In addition to his national VA role, Kelley is Chief of Hematology and Oncology and a thoracic medical oncologist with the Durham VA Health Care System. (As a professor of in the Department of Medicine, Division of Medical Oncology, Kelley focuses on lung cancer research.) Both Menendez and Kelley are DCI members.
Angeles Alvarez Secord, MD, MSc, President-Elect of the Society of Gynecologic Oncology, was asked by Clancy how to expand clinical research opportunities in the general population of cancer patients to ensure that studies are more diverse — representative of the general population. According to the FDA, only 8% of participants in clinical trials that led to FDA approvals were Black, which Secord says, “limits the ability to assess underlying prognostic factors and explore underlying tumor biology.”
“We need to ensure that that we move into an era where there's more trust with our patients and that they're willing to participate in trials,” Secord said in response to Clancy’s question. “Dr. Nadine Barrett at Duke has developed a program that's called “Just Ask.” We can't assume, have our bias, that patients won't participate in clinical trials. We need to ask all our patients about participation, and we need to offer ways that we can reduce barriers to participation in trials like offering to cover transportation and childcare costs.”
According to the latest figures from the VHA, about 43% of women who use VHA Services belong to a racial or ethnic minority group. The majority within this group are Black/African American women (30%), which is not surprising given that, according to the U.S. Department of Labor, Black women Vets account for 19% of all women Vets in the U.S.
Clancy noted while there’s been some narrowing of the racial gap and mortality trends for most cancers, the opposite is true for uterine cancers. She asked Secord to shed light on why studies show that Black women in particular are more likely to be diagnosed with uterine cancer (aggressive non-endometrioid carcinoma) than White women and are twice as likely to die from the disease.
“When we talk about Black patients being at higher risk, this is something that we're incredibly concerned about. We’ve identified that Black women tend to have these cancers that are more aggressive — the serous histology, cancers that have P53 mutations, and the copy-number-high tumors — that portend a worse prognosis,” said Secord, while noting that the reasons behind the disparity are likely multi-factorial.
Uterine cancer is the fourth most common cancer and the sixth leading cause of cancer mortality among women overall. The average annual increase in mortality from uterine cancer is greater than from any other malignancy in either males or females. Three of Secord's colleagues at Duke — Moss, Laura Havrilesky, MD, MHSc, and Evan Myers, MD, MPH — were awarded $1.2 million in funding from the National Cancer Institute Cancer Intervention and Surveillance Modeling Network last year to study ways to reduce uterine cancer mortality through primary prevention, screening, and treatment approaches.
"Despite the availability of diagnostic tests to detect uterine cancer, screening is not routine and evidence-based recommendations for screening and prevention are lacking," says Havrilesky, adding that "for those women diagnosed with uterine cancer, optimal treatment strategies and precision therapeutics are often uncertain."
