News - Research

Partnership Addresses Cancer Disparities in SE Michigan

MEDIA CONTACTS:

Henry Ford Health System
Krista Hopson
313.874.7207
khopson1@hfhs.org

Karmanos
Patricia A. Ellis
313.576.8629; cell, 313.410.3417

Wayne State University
Julie O'Connor
313.577.8845; cell, 734.748.4207
Matt Lockwood
313.577.9098; cell, 248.622.8060

November 12, 2010

Karmanos Cancer Institute, Josephine Ford Cancer Center and Wayne State University
Partner to Address Cancer Disparities in Southeast Michigan

$4 MILLION NATIONAL CANCER INSTITUTE GRANT SPURS SOUTHEAST MICHIGAN PARTNERS AGAINST CANCER

DETROIT - Three institutions dedicated to health, innovative science and quality cancer care announced today the creation of the Southeast Michigan Partners Against Cancer (SEMPAC) to help close the gap on racial disparities related to cancer care in southeast Michigan. SEMPAC is made possible by a more than $4 million, five-year grant from the National Cancer Institute (NCI). It's one of 23 NCI-supported projects in the nation, one of six dedicated to addressing cancer health disparities among African Americans, and the only one focused on older, underserved African Americans from urban areas.

The Barbara Ann Karmanos Cancer Institute, the Josephine Ford Cancer Center at Henry Ford Health System, and Wayne State University School of Medicine (SOM) have committed to work together to improve access to cancer screenings and treatment for older, underserved African Americans throughout the tri-county area.

Co-principal investigators for SEMPAC are Terrance Albrecht, Ph.D., associate center director and professor, Population Sciences, Karmanos Cancer Institute and Wayne State University SOM; and Robert Chapman, M.D., director, Josephine Ford Cancer Center, Henry Ford Health System.

The tri-county urban areas, including residents of Detroit, Inkster, Southfield and Pontiac, account for more than 71 percent of Michigan's African American population and 42 percent of the state's below poverty population (2008 U.S. Census estimate). According to the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute, older African Americans in southeast Michigan have disproportionately higher rates of cancer and have significantly higher mortality rates compared to Caucasians in this region, as well as African Americans nationally.

"We're fortunate to have so many excellent health care facilities in our region, yet there are many in our community who are not aware of the services available to them, may not understand how to access services, and therefore don't have the greatest chance of survival. That is just not acceptable," said Gerold Bepler, M.D., Ph.D., president and CEO, Karmanos Cancer Institute. "As cancer physicians and researchers our focus is to find the best treatment options and cures to save lives. We believe everyone deserves that right. This partnership will magnify our outreach and help save the lives of some of our most vulnerable citizens."

Background

Both Dr. Albrecht and Dr. Chapman have worked extensively to help close the gap on racial disparities in the metropolitan Detroit area. Since May 2005, Dr. Albrecht and her team at Karmanos have engaged several community partners to participate in the Detroit Community Network Program (CNP), receiving a $2 million grant over a five-year period from the NCI, one of 25 such programs nationally. The Detroit CNP served as a community-based participatory education, training and research collaboration to address the disparities of older African Americans in the city of Detroit.

Dr. Chapman from the Josephine Ford Cancer Center (JFCC) realized that even with great programming, older African Americans still tended to be diagnosed with late stage cancer. As he put it," We had a real problem right under our noses and needed to do something about it."

In 2006, Dr. Chapman's program was selected as one of six sites nationally for the Centers for Medicare & Medicaid Services (CMS) Demonstration Project for community-based patient navigation to enroll Medicaid-eligible African American seniors in cancer screening. The program resulted in thousands of older African Americans being screened and they were empowered to see their primary care physician for additional care.

Dr. Albrecht and Dr. Chapman have collaborated informally since 2006, recognizing that their work complements each others rather than competes. With the help of Karmanos' CNP-partner organizations and the JFCC CMS screening program, nearly 5,900 African American seniors were enrolled in cancer screenings, more than any other CMS Demonstration Project nationally. Together, these programs impacted nearly 7,000 African American seniors, providing cancer education, screening, and research efforts.

These efforts now serve as the foundation for the Southeast Michigan Partners Against Cancer, an expansion to serve underserved, older African Americans throughout the tri-county area of southeast Michigan.

"The Southeast Michigan Partners Against Cancer is a powerful community collaboration that will move the needle forward in reducing racial disparities and cancer deaths among underserved African Americans in our area," says Nancy Schlichting, president and chief executive officer of Henry Ford Health System. "This partnership is best poised to not only improve cancer screening and early diagnosis for African Americans, but ensure that patients get the best and most advanced cancer care available."

Southeast Michigan Partners Against Cancer (SEMPAC)

The partnership will collaborate with several community agencies to help carry out practical intervention elements to achieve results. SEMPAC's goal to reduce cancer disparities of older, underserved African Americans within southeast Michigan, improving early detection, diagnosis, treatment and survivorship, will be achieved by:

Enhancing communication skills, behavioral attitude and information exchange with the help of a patient advocate so that older, underserved African Americans have the best chance of high quality intervention for early diagnosis and treatment, especially related to breast, prostate, colorectal and lung cancers
Enhancing the cultural understanding for those who provide treatment to assure that communication is understood between the patient and the health provider
Building on the growing trust of patients and the community to enhance the collection of biospecimens for research and clinical studies, and recruiting and training future researchers and physicians to better work with and for the community to reduce cancer disparities

Valerie M. Parisi, M.D., M.P.H., M.B.A., dean of the Wayne State University School of Medicine, said, "This project not only reaches out to one of our city¹s underserved populations, it will also provide valuable information for our next generation of physicians, which will allow them to better understand the causes of racial disparities and to eventually eliminate them."

SEMPAC and the ongoing commitment of its partners will work to create tri-county regional partnerships that will build awareness and educate residents of cancer treatment options, provide tools to make better health care decisions related to cancer care, and increase understanding of the importance of biospecimens to advance cancer research.

Dr. Chapman added, "Detroit and southeast Michigan's ability to create partnerships, even with scarce resources, on behalf of its citizens will be the envy of the nation."

"No one institution alone can restore the health of our community and region," said Dr. Albrecht. "We need everyone's support: health institutions, community leaders, businesses and government, community and religious groups. We can and will make an impact on cancer disparities. We invite everyone to help us in this unprecedented effort to save lives."

About the Barbara Ann Karmanos Cancer Institute
Located in mid-town Detroit, Michigan, the Barbara Ann Karmanos Cancer Institute is one of 40 National Cancer Institute-designated comprehensive cancer centers in the United States. Caring for nearly 6,000 new patients annually on a budget of $216 million, conducting more than 700 cancer-specific scientific investigation programs and clinical trials, Karmanos is among the nation's best cancer centers. Through the commitment of 1,000 staff, including nearly 300 physicians and researchers on faculty at the Wayne State University School of Medicine, and supported by thousands of volunteer and financial donors, Karmanos strives to prevent, detect and eradicate all forms of cancer. Its long-term partnership with the WSU School of Medicine enhances the collaboration of critical research and academics related to cancer care. Karmanos is southeastern Michigan's most preferred hospital for cancer care according to annual surveys conducted by the National Research Corporation. Gerold Bepler, M.D., Ph.D., is the Institute's president and chief executive officer. For more information call 1-800-KARMANOS or go to www.karmanos.org.

About the Josephine Ford Cancer Center
The Josephine Ford Cancer Center, part of the Henry Ford Health System, is an international leader in the research, detection and treatment of cancer, featuring advanced gene therapy, the region's most experienced radiosurgery program, and the world's most experienced robotic surgery program. Each year, more than 5,000 patients are diagnosed and treated at JFCC. Its multidisciplinary approach to cancer management incorporates a team of professionals from 20 specialties to fight a variety of cancers. And its expertise has touched lives beyond Michigan and the Midwest, with patients traveling from as far as Antarctica to receive cancer treatment from Henry Ford physicians. Physicians from around the world also have traveled to JFCC to be trained in cancer diagnostic and treatment methods pioneered at Henry Ford. JFCC is led by Robert Chapman, M.D., a highly respected lung cancer specialist. To learn more about JFCC, visit HenryFord.com.

About Wayne State University School of Medicine
Founded in 1868, the Wayne State University School of Medicine is the largest single-campus medical school in the nation with more than 1,000 medical students. In addition to undergraduate medical education, the school offers master¹s degree, Ph.D. and M.D.-Ph.D. programs in 14 areas of basic science to about 400 students annually. For more information, visit home.med.wayne.edu.

Study: Race May Influence Uterine Cancer Recurrence

MEDIA CONTACT:
Krista Hopson
khopson1@hfhs.org

Nov. 1, 2010

Study: Race May Influence Uterine Cancer Recurrence, Despite Treatment

DETROIT - African Americans are more likely to have a recurrence of uterine cancer despite undergoing a total hysterectomy or a hysterectomy followed by radiation therapy, according to researchers at Henry Ford Hospital in Detroit.

"The African American patients in our study had similar surgeries and radiation therapy as the Caucasian patients in the study. So access to care certainly wasn't a factor in race being identified as a negative predictor for outcome," says lead author Mohamed Elshaikh, M.D., senior staff physician in the Department of Radiation Oncology at Henry Ford Hospital.

"At this point, our next step is to take a closer look at the underlying molecular biology of these cancer cells to help identify a cause for race being a negative predictor for uterine cancer outcome."

This retrospective study - one of the largest of its kind with 750 uterine cancer patients - will be presented Nov. 2 at the 52nd annual American Society for Radiation Oncology (ASTRO) meeting in San Diego. Results also are now online in the November issue of the International Journal of Radiation Oncology.

"What's notable about our study is that we were able to confirm on a larger scale the known prognostic factors in uterine cancer, and also identify African American race as a negative predictor for outcome despite adequate surgery and radiation treatment," says Dr. Elshaikh.

Endometrial cancers mainly arise from the tissue lining the uterus. They are the most common gynecologic cancers in the United States, with more than 43,000 women diagnosed and an estimated 7,950 dying from the disease in 2010, according to the National Cancer Institute. The most common type, endometrioid adenocarcinoma, typically occurs within a few decades of menopause.

While a total hysterectomy (surgical removal of the uterus) is the most common therapeutic approach, treating physicians often differ on the next step for treatment after surgery. Some recommend radiation treatment, while others recommend no further treatment.

For the Henry Ford study, Dr. Elshaikh and his colleagues identified 750 patients with stage I or II uterine cancer who underwent a total hysterectomy between 1987 and 2008. The median age was 64, and 30 percent of the study group were African American.

The study was limited to those patients who underwent surgery and received no further treatment, and those who underwent surgery and had radiation therapy.

Recurrence-free survival for the study group at 5 years and 10 years was 94 percent and 93 percent, respectively.

The median time for uterine cancer recurrence among the group was 1.2 years.

The site of recurrence was primarily vaginal (74 percent) for those who did not receive radiation therapy.

The study also found that higher tumor grade and cancer stage, along with age (older than 65), were risk factors for uterine cancer returning after treatment. African American patients in the study also were more likely to have their cancer return than Caucasian patients.

Along with Dr. Elshaikh, Henry Ford study co-authors are Benjamin Laser, M.D.; Jared Robbins, M.D.; Michael Haley, D.O.; and Adnan Munkarah, M.D.

Research support: Henry Ford Department of Radiation Oncology.

Targeted Radiation Therapy May Slow Pancreatic Cancer Progression

MEDIA CONTACT
Krista Hopson
khopson1@hfhs.org

Oct. 29, 2010

Stereotactic Radiotherapy Slows Pancreatic Cancer Progression for Inoperable Patients

DETROIT - For pancreatic cancer patients unable to undergo surgery - the only known cure for this form of cancer - a highly targeted cancer radiation therapy may help slow cancer progression and lessen disease symptoms, according to researchers at Henry Ford Hospital in Detroit.

Called stereotactic body radiotherapy (SBRT), the study found it was able to delay pancreatic cancer progression locally, on average, by almost six months.

While, on average, the patients in the study lived about 10 months, one-third lived more than a year.
Without any treatment - surgery, chemotherapy or radiation therapy - most pancreatic cancer patients only live about four to six months.

"Our research establishes stereotactic body radiotherapy as a reasonable treatment option for patients who can't have surgery or aren't candidates for chemotherapy," says study lead author Michael Haley, D.O., a resident in the Department of Radiation Oncology at Henry Ford Hospital.

"While it's not a curative therapy, it does seem to allow some progression-free survival benefit with minimal side-effects for patients. Ultimately, we're able to provide a treatment to patients who don't have any other options other than a traditionally prolonged course of radiation, which may not be as effective, and possibly has more side effects."

Says study co-author Munther Ajlouni, M.D., senior staff physician in the Department of Radiation Oncology at Henry Ford: "SBRT allows us to effectively treat patients who are unable to tolerate prolonged, aggressive therapy within a short period of time and with minimal toxicity."

The study will be presented Nov. 2 during the poster session at the 52nd annual American Society for Radiation Oncology (ASTRO) meeting in San Diego. Results also are online in the November issue of the International Journal of Radiation Oncology.

According to the National Cancer Institute, in 2010 there will be an estimated 43,140 new cases of pancreatic cancer, and approximately 36,800 will die from the disease. Risk factors for pancreatic cancer include smoking, diabetes, obesity, family history of the disease and pancreatitis. Most people diagnosed with the disease are older than 65.

Surgery is the only known cure for resectable pancreatic cancer, where the cancer is localized to the pancreas and hasn't spread.

It is estimated that only 20 percent of pancreatic cancer patients have their tumors present with localized disease amendable to surgical removal. A select number of those patients, however, are not candidates for surgery due to having other co-morbidities such as heart disease. This leaves only chemotherapy and radiation, or a combination of the two, available for treatment.

SBRT is a method of giving radiation that can be highly targeted to the tumor, sparing the normal tissue around it. It also provides a higher dose of radiation, meaning patients have fewer treatments. It is most commonly used for lung cancer patients, but has been used for liver and brain tumors as well.

The Henry Ford study looked to determine if SBRT was a viable option to slow cancer progression in medically inoperable patients with potentially resectable pancreatic cancer.

The study included 12 medically inoperable patients with stage I or II pancreatic cancer. The median patient age was 83. Patients received between three and seven SBRT treatments.

Among those patients whose cancer spread, SBRT was able to slow cancer progression for five to six months. Once the patients' cancer started to progress, they lived about 2.5 months. "This may indicate that this slowing of the progression of disease accomplished by SBRT may modestly increase overall life span," notes Dr. Haley.

A few patients reported some minor side effects from treatment, including fatigue, loss of appetite and weakness. Two patients developed gastric ulcers, but both recovered.

Study funding: Henry Ford Hospital

Along with Dr. Haley and Dr. Ajlouni, Henry Ford study co-authors are Samuel Ryu, M.D.; Indrin Chetty, Ph.D.; Teamour Nurushev, Ph.D.; and Benjamin Movsas, M.D.

Henry Ford Physicist Awarded for Radiation Therapy Research

MEDIA CONTACT
Krista Hopson
khopson1@hfhs.org

Thursday, Oct. 28, 2010

Henry Ford Physicist Awarded for Cancer Radiation Therapy Research

DETROIT - Henry Ford Hospital physicist Lei Ren, Ph.D., is among an elite group to be awarded for basic science research in radiation oncology at the 52nd annual American Society for Radiology Oncology (ASTRO) meeting in San Diego.

Dr. Ren received ASTRO's Basic Science Abstract Award for his research to reduce radiation therapy imaging dose and improve treatment accuracy by optimizing use of cone beam computed tomography (CT) - an imaging technique that helps guide radiation therapy to better target tumors. Dr. Ren is a senior associate physicist in the Department of Radiation Oncology at Henry Ford.

The Basic Science Abstract Award is designed to encourage participation in the ASTRO Annual Meeting by basic scientists with an accepted abstract in either biology or physics.

In addition to receiving the award at the annual meeting, Dr. Ren will be presenting his research Oct. 31 during a special session to honor ASTRO's "Best in Physics" papers.

Unlike traditional CT which uses a multi-slice scanner to image the body, cone beam CT is smaller and its cone shaped x-ray beam reduces radiation dosage and time needed for scanning.

Cone beam CT has been widely used as an imaging guidance tool for radiation therapy of different types of cancer to improve the treatment accuracy.

Led by Dr. Ren, the Henry Ford research team worked to further enhance the performance of cone beam CT for image-guided radiation therapy. Currently, cone beam CT is being used at Henry Ford for radiation therapy to localize tumors more accurately and provide more precise treatment.

Using the prior knowledge about patient anatomy, the researchers were able to reconstruct high quality cone beam CT images with as low as 1/8 of the conventional cone beam CT imaging dose. The study revealed that the image quality was improved as the scan angle increased.

"Using this method, we can potentially reduce the imaging dosage in radiation therapy by eightfold," says Dr. Ren.

"Our study results will be especially useful for lung cancer patients, where breathing motion during treatment can impact treatment accuracy. It will allow us to track the tumor during motion to improve treatment, evaluate dose delivered in each treatment fraction and adjust treatment for better coverage of the tumor."

Overall, the new technique to use cone beam CT will help reduce the imaging dose and improve treatment outcomes for cancer patients undergoing radiation therapy, he says.

In addition to Dr. Ren, the study co-authors from Henry Ford Department of Radiation Oncology are Jian-Yue Jin, Ph.D.; Benjamin Movsas, M.D., and Indrin J. Chetty, Ph.D.

Study funding: Henry Ford Hospital

EDITOR'S NOTE: Dr. Ren is a resident of Madison Heights, Mich.
A high-resolution image of Dr. Ren is available on Flickr at http://www.flickr.com/photos/hfwbh/5123472148/.

Study ID’s 5 Risk Factors for Late-Stage Head & Neck Cancer

MEDIA CONTACT
Krista Hopson
khopson1@hfhs.org

Oct. 28, 2010

Study ID's 5 Risk Factors for Late-Stage Head & Neck Cancer

DETROIT - Developing a molecular fingerprint for head and neck cancer tumors could help improve diagnosis and treatment for this deadly and often-times disfiguring form of cancer, according to researchers at Henry Ford Hospital in Detroit.

Their new study has taken the first step toward doing that by identifying five risk factors for late-stage head and neck cancer - two genes, tumor grade, and vascular invasion and location of the tumor.

Race, however, was not an independent predictor for late-stage disease, contrary to other research findings. In fact, 88 percent of the African American patients in the study had some form of insurance.

"We were able to look at the many intertwined variables influencing health and disease to understand the contribution of tumor genetic alterations, pathologic, and patient factors in head and neck cancer diagnosis and outcomes," explains study lead author Maria J. Worsham, Ph.D., director of research in the Department of Otolaryngology at Henry Ford Hospital.

"We then used comprehensive modeling that accounted for the different variables, which no other study has done. By taking into account so many different factors, we were able to look at what rises to the top as a predictor for late-stage disease."

These initial findings, part of a five-year National Institutes of Health-funded study, will be presented by Dr. Worsham Oct. 28 during a panel discussion at the American Head and Neck Society 2010 Research Workshop in Arlington, VA. She also is chairing the session.

In 2009, there were an estimated 35,720 new cases of head and neck squamous cell carcinoma (HNSCC) and approximately 7,600 deaths.

Despite considerable efforts in medical diagnosis and treatment, the five-year survival rate for HNSCC has not significantly improved. In addition, African Americans tend to have later-stage cancer and poorer survival than Caucasians.

In an effort to learn more about what factors influence HNSCC stage and survival, Dr. Worsham and her colleagues went beyond looking at patient demographic and tumor pathology factors, like so many previous studies have done.

Instead, they took a more holistic approach with a very diverse patient population to better understand how a wide array of risk factors - the killer aspects of the tumor and patient factors like smoking and alcohol use - interact with disease stage, diagnosis and survival.

The study looked 689 Henry Ford patients from 1986 to 2005 with a primary diagnosis of HNSCC. Most notably, 42 percent of the study group was African American.

It examined 23 non-genetic patient risk factors including race, martial status and family history, and also looked at patients' tumor biology by examining tumor DNA for 113 genes from 2,166 tissue blocks.

All of these factors were placed into statistical models to determine both individual (univariate) and commingling independent variables (multivariate) that influence late-stage disease.

While previous studies have suggested African Americans are more likely to have late-stage disease with worse survival, the Henry Ford multivariate analysis found that race is not a risk factor for late-stage HNSCC.

Dr. Worsham suspects her team's study was not able to support that for two reasons: Unlike previous studies, their study included a large African American population and of those patients, 88 percent had some form of insurance.

"A large proportion of our study group, both African American and Caucasian, had insurance," notes Dr. Worsham. "This finding really shows the impact of insurance and access to care on overall patient care. Removing barriers does make a difference."

The study also found that the site of the tumor in head and neck cancer had an impact on disease stage. Patients with cancer in the oropharynx, which lies behind the oral cavity, and those with cancer in the hypopharynx, located at the bottom part of the pharynx, are more likely to have late-stage disease.

Poor tumor grade also placed patient at greater risk for late-stage disease. The researchers also identified two genes that signaled late-stage HNSCC.

"Ultimately, the more clues we have about what influences head and neck cancer diagnosis and survival, the more we can put toward understanding how to treat patients and counteracting its effects through designing special drugs," says Dr. Worsham.

Study co-authors from Henry Ford: Mei Lu, Ph.D.; Josena K. Stephen M.D.; Kang Mei Chen, M.D.; Shaleta Havard, BS; Veena Shah, M.D.; and Vanessa P. Schweitzer, M.D.

Research Support: NIH grant R01DE15990.

Unique Henry Ford Case Offers Cautionary Cotton Swab Tale

MEDIA CONTACT:
Krista Hopson
Krista.Hopson@hfhs.org

Unique Henry Ford Case Offers Cautionary Cotton Swab Tale

DETROIT - The old saying, "never put anything smaller than your elbow in your ear," couldn't be truer for a patient who experienced vertigo and severe hearing loss after a cotton swab perforated her eardrum and damaged her inner ear.

But what makes this patient's case unique is that otolaryngologists at Henry Ford Hospital in Detroit were not only able to alleviate her vertigo with surgery, but restore her hearing - an extremely rare occurrence.

"This case is rare because the goal of surgery is not to recover hearing, but to improve vertigo," says case report lead author Ilaaf Darrat, M.D., an otolaryngologist in the Department of Otolaryngology-Head and Neck Surgery at Henry Ford Hospital.

"Once your hearing is gone, it's usually gone. This case report shows that even in a dead ear, there is hope for hearing recovery."

The report will be presented Sept. 28 as part of the poster session at the American Academy of Otolaryngology-Head & Neck Surgery Foundation Annual Meeting in Boston.

Beyond showcasing an unusual case, the Henry Ford report also offers a cautionary tale to those who use cotton swabs to clean their ears: Never put anything in your ears without your doctor's recommendation.

"Using cotton swabs in your ears can cause serious hearing issues," says co-author Michael D. Seidman, M.D., F.A.C.S., director of the Division of Otologic/Neurotolgic Surgery in the Department of Otolaryngology-Head and Neck Surgery at Henry Ford.

"Several times a year, I see patients who have put a hole in their eardrum or damaged the inner ear because they've pushed a cotton swab too far into the ear canal. This type of an injury can deafen a patient, cause vertigo, shatter the eardrum, or even paralyze the face."

Since the ear canal is curved - and a cotton swab is not - Dr. Seidman also sees a lot of patients who cut or scratch their external ear canal using cotton swabs.

The 59-year-old female patient who is the focus of the Henry Ford case report was using a cotton swab to clean her left ear when a sudden movement caused the swab to be pushed deep into the inner ear.

About five hours later, the patient began experiencing symptoms of vertigo, a disturbance of balance and equilibrium, and went to the emergency department at Henry Ford Hospital.

The patient had perforated the ear drum, creating an abnormal opening between the air-filled middle ear and the fluid-filled inner ear called a perilymphatic fistula. A hearing test also revealed deafness in the affected ear, which typically cannot be restored.

The patient was initially treated with bed rest, commonly prescribed for vertigo caused by a perilymphatic fistula. But when this method did not alleviate the patient's vertigo after several days, Dr. Seidman and Dr. Darrat decided to perform surgery to repair the crack in her inner ear organ and the hole in the eardrum.

Nearly six weeks later, the patient's vertigo was gone. But what surprised the physicians was that the hearing test revealed that the patient had recovered most of her hearing.

"It's nearly miraculous that her hearing returned from a non-functioning ear," notes Dr. Seidman. "We were able to perform surgery early and stop the leak of inner ear fluid. We believe that helped to restore the patient's hearing."

Study funding: Henry Ford Hospital

New Look at Racial Disparities in Head, Neck Cancer

MEDIA CONTACT:
Krista Hopson
khopson1@hfhs.org

Genetic Ancestry: A New Look at Racial Disparities in Head & Neck Cancer

DETROIT - Head and neck cancer outcomes associated with race may be more closely linked to social and behavioral factors than biological differences, especially for African Americans, according to a new Henry Ford Hospital study.

Researchers found that while those who self-reported to be African American are at greater risk for late stage cancer, there was no correlation between patients' genetic ancestry and cancer stage or survival.

In fact, the study shows only 5 percent of patients who self-reported to be African American had more than 95 percent West African ancestry.

"We believe this is the first piece of evidence using genetic race to take a closer look at outcomes with respect to stage - early or late - and survival in patients with head and neck cancer," says study lead author Maria J. Worsham, Ph.D., director of research in the Department of Otolaryngology at Henry Ford Hospital.

"We know that African Americans are disproportionately diagnosed with late-stage cancer and have worse outcomes than Caucasians. While there has been no real consensus on the causes for this difference, it is possible access to care, stage at diagnosis and insurance status may be factoring into the equation."

Study results will be presented Sept. 26 at the American Academy of Otolaryngology-Head & Neck Surgery Foundation Annual Meeting in Boston.

In 2009, there were an estimated 35,720 new cases of head and neck squamous cell carcinoma (HNSCC) and approximately 7,600 deaths. Smoking and alcohol use are the primary risk factors for this type of cancer.

African Americans are more likely to be diagnosed with late-stage HNSCC and have worse survival than Caucasians. It's unknown whether significant biological rather than socioeconomic differences account for some of the disparities in outcomes.

Since self-reported race doesn't always offer a complete picture of a person's biologic make-up, Dr. Worsham and her colleagues set out to compare patients' self-reported race with their genetic ancestry to determine if there is any connection to head and neck cancer outcomes.

The study included 358 patients; 37 percent were African American.

The researchers examined diagnosis (late versus early stage) and overall survival for African Americans with HNSCC based on self-reported race and genetic West African ancestry.

During the past decade, many groups have developed and characterized sets of single nucleotide polymorphism markers that can distinguish genetic ancestry among major ethnic groups such as Asian and West African, called ancestry information makers (AIMs).

For the study, genetic ancestry was based on a panel of 100 AIMs to estimate genetic background.

"Using these genetic markers gives you additional statistical power. It's no longer two just categories - Black or White; it becomes a continuous variable. Race is not equal to genetics. Genetic markers don't define specific races," says Dr. Worsham.

Ultimately, the study found no correlation between West African genetic ancestry and HNSCC outcomes. Only self-reported race was associated with head and neck cancer stage.

Only 5 percent of self-reported African Americans had more than 95 percent West African ancestry, with 27 percent having less than 60 percent West African ancestry. By comparison, 48 percent who self-reported as Caucasian had more than 95 percent European American ancestry.

"The goal of using genetic ancestry is not to point out differences, but relatedness," says Dr. Worsham. "Health disparities within certain racial groups are very real, and what we're trying to achieve in terms of learning more about head and neck cancer is a leveling of the playing field to better diagnose and treat patients."

Study co-authors: George Divine, Ph.D., Henry Ford Biostatistics and Research Epidemiology; and Rick A. Kittles, Ph.D., University of Illinois School of Public Health.

Research Support: NIH grant R01DE15990 and a grant from the Health Disparities Research Collaborative, Henry Ford Health System.

Henry Ford Begins IBD Research Study

Aug. 2, 2010
CONTACT: Maria Seyrig
mseyrig1@hfhs.org
(313) 874-4039

Henry Ford Health System Begins Inflammatory Bowel Disease Clinical Research Study

DETROIT - Henry Ford Health System is seeking individuals to participate in a clinical research study to identify genetic factors contributing to inflammatory bowel disease, specifically in those with an Ashkenazi Jewish or Chaldean background.

Henry Ford is the only clinical center in the country to participate in the clinical research study and is seeking 400 individuals.

The purpose of study is to identify genes that are involved in inflammatory bowel disease in Ashkenazi Jews and Chaldeans because, historically, both groups came from the same area and have remained as distinct groups for thousands of years, says Ann Silverman, M.D., director of Henry Ford Health System's Inflammatory Bowel Disease Center.

"Because the Detroit area is the largest home for Chaldeans outside the Middle East, and also has a large Jewish community, Henry Ford is afforded a unique opportunity to study the genetic links to IBD in these groups," says Dr. Silverman.

It is estimated that between one and two million Americans suffer from inflammatory bowel disease (IBD), which is comprised of two chronic diseases that cause chronic and relapsing intestinal inflammation: Crohn's disease and ulcerative colitis. IBD is thought to be immune-related, with symptoms such as abdominal cramps, bloody diarrhea, fever, and weight loss. The causes of IBD are unknown but there are known racial and ethnic differences in the risk for developing IBD.

"We know that inflammatory bowel disease is inherited, particularly Crohn's disease, therefore if we can identify the specific genes involved in specific populations, we can tailor drug therapy to treat these patients," says Dr. Silverman, M.D. "Right now, the drugs used to treat the disease cause a general suppression of the immune system. It's like using a chain saw to cut a twig. If we can identify patients by ethnic characteristics, we can identify and treat the disease in a more effective and efficient manner."

The study is sponsored by Yale University, Crohn's and Colitis Foundation of America, and the National Institutes of Digestive Diseases and Kidney (NIDDK).

Patients may be eligible if they meet the following criteria:

Have been diagnosed (by a physician) with Crohn's disease or ulcerative colitis
Are age 18 or older

Participation in the study will require one visit to Henry Ford's IBD Clinic, where participants will be asked to donate a small sample of blood and/or, if determined by the physician, a sample of saliva. Participants will be asked to share their medical histories and may also be asked if their family members would be willing to participate in the study.

All eligible participants will receive final assessment by the study coordinator or study physician.

Patients who agree to volunteer and meet the eligibility requirements will need to complete a patient questionnaire and sign a consent form.

To participate in the Henry Ford study, contact: Nicole Samuels at (248) 344-2358 or QSAMUEL1@hfhs.org.

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New Breast Cancer Screening Clinical Research Study

MEDIA CONTACT:
Krista Hopson
khopson1@hfhs.org

PATIENT CONTACT:
Melaney Aschenbrenner
MASCHEN1@hfhs.org
(248) 325-3856

Henry Ford Begins New Breast Cancer Screening Clinical Research Study

WEST BLOOMFIELD - A clinical research study is underway at Henry Ford
West Bloomfield Hospital to determine if 3D Automated Breast Ultrasound technology coupled with routine screening mammograms can more accurately detect breast cancer in women with dense breast tissue than a mammogram alone.

Henry Ford Hospital is the only clinical center in Michigan to participate in SOMO•INSIGHT, a national, multi-center clinical research study.

Using the somo•v^TM 3D Automated Breast Ultrasound (ABUS) radiologists can create a 3D image of both breasts in about six minutes, allowing for real-time results. The device has previously only been used as a diagnostic tool for breast cancer patients.

"While mammography remains the gold standard, visualization of cancers in dense breast tissue with mammography can be limited in some women," says Henry Ford radiologist Biren A. Shah, M.D., who is leading the study.

Unlike mammography, the ABUS imaging technology is less affected by a woman's breast density because it uses sound waves to create 3D pictures of breast tissue. The ultrasound device is U.S. Food and Drug Administration cleared for use by doctors in combination with mammography for diagnostic use only.

Women who have more fibrous connective and glandular tissue than fatty tissue
have more breast density. Regardless of size or shape, dense breasts have a 4-6 times higher increased risk of breast cancer than women whose breasts are classified as fatty. Complicating matters, dense breast tissue often makes it difficult to detect tumors using standard screening tools such as mammography.

This two-year study is part of the SOMO INSIGHT study, a national multi-center clinical research study evaluating the use of somo-v ABUS as a screening tool for women with dense breast tissue in combination with digital mammography.

The study is sponsored by U-Systems, Inc., developer of the somov ABUS.

Eligible participants
Henry Ford is looking to recruit patients to participate in this study.

You may be eligible to participate if you meet the following criteria. All eligibility will receive final assessment by the study coordinator or study doctor.

Female, age 25 or older
Asymptomatic for breast cancer
Not currently pregnant or breast feeding
Not planning on becoming pregnant in the following 18 months
No breast surgeries or interventional procedures in the past year
No history of a cancer diagnosis and/or treatment in the past year
> 50 percent breast density on your next digital mammogram at Henry Ford Hospital.
Willing to return to Henry Ford Hospital for follow up evaluations if needed and for a routine screening mammogram in 12 months

Patients who are at high risk due to family history or proven genetic mutation are not precluded from participation in this study. Cancer survivors, women with breast implants and those who have known benign abnormalities such as cysts or fibroadenoma, may also participate if they meet the inclusion criteria.

Eligible participants who are enrolled in this clinical research study will receive a 3D ABUS exam at no cost to them or their insurance.

Patients who agree to volunteer and meet the eligibility requirements will need to complete a patient questionnaire and sign a consent form.

In addition to Dr. Shah, sub-investigators at Henry Ford are: Riffat Ahmed, M.D.; Sami Fakir, M.D.; Diane Holland, M.D.; Ewa Lacka, M.D.; and Sabala Mandava, M.D.

To learn more about this study: www.somoinsightstudy.org

To participate in the Henry Ford study, contact: Melaney Aschenbrenner at (248) 325-3856 or MASCHEN1@hfhs.org.

Study: Getting Patients to Take Their Asthma Meds

MEDIA CONTACT:
Krista Hopson
khopson1@hfhs.org

Study: Getting Patients to Take Their Asthma Meds

DETROIT - Armed with the right information, physicians can play a stronger role in ensuring asthma patients don't waver in taking drugs proven to prevent asthma attacks, according to researchers at Henry Ford Hospital in Detroit.

The study finds patients are more likely to routinely take inhaled corticosteroids (ICS) for asthma control when physicians kept close watch over their medication use and reviewed detailed electronic prescription information, including how often patients fill their prescriptions and the estimated number of days each prescription would last.

"Better inhaled corticosteroid adherence means better overall asthma control, and less hospitalization," says lead study author L. Keoki Williams, M.D., MPH, Center for Health Services Research and Department of Internal Medicine at Henry Ford Hospital.

"Unfortunately, overall patient adherence to ICS medication is poor, accounting for an estimated 60 percent of asthma hospitalizations. So it's important, as we move forward with health care reform, to look for more effective ways to make sure patients stay with their prescription regimens."

The study - the first large-scale, controlled study to test the effectiveness of routinely providing patient medication adherence information to physicians - appears online in the Journal of Allergy and Clinical Immunology (www.jacionline.org).

ICS, taken using an inhaler, help prevent and reduce airway swelling, and are considered the cornerstone therapy for controlling persistent asthma in patients, says Dr. Williams.

The Henry Ford scientific team set out to design an intervention that would provide physicians information on the most recent national asthma guidelines and methods for discussing medication non-adherence with their patients.

The intervention also offered physicians electronic access to patients' medication prescription fill/refill information via Henry Ford's ePrescribing application, part of its electronic medical record system that allows physicians to prescribe and review patient medications electronically.

The study enrolled 193 Henry Ford primary care physicians (family medicine, internal medicine, pediatrics). Eighty-eight were randomly assigned to the intervention group, while 105 were assigned to the control group (no intervention).

Physicians in the intervention group used ePrescribing to track medication fills and refills. The application also offered physicians the option to take it one step further: To review detailed adherence data, including estimates of the proportion of time that the patients took their medication.

Medication adherence for both groups was measured by using both electronic prescriptions and pharmacy claims for medication fills and refills.

Researchers found ICS adherence to be very similar among patients in the intervention group and those in the control group (21.3 percent vs. 23.3 percent).

But adherence was significantly higher in the intervention group (35 percent) when the patient's physician elected to view detailed adherence information via the ePrescribing application.

Few physicians, however, in the intervention group accessed the detailed adherence information. "Going forward, one of the obstacles will be finding time for physicians to review and discuss this information with patients in their typically busy practices," says Dr. Williams.

Funding: Henry Ford Hospital; National Heart, Lung and Blood Institute; National Institute of Allergy and Infectious Diseases; National Institute of Diabetes and Digestive and Kidney Disease; National Institutes of Health; and Strategic Program for Asthma Research of the American Asthma Association.