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Mayo Clinic Medical Science Blog – an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic.

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Mon, Jul 9 6:00am · Offering underserved groups access to cutting-edge research

For many patients, clinical trials offer a chance to benefit from promising new treatments that are not available in the doctor’s office. Yet not all people have the same access to these opportunities.

Groups such as racial minorities, older individuals, and those with low income are less likely than others to participate in clinical trials, according to government agencies. For example, the U.S. Food and Drug Administration reports that racial and ethnic minority groups represent only 19 percent of drug trial participants in the U.S., yet these groups make up approximately 36 percent of the population, according to the 2010 U.S. Census. This lack of diversity also means that research findings ­may not apply to the general population.

Mayo Clinic has many efforts underway to address this gap. The Mayo Clinic Office of Health Disparities Research works to increase participation of underserved minorities in clinical trials, in collaboration with organizations that serve these groups.

One such effort is Mayo Clinic’s 13-year collaboration with the Volunteers in Medicine clinic in Jacksonville, Florida. Part of a national organization, the Jacksonville clinic serves working, low-income, uninsured patients and is staffed by two employees and 230 volunteer medical professionals. Approximately half of the clinic’s patients are African-American and 10 percent are Hispanic.

“Mayo Clinic is trying to reach out to the underserved populations in the communities that we serve, to make sure that they have access to cutting-edge research that would benefit them,” says oncologist and researcher Gerardo Colón-Otero, M.D., who leads Mayo’s research collaboration with Volunteers in Medicine and is office chair of the Office of Health Disparities Research at Mayo’s Florida campus.

Providing the continuum of breast cancer care and research

Dr. Colón-Otero and other Mayo staff volunteers have provided breast cancer care to more than 250 patients at Volunteers in Medicine. Patients who have abnormal mammograms or breast exams receive further consultation and treatment at Mayo Clinic — including therapies available through clinical trials.

“If you look at the population that is represented in the publications from cancer research trials, they’re almost invariably white patients, with an underrepresentation of African-American and Hispanic patients. Therefore, whether or not the results are applicable in those populations is a total unknown,” says Dr.  Colón-Otero. “It is a commitment of the Office of Health Disparities Research and the Mayo Clinic Cancer Center to make sure that all segments of the population in the area we serve have access to the advances in cancer research.”

Measuring prevalence of a genetic marker for cancer

Volunteer nurse practitioner Mary Lesperance and Mayo Clinic oncologist Gerardo Colón-Otero, M.D., collaborate at Volunteers in Medicine clinic.

In collaboration with Volunteers in Medicine and several faith communities in Jacksonville, Dr. Colón-Otero and his team conducted one of the first studies of genetic markers for follicular lymphoma in African Americans.

Follicular lymphoma is one of the most common lymphomas in the U.S. Eighty-five percent  of patients with follicular lymphoma have a chromosomal abnormality called a translocation that occurs between chromosomes 14 and 18. This abnormality, denoted as t(14;18), can be detected in a blood test. Recent data shows that when detected at high levels, t(14;18) is associated with a 23 times higher risk of lymphoma than in the general population.

“The problem with follicular lymphoma is that many times it’s a very indolent disease, so not everybody who is diagnosed needs treatment right away,” says Dr. Colón-Otero. “This suggests these kinds of tests may potentially be used for screening, to increase awareness of a much higher risk and the need for closer monitoring. It also brings the prospect of evaluating preventive measures aimed at eliminating the t(14;18) before the development of follicular lymphoma.”

The researchers collected blood samples from participants using Mayo Clinic’s mobile research unit, then analyzed the samples in comparison with Mayo Clinic Biobank specimens collected from white patients.

Based on previous studies on the prevalence of follicular lymphoma, the researchers were expecting the genetic marker to be less common in African Americans. To their surprise, it was equally common in the two groups. Their findings were published in 2017 in Annals of Hematology.

In addition to helping identify biomarkers, this data adds to the body of knowledge about follicular lymphoma, providing clues into factors that may cause the disease.

Closing an awareness gap on the HPV vaccine

In a study published in 2016 in Cancer Medicine, a team led by Mayo Clinic researcher Carmen Radecki Breitkopf, Ph.D., surveyed Volunteers in Medicine patients about their knowledge of the human papillomavirus (HPV) and the HPV vaccine. HPV vaccination is an effective way to prevent cervical and other cancers.

The researchers found low awareness — only half of those surveyed had heard of HPV, compared with 64 percent of the general population. Likewise, just 32 percent of survey participants had heard of the HPV vaccine, compared with 63 percent of the population at large.

These findings signal a critical need to promote HPV awareness and vaccination. “Our findings have implications for reducing cancer disparities through outreach efforts in underserved communities that focus on prevention,” says Dr. Radecki Breitkopf, who is a member of the Office of Health Disparities Research Steering Committee. “In collaboration with Volunteers in Medicine, our team is working toward ensuring awareness of a vaccine to protect against HPV-associated cancers and facilitating access to HPV vaccination.”

The Office of Health Disparities Research team is currently piloting an HPV vaccination program at the clinic.

Mayo research collaborators with Volunteers in Medicine

Mayo Clinic staff involved in health disparities research with Volunteers in Medicine include:

More information

Learn more about health disparities research at Mayo Clinic.

Jul 11, 2017 · Is it fair to expect students from minority backgrounds to ‘give back’ in their careers?

Imagine you are a medical student and you’ve received financial aid based on your status as a member of a minority or low-income group. Should you be expected to pursue a career serving in underserved communities?

Not if society wants to tackle social inequity, according to a recent commentary published in the AMA Journal of Ethics by researchers from the University of Delaware, the University of Toronto and Mayo Clinic.

“Society flourishes when we allow its most talented to be free of our biasing expectations of where and how they should use their talents,” says co-author Jon Tilburt, M.D., a health disparities researcher and professor of biomedical ethics and medicine at Mayo Clinic. “We should challenge the status quo that assumes that talented minority clinicians owe more to society than any other clinicians.”

In the commentary, the authors untangle the expectations on a second-year medical student of Native and Latin American ethnicity. She is enthusiastic about applying for a competitive specialty program, but her fellow students assume she will put to use her cultural and language skills as a primary care provider in underserved communities.

Many assumptions — both conscious and unconscious — are at play, related to gender, race, and even the student’s receipt of a scholarship and federal financial aid, say the authors. And these assumptions create barriers at the personal, institutional and societal levels for students who are members of underrepresented minority groups.

“We shouldn’t hold minority clinicians to a higher standard of service just because they grew up in deprivation. We should address the fundamental drivers of inequities in society and then give individuals the latitude to use their gifts like any other student,” says Dr. Tilburt.

“Conversely, we should revisit and potentially bolster the citizenship expectations of all professionals to serve the common good regardless of their background and ethnicity, so that it becomes a common norm that serving in less economically or geographically desirable locations becomes part of the healthcare culture of services.”

Read the article: “Why It’s Unjust to Expect Location-Specific Language-Specific or Population-Specific Service From Students With Underrepresented Minority or Low-Income Backgrounds.”

Authors are:

  • Barret Michael, Ph.D., University of Delaware
  • Maria Athina (Tina) Martimianakis, Ph.D., University of Toronto
  • Jon Tilburt, M.D., Mayo Clinic
  • Frederic Hafferty, Ph.D., Mayo Clinic

Learn about health disparities research at Mayo Clinic.

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