By Sara Bondell - October 18, 2021
At Moffitt Cancer Center, the mission is simple: to contribute to the prevention and cure of cancer. Many read that statement and focus on cure — the research to discover new lifesaving treatments. But prevention is also heavily steeped in Moffitt’s core, and the cancer center has embraced the growing field of cancer prevention research.
“The field focuses on identifying ways to prevent cancer from happening and to detect cancers early so they are more readily responsive to treatments or surgeries, which can translate into decreased morbidity or mortality,” said Peter Kanetsky, Ph.D., department chair of Cancer Epidemiology. “We can also think about prevention of unwanted long-term outcomes or adverse short-term outcomes involving therapies for cancer.”
In addition to studying ways things like diet and obesity affect cancer risk, prevention researchers also practice precision prevention. Just as precision medicine involves finding the most individualized treatment for a patient, precision prevention identifies which individual is more likely to respond to a certain therapy, such as immunotherapy. If researchers can target which treatments will be successful for certain patients in advance, they can prevent them from experiencing adverse side effects or wasting time undergoing treatments that don’t work.
Cancer prevention research is a requirement for all comprehensive cancer centers, and Moffitt has worked over the past two decades to create robust programs that focus on cancer prevention and control. That includes recruiting some of the best and brightest, who not only focus on prevention and wellness research, but also want to dig deeper into health disparities.
“With any research program it is important to seek out and hire the top-ranking individuals of the next generation of researchers,” said Kanetsky. “It allows for continuity of progress where these outstanding young investigators can be mentored by established individuals, and we can watch them grow on the trajectory of gaining experience, obtaining grants and leading a team.”
Two of the new cancer epidemiology research recruits, Jessica Islam, PhD, MPH, and Tiffany Carson, PhD, MPH, have already hit the ground running at Moffitt.
For Islam, her passion for describing racial and ethnic disparities is rooted in her upbringing. Her mother is from Ecuador and her father is from Bangladesh.
“It’s a personal mission to focus on diverse and minoritized communities in the United States to be able to speak to the disadvantages they experience when accessing care, specifically in the context of cancer,” said Islam.
It is common for minority populations to be underrepresented in clinical trials and research studies, and Islam wants to bridge that gap. “As an epidemiologist one of the important aspects of my research is to be able to do the work, to be able to describe these differences acknowledging small sample sizes to move the research agenda forward,” she said. “I frequently receive feedback that the numbers are too small to focus on X or Y population, but if we continue to use this framework, academics like myself will consistently face roadblocks towards their ultimate career goals. Even if the numbers are small, let’s still publish it; maybe someone in the future can conduct a meta-analysis on the topic.”
Islam’s health disparities research began in her father’s home country of Bangladesh in 2012, where she participated in the first population-based study looking at the burden and risk factors of human papillomavirus (HPV) and cervical cancer. Results gave her the first glimpse into the importance of prevention methods in areas where there are few treatment resources once cervical cancer is detected at later stages.
“Prevention is very important because if we can prevent the cancer before it starts or fully develops or even identify cancer at early stages, we are not only alleviating the burden associated with invasive treatment the patient will face, but we are also alleviating the burden to the health care system and improving the cost effectiveness of our efforts as a whole,” said Islam.
Now at Moffitt, Islam is focusing on leveraging large existing registry studies for the state of Florida, including the Florida Cancer Registry and University of Florida’s OneFlorida Data Trust. She is interested in addressing the disproportionate burden of cancer among people living with HIV in the state through characterizing cancer screening uptake and determinants, specifically of lung, colorectal and breast cancers.
“Florida is an important place to do this work given the high burden in the state; in fact, three of the 10 U.S. cities with the highest incidence of HIV are in the state of Florida,” said Islam. “I am very grateful to be at Moffitt with the ample resources and support from leadership to focus on this vulnerable population.”
Using the Florida Cancer Registry, Islam aims to estimate the burden of HPV-associated cervical cancer by county and other geographic metrics, specifically after correction for hysterectomy. This is important because racial/ethnic minority women are more likely to undergo hysterectomy, so the true disparities experienced by minoritized communities in the state of Florida will be described. Islam’s study will address these gaps.
Islam also plans to continue her work in cervical cancer prevention in collaboration with Anna Giuliano, Ph.D., specifically through her large project looking at cervical cancer prevention among women living with HIV in three different Latin American countries. Doing research on cancer prevention for patients with HIV, both domestically and internationally, is on Islam’s list of passion projects.
“It is important to me that we can identify and prevent an infection at an early stage,” said Islam, “to be able to prevent this long-standing morbidity that comes with many consequences that have a high mortality rate, such as cervical cancer.”
Islam’s other areas of research also include disparities in access to palliative care and treatment, implementation science of cancer screening programs, cancer survivorship during the COVID-19 pandemic and outcomes among adults living with chronic conditions who endorse cannabis use.
Decoding the Gut Microbiome
Tiffany Carson found her sweet spot between epidemiology and behavioral sciences. During her postdoctoral training, she became interested in interventions on lifestyle factors, such as diet, stress and physical activity, that can lower obesity-associated diseases, particularly in ethnic minorities in the U.S.
When she was training at the University of Alabama at Birmingham, she helped develop a research program that found ways to modify behavioral weight loss interventions that are culturally appropriate for diverse populations. Carson is focused on the impact of dietary patterns on the gut microbiome, which has been linked to both risk for obesity and multiple cancers, specifically in the colorectal cancer space.
“When I started to learn more about the opportunity to bring my research program to Moffitt I was particularly excited because I know that there’s a lot of interest and energy in growing this area of focus here and building teams to think about how diet and weight management are important parts of the wellness spectrum and how these behaviors can be related to cancer prevention,” said Carson.
While there has been a decent amount of gut microbiome research in the larger medical community, more needs to be done to understand its role in cancer development, especially when it comes to understanding racial differences that may contribute to disparities and obesity.
“In my mind, the next step is thinking about how we can attempt to manipulate or modify the gut microbiome to make a more health-promoting environment and lower risk for chronic diseases and poor outcomes,” said Carson.
Carson recently received funding from the National Cancer Institute to conduct a study to look at the impact of different dietary patterns across different racial groups of men and women, targeting different bacterial groups that we know are associated with colorectal cancer. That study should launch this year.
She hopes her research can help shed some light on the importance of identifying cultural differences when making health care recommendations, especially when it comes to dictating behavioral changes like diet and exercise. “We can’t make guidelines based off some prototype that may not be generalized or applicable to the entire population,” she said. “We have to consider culture, environment, resources and beliefs.”
Carson says it’s also important to identify individuals’ goals related to quality of life and even treatment, which are also commonly dictated by cultural backgrounds.
‘An Ounce of Prevention Is Worth a Pound of Cure’
Both Carson and Islam know their research will be successful thanks to the environment created at Moffitt that fosters collaboration. They are thankful their studies not only have institutional buy-in, but also a framework in place that is already working to tackle health disparities, such as the newly established Office of Community Outreach, Engagement and Equity.
"All cancer centers are required to include community outreach and engagement in their research agenda, but some take it more seriously than others. And the dedication Moffitt has shown through different initiatives and just the supportive words I have already heard from leadership, the future is looking pretty bright in my opinion."- Dr. Jessica Islam
“All cancer centers are required to include community outreach and engagement in their research agenda, but some take it more seriously than others,” said Islam. “And the dedication Moffitt has shown through different initiatives and just the supportive words I have already heard from leadership, the future is looking pretty bright in my opinion.”
By furthering prevention research — especially in diverse populations — the researchers can continue to make behavioral recommendations tailored to individuals and move the needle forward in the space.
“There is an old public health quote that says an ounce of prevention is worth a pound of cure,” said Carson. “In many cases, it’s much easier to prevent things from happening than to think of how to treat something once it happens. The difficulty with that is it’s hard to get people to think of how day-to-day decisions contribute to risk level and to convince people that prevention work is as important, if not more important, than the treatment work.”
But with increased funding and Moffitt’s dedication to this important research, these young investigators are hoping to be part of a paradigm shift that ultimately reduces the cancer burden in the U.S.