University of California San Francisco
Helen Diller Family Comprehensive Cancer Center

Cancer Control

R.Hiatt Program Leader Robert A. Hiatt, MD, PhD
T.Nguyen Program Co-Leader Tung T. Nguyen, MD

The Cancer Control Program includes 28 members from 13 academic departments in the UCSF Schools of Medicine, Nursing, and Pharmacy. The overarching goal of the Program is to focus on social, behavioral, communications, and health policy research integrating it with cancer research across the spectrum from the basic to the population sciences.

The Cancer Control Program conducts research under three themes:

  • Theme 1: Social and Behavioral Factors in Cancer
  • Theme 2: Cancer Health Disparities
  • Theme 3: Health Outcomes and Comparative Effectiveness

The goal of the Cancer Control Program is to foster and sustain an integrated transdisciplinary environment for dedicated multi-level and multi-ethnic cancer control research. The scope includes studies of mechanisms of cancer etiology at a population level, interventions from prevention through survivorship, and the application of health services research methods to understanding health care system issues. The Program’s research encompasses biological, behavioral, and social factors, as well as healthcare delivery services affecting cancer prevention and cancer care, particularly for people living in the geographic catchment area of Northern California served by the HDFCCC. This diverse population includes large proportions of African Americans, Asian Americans, and Latinos as well as those who have limited English proficiency or are otherwise disadvantaged in receiving high quality prevention and clinical care for cancer.

Our aims are to understand the social and behavioral determinants of cancer, to develop and implement interventions to reduce inequities in cancer outcomes across race/ethnic, socioeconomic and other categories, and to develop the most effective policies and health care approaches to the delivery of new knowledge, diagnostics and therapies.

The Program also adds value to the Helen Diller Family Comprehensive Cancer Center (Center) by bringing expertise in diverse populations to clinical programs; by connecting community members and clinicians; by fostering the intra-programmatic and inter-programmatic collaborations that advance knowledge in cancer disparities; and by conducting significant and successful training programs to increase the number of researchers who are under-represented minorities.

> Social and Behavioral Factors in Cancer
> Cancer Health Disparities
> Health Outcomes and Comparative Effectiveness

Theme 1: Social and Behavioral Factors in Cancer

Dr. Bob Hiatt led a transdisciplinary team with Drs. Allan Balmain, Mark Moasser, Zena Werb, and Dejana Braithwaite that created a multi-level model of postmenopausal breast cancer incidence (Hiatt et al., Cancer Epidemiol Biomarkers Prev, 2014). Drs. Hiatt, Braithwaite, Karla Kerlikowske, and Hope Rugo found that more comorbidities were associated with increased risk of other-cause mortality but not breast cancer-specific mortality among African American and white women with breast cancer (Izano et al., J Geriatr Oncol, 2014). Drs. Hiatt and Braithwaite also reported that current smoking at the time of breast cancer diagnosis was associated with increased risk of breast-cancer-specific and other-cause mortality.(Izano et al., Cancer Med, 2015) Dr. Braithwaite and the Breast Cancer Surveillance Consortium studied nearly 300,000 mammograms and found that with increasing age, the cancer detection rate of digital screening mammography improved, and the proportion of women with invasive ductal carcinoma rose (Henderson et al., Cancer, 2014).

In 2014, Dr. Joel Palefsky’s team initiated a 15-site, 8-year, NCI-funded randomized controlled trial (RCT) to determine whether treatment of anal high-grade squamous intraepithelial lesions (HSIL) reduces the incidence of anal cancer. A large biobank will be collected to allow for discovery of biomarkers of progression to invasive cancer and new pathways of pathogenesis that may lead to new therapeutic approaches. Dr. Palefsky also studied the natural history of anal HPV in a prospective study in HIV-infected men who have sex with men (MSM) and found that there was high ongoing risk of acquisition of anal HPV infection (Hernandez et al., AIDS, 2014).

Dr. Elad Ziv and Dr. Adam Olshen of the Computational Biology Core obtained an R01 to perform exome sequencing to identify and characterize new breast cancer susceptibility genes in Hispanic women. Drs. Ziv and Blake Aftab obtained an R01 in collaboration with the Mayo Clinic to perform additional clinical/epidemiological characterization of a novel GWAS hit for survival in multiple myeloma patients. Drs. Fejerman, Ziv, and Perez-Stable identified a novel polymorphism originating from Native American ancestry and strongly associated with protection against breast cancer in Hispanic populations (Fejerman et al., Nat Commun, 2014). Dr. Ziv described the high rates of BRCA1 and BRCA2 mutations among Mexican breast cancer patients with no family history of breast cancer, supporting a strategy of screening for recurrent mutations in all women with breast cancer, not just those with a family history (Torres-Mejia et al., Cancer Epidemiol Biomarkers Prev, 2015).

Theme 2: Cancer Health Disparities

Dr. Perez-Stable conducted a population-based study of smoking behaviors among Latinos disaggregated by national origins and found that prevalence of smoking was highest among Puerto Ricans and Cubans and among Latinos who were more acculturated or born in the US (Kaplan et al., Am J Prev Med, 2014). He also found that there have been significant increases in light and intermittent smoking behaviors among Mexicans, Puerto Ricans, and Cubans in the US (Blanco et al., Am J Public Health, 2014). Drs. Anna Napoles and Perez-Stable found that physician encouragement was more strongly associated with colorectal cancer (CRC) screening among Latino patients than providing risk information and addressing concerns about screening. (Napoles et al., J Gen Intern Med, 2014).

Drs. Nguyen and Janice Tsoh described the health effects associated with obesity using the new lower body mass index (BMI) cut-off point for obesity recommended by the American Diabetes Association for Asian Americans (Jih et al., Prev Med, 2014). Dr. Nguyen wrote the lead editorial discussing the link between research and policy for a Cancer Epidemiology, Biomarkers & Prevention special issue on Asian Americans (Nguyen, Cancer Epidemiol Biomarkers Prev, 2014). Dr. Nguyen published a paper assessing the use of hepatitis B preventive services in medically-underserved Asian patients (Mukhtar et al., J Gen Intern Med, 2015). With Drs. Nguyen and Nancy Burke, Dr. Tsoh received an R01 grant and a California Tobacco-Related Disease Research Program (TRDRP) grant to conduct two large-scaled RCTs of a family-focused social network smoking cessation intervention with Chinese- and Vietnamese-Americans.

Dr. Burke obtained an R01 to study health literacy systems in the safety net setting. She continued her collaborations with the Fred Hutchinson Comprehensive Cancer Center and the UCLA Comprehensive Cancer Center to study HPV vaccine uptake among Cambodian American girls (Taylor et al., J Community Health, 2014). Drs. Burke and Galen Joseph published the results of a pilot study of a patient navigator intervention to increase access to breast cancer research opportunities for multilingual low-income breast cancer patients (Nickell et al., J Cancer Educ, 2014). Dr. Joseph obtained funding from the California Breast Cancer Program to conduct a RCT of this intervention.

Together with Drs. Perez-Stable, Rena Pasick, Leah Karliner, and Karla Kerlikowske, Dr. Lawrence Kaplan showed that a tablet-based breast cancer risk assessment program significantly increased discussions between diverse patient and providers about family history, breast cancer risk, and genetic counseling/testing, particularly among high-risk groups (Kaplan et al., Cancer Epidemiol Biomarkers Prev, 2014).

Drs. Kaplan, Napoles, and Karliner studied 349 Latinas and 396 white women with ductal carcinoma in situ of the breast and found that language barriers resulted in less satisfaction with the decision-making process and more treatment regret (Lopez et al., Patient Educ Couns, 2014). Dr. Rena Pasick received the 2014 Woman of the Year Award from Women Executives in Health Care for research and mentoring in disparities research.

Theme 3: Health Outcomes and Comparative Effectiveness

Dr. Kathryn Phillips completed (with Drs. Katie Kelley, Trevor Bivona, Laura Van ‘t Veer, and Boris Bastian) a HDFCCC Transdisciplinary Translational Team Science Award to delineate how next-generation tumor sequencing is being moved into clinical care. Working with researchers, policy makers, and private healthcare payers on precision oncology, she found four key areas of need (new model of personalized medicine in cancer care, challenges in genomic translational research, defining the value of genomic medicine, and paying for it) (Trosman et al., J Natl Compr Canc Netw, 2015). Dr. Phillips obtained R01 supplemental funding to work on reimbursement for genomic sequencing.

Dr. Barbara Koenig’s NCI-funded R01 on offering genomic “incidental findings” to the family members of deceased participants in an NCI-supported pancreatic cancer discovery biobank deals with the ethical challenges of precision medicine. Her team, including a genetic epidemiologist and a legal scholar, has edited a special issue of the Journal of Law, Medicine, and Ethics, to be published in 2015, that will report policy recommendations by a national ethics working group. Dr. Koenig received HDFCCC funding to examine “risk-based” genetic screening for breast cancer in collaboration with Drs. Laura Esserman and van ’t Veer. This project is the centerpiece of Dr. Koenig’s NHGRI-funded Kaiser/ UCSF “Center of Excellence in ELSI (ethical, legal, social implications) Research.” Dr. Koenig is also working with Dr. Dan Dohan and others to develop biobanking research across all UC campuses, including the Cancer Centers (Garrett et al., Clin Transl Sci, 2015).

Drs. George Sawaya and Megan Huchko, along with Dr. Hiatt, obtained an NCI-funded R01 to study a community-driven cervical cancer prevention model in Kenya. Dr. Sawaya published an editorial in Obstetrics & Gynecology describing an approach to guideline development that incorporates the patient experience in the screening process and the economic implications of various screening strategies (Sawaya et al., Obstet Gynecol, 2015). Dr. Sarkar obtained an R01 with Dr. Pasick to study using mixed methods online social media and social networks as to promote cervical cancer screening. Dr. Sarkar also wrote a JAMA editorial on the opportunities and challenges facing the design of electronic patient portals to incorporate usage by caregivers of chronically ill patients (Sarkar et al., JAMA, 2014).

Drs. Paul Volberding and Jeff Martin have created a strong infrastructure for AIDS-related malignancy research in Uganda. Dr. Martin has an NCI-funded U54 that supports the Uganda-UCSF Consortium on Prevention and Early Detection of HIV-associated Cancer. Dr. Martin found that the rate of tobacco use among Ugandan HIV-positive patients who are initiating antiretroviral therapy was twice as high as the general population (Kruse et al., AIDS Behav, 2014). Drs. Hiatt and Katherine van Loon are carrying out an NCI-funded case-control study of esophageal cancer in Tanzania.

Drs. Christine Miaskowski, Michelle Melisko, and Dunn found that there are three distinct subgroups of patients at different risk for having symptoms with chemotherapy. Those at highest risk were significantly younger and more likely to be female and nonwhite, and had lower levels of social support, lower socioeconomic status, poorer functional status, and a higher level of comorbidity (Miaskowski et al., Cancer, 2014). Dr. Jeff Belkora continues to disseminate his decision support program for cancer patients called the Patient Support Corps, including nationally through the Cancer Support Community and internationally to Edinburgh, Scotland (Hacking et al., Psychooncology, 2014).