditional candidates tend to come from groups that vote Democratic.

"We suspect that Bush had many Hispanic conservatives from which to choose when filling vacancies on the bench, and he chose to appoint traditional candidates instead," Diascro said. "He cared about diversity, but it was not his first priority."

The study's authors stress that diversity in the federal court system remains important as a way of representing the broad range of experiences of the public that the system is supposed to serve. This is true from a symbolic perspective, lending legitimacy to an otherwise non-democratic branch of government; but it may also be true substantively, said Diascro.

"Personal experiences matter and impact how you view the law," Spill Solberg said. "The experiences of woman may differ from those of a man in the same way that the experiences of a prosecutor may differ from the experiences of other lawyers. It is more complicated as we see with Justice Thomas who brings the experiences of an African American filtered through the lens of a conservative ideology."

Looking ahead, Diascro and Spill Solberg thoughtfully analyze what the judicial legacy of Barack Obama's presidency will be compared to his predecessors. Their conclusion so far is that Obama will emphasize diversity over ideology like Clinton and that his nomination of Judge Sotomayor to the Supreme Court is a demonstration of this.

"His nominations thus far demonstrate his reluctance to appoint ideologues," the authors write. "This is especially true for Judge Sotomayor, who is not the most liberal choice among the female candidates reportedly on the President's short list." ###

Note: For copies of the upcoming issue of Judicature, contact David Richert, editor, Judicature, American Judicature Society (www.ajs.org) 848 Dodge, #468, Evanston, IL 60202 (773) 973-0145 tel; (773) 338-9687 fax; drichert@ajs.org or Laury Lieurance, llieurance@ajs.org, 800-626-4089.

Media contact: Angela Yeager, 541-737-0784; angela.yeager@oregonstate.edu
Sources: Rorie Spill Solberg, 541-737-2811, rorie.spillsolberg@oregonstate.edu; Jennifer Segal Diascro, 202-885-2246, diascro@american.edu

Contact: Rorie Spill Solberg rorie.spillsolberg@oregonstate.edu 541-737-2811 Oregon State University

James Webster Smith and Henry O. Flipper

In 1870, James Webster Smith became the first African-American admitted to the United States Military Academy. Ironically, the academy's first African American cadet came from South Carolina, the first state to secede from the Union and the state with the highest percentage of slaves before the Civil War.

Smith was spared the hazing that was so common among his classmates. He was, rather, completely ostracized by the Corps and, after being turned back (forced to repeat a year) once for academic deficiencies, was dismissed for academic failure after four years at West Point. Smith had broken a critical barrier, however, and in 1873, a Georgian by the name of Henry O. Flipper would benefit.

Flipper was no more popular than Smith, but, in the words of a classmate, “never pushed” the bounds of social equality and so was more easily tolerated. Flipper survived his years at the academy by being as determined as his classmates were prejudiced. In 1877 he became the academy’s first African-American graduate, ranking 50th in a class of 76.

Henry O. Flipper

Cadet Smith. James Webster Smith's cadetship was marred by discrimination from his very first day at West Point, When Smith presented his appointment papers to the commandant, he was waved away and several white cadets threatened to resign. During his four years at West Point he was the center of oontroversy, being tried by court-martial on two occasions, Smith was a pioneer in a hostile environment and suffered dearly as a result. Cadet O;Flipper, on the other hand, was of a more accommodating nature. Flipper, whose interest in West Point extended back several years before his admission, was aware of' Smith's difficulties through newspaper articles of the day. He went to West Point expecting to be mistreated.

He was mentally prepared for the worst, and when the worst did not occur, felt relieved. He took particular care not to repeat conduct which had caused Smith trouble. The greater majority of this avoided conduct dealt with social equality. Flipper was ostracized socially and, in contrast to Smith, did not complain

For this, he was spared the brutality that Smith had suffered. In modern terminology, Cadet Flipper may have been called an Uncle Tom. Yet, if he had not acquiecsed, he probably would have been forced out as was Smith.

SOURCES:

• Postwar Change and Contraction
• Recruiting the Black Cadet

Racial variations in excessive daytime sleepiness depend on measurement

WESTCHESTER, Ill. – According to a research abstract that was presented on Monday, June 8, at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies, white Americans are more likely to report experiencing excessive daytime sleepiness (EDS) more days per month than Asians, African Americans and Hispanics, but African Americans experience more severe EDS.

Results indicate that of all racial groups in the study, white participants were most likely to report feeling excessively sleepy for more than five days a month. Of the total sample, 18.4 percent of white Americans reported EDS, as compared to 12.1 percent of Chinese, 14.3 percent of African Americans and 16.8 percent of Hispanics. The study also found that according to the Epworth Sleepiness Scale (ESS), a questionnaire used to measure the frequency of dozing off during the daytime, African Americans experienced higher rates of EDS than other racial groups. Of the total study, 13 percent of African Americans, 7.9 percent of whites, 7.7 percent of Chinese and 9.3 percent of Hispanics experience daytime sleepiness.

According to lead author of the study Kelly Glaze Baron, PhD, postdoctoral fellow, at the Feinberg School of Medicine at Northwestern University in Chicago, Ill., the largest factor that explained higher EDS in African Americans was differences in physical health, including being more likely to be overweight and having higher rates of chronic diseases such as diabetes and high blood pressure. African Americans also reported to sleeping for less hours than other racial groups, which also contributes to higher rates of sleepiness.

These results have public health implications. "If African Americans are less likely to report feeling overly sleepy but more likely to have pathological sleepiness, they may be less likely to get treatment for sleep disorders," said Baron.

The study included data from 5,173 men and women with an average age of 66.4 years. Of the total sample, 40.7 percent of participants were white, 11.3 percent were Chinese, 26.2 percent were African American and 21.3 percent were Hispanic. Demographic information, health behavior (exercise and smoking), physical health and medications, sleep (self reported sleep time, diagnosis with sleep disturbance symptoms), depression, social support and chronic burden were collected. EDS was measured through self report of frequency (more than five days per month) and the ESS.

Authors of the study claim that feeling overly sleepy takes into account attitudes, values and comparisons to family and friends. Findings of this study indicate that dozing off during the daytime has a stronger relationship to current health status. ###

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you.

Use the following scale to choose the most appropriate number for each situation:

• 0 = no chance of dozing
• 1 = slight chance of dozing
• 2 = moderate chance of dozing
• 3 = high chance of dozing

Situation	Chance Of Dozing
Sitting and reading
Watching TV
Sitting inactive in a public place (e.g. a theater or a meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
In a car, while stopped for a few minutes in traffic

The annual SLEEP meeting brings together an international body of 6,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.

More than 1,300 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.

Abstract Title: Race/Ethnic Variation in Excessive Daytime Sleepiness: The Multi-Ethnic Study of Atherosclerosis. Presentation Date: Monday, June 8. Category: Healthcare Services, Research & Educatio, Abstract ID: 1197

Contact: Kelly Wagner kwagner@aasmnet.org 708-492-0930 American Academy of Sleep Medicine

Black gay men may be at increased HIV risk

Preferences in the race of sexual partners influenced by subtle racism may perpetuate HIV-related health disparities

Black gay men have less choice when it comes to sexual partners than other groups and, as a result, their sexual networks are closely knit. These tightly interconnected networks make the rapid spread of HIV more likely. In a study1) looking at social and sexual mixing between ethnic groups in men who have sex with men, H. Fisher Raymond and Willi McFarland, from the San Francisco Department of Public Health in the US, show that social barriers faced by Black gay men may have a serious impact on their health and well-being. Their findings are published in Springer's journal AIDS and Behavior.

In the US, there is a disproportionate burden of HIV infection in Black Americans, who accounted for nearly half of all HIV/AIDS cases diagnosed in 2006 – four times the national average.

Raymond and McFarland's research looks at the current levels of sexual mixing between racial and ethnic groups of men who have sex with men in San Francisco, and identifies reasons that underlie these sexual mixing patterns.

A total of 1,142 gay men took part in computer-assisted interviews. They were asked about their own ethnicity, the race of their sexual partners in the last six months, their perception of how easy it is to meet sexual partners of different ethnicities, where they meet sexual partners, their view of HIV infection risk and the predominant race of their network of friends.

Black gay men are the least preferred of sexual partners by other races. Black men are perceived to be riskier to have sex with, which can lead to men of other races avoiding Black men as sexual partners. They are also perceived as less welcome in the common social venues of gay men in San Francisco. As a result, Black men are three times more likely to have sexual partners that are also Black, than would be expected by chance alone.

In the authors' view, the combination of attitudes on the part of non-Black gay men, friendships and social networks that are less likely to include Blacks, and the environments found in gay venues serve to separate Black gay men from other groups. Consequently, the sexual networks of Blacks are pushed to be more highly interconnected than other groups, with the potential for a more rapid spread of HIV and a higher sustained prevalence of infection among Black gay men.

The authors conclude: "The racial disparity in HIV observed for more than a decade will not disappear until the challenges posed by a legacy of racism towards Blacks in the US are addressed." ###

The study is available online free of charge on Springer's information platform SpringerLink at dx.doi.org/10.1007/

Reference

1. Raymond HF & McFarland W (2009). Racial mixing and HIV risk among men who have sex with men. AIDS and Behavior; DOI 10.1007/s10461-009-9574-6. The full-text article is available to journalists as a pdf.

Contact: Joan Robinson joan.robinson@springer.com 49-622-148-78130 Springer