Chapter 07: Research on Cancer in Diversity Populations

Chapter 07: Research on Cancer in Diversity Populations

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Description

Dr. Jones outlines several studies he has conducted on cancer patients from different ethic/racial groups. He begins with the Tri-Ethnic study conducted in partnership with the Kellogg's Company. He talks about setting up the partnership then talks about the Healthy Friends initiative that focused on screening Hispanic women for cancer and his involvement in trials in South American focused on secondary and tertiary prevention of breast cancer via diet. He showed that intervention with diet had the same effect as treatment with Tamoxifen. Dr. Jones then returns to the Tri-Ethnic Study and explains nuances in the results: the media reported that the results showed no influence of diet on cancer rates, but he explains how this was an extreme oversimplification and, in fact, they discovered very positive results.

Identifier

JonesLA_02_20140116_C07

Publication Date

1-16-2014

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Interview Subject's Story - The Researcher; The Researcher; Overview; Definitions, Explanations, Translations; Institutional Politics; Controversy

Transcript

Tacey Ann Rosolowski, PhD:

I had a list of some of the other studies that you worked on, and maybe some of these are more important than others, so just let me now which you'd like to really focus on. There was the Healthy Friends Study and-

Lovell A. Jones, PhD:

[unclear].

Tacey Ann Rosolowski, PhD:

Okay. Yeah. I mean, is that something you'd like to talk about?

Lovell A. Jones, PhD:

Well, [unclear] was our first major-actually, before that was the Tri-Ethnic Study. That study came about because of a relationship with Kellogg's Company. In starting the Biennial Symposium on Minorities, and Medically Underserved, & Cancer, Kellogg's happened to be one of the initial supporters. In fact, they supported the award we created, the LaSalle D. Leffall Cancer Prevention Control Award. As you may or may not know, Dr. Leffall was the first African American president of the American Cancer Society and actually led to the focus by the American Cancer Society on cancer in African Americans and then cancer in other populations during his presidency, right before and during his presidency. So at the time, there had not been any award in his name, so I thought that as part of this first biennial, biennials have awards, and so it would be nice to have an award in his name, have a banquet and that sort of thing. After the third biennial in '91, I had breakfast with the leadership of Kellogg's. They didn't fly in for the first meeting, nor did they fly in for the second meeting, I think. They had a representative. But by the third meeting, the senior leadership of Kellogg's, since they were putting more money of a sizeable amount into the biennial, the senior leadership wanted to know what else did I do other that put this meeting on. And then I talked to them about the role of nutrition in cancer, cancer initiation, and the idea that high-fat diets led to an increased level of bioavailable estrogens, and what I wanted to do was to do a study looking at low fat, high fiber in a group of women and measure the bioavailable estrogen levels over the time of intervention and do it for a period of time. So they initially gave me some funding to do the Tri-Ethnic Study, which was looking at whites, blacks, and Hispanics primarily here within the institution. For a long time, I joked and said I could know the people who were in the study because we gave them a little lunch pail, and it was a very durable lunch pail because we bought it to last a year or more. So even years after, I would see people with their little lunch pails. (Rosolowski laughs.) But to go back, that's why when we started this with normal individuals, sometimes employees, mostly employees here, to identify them, their medical records, was the Kellogg's stamp, because Kellogg's was the one that supported them.

Tacey Ann Rosolowski, PhD:

Right. Interesting.

Lovell A. Jones, PhD:

So after we were able to demonstrate some of this, we were trying to get to be a part of the women's healthy eating-the Women's Health Initiative, which originally started as the Women's Health Trial to look at cancer and diet and that sort of thing, and work with Bill Enzel [phonetic], who was a professor over at Baylor, who was part of the cardiovascular program over there. And part of the Women's Health Trial, WHT, was cancer, and he knew of my interest in nutrition, and so we formed a partnership and worked through recruiting these normal women through his center and having them first enter there to be registered and then coming over here. And then through him I met Bill Clish [phonetic], who is a gastroenterologist, and Clish had developed this instrument, the T_____ unit, to measure total body fat, and the unit was originally developed for children, because he was a pediatric gastroenterologist, to look at [unclear] children, who have eating disorders, and then measure their body fat and that sort of thing. So he developed it as a small pediatric unit, but as they got bigger in terms of adults, he had to develop a larger unit. So I needed a way other than [unclear] to measure total fat, and [unclear] gave you some, but not real accurate enough that I wanted, in [unclear] units, which also you can use to do that, was expensive to have done. It was just coming into being. So I was able to work out an arrangement with Bill to have it done for very little to no cost. So that led to the [unclear] Healthy Friends, in that we wanted to focus on Hispanic women because they had a low risk of developing-or thought they had a low risk-

Tacey Ann Rosolowski, PhD:

Of developing cancer?

Lovell A. Jones, PhD:

Breast cancer.

Tacey Ann Rosolowski, PhD:

Breast cancer. Okay.

Lovell A. Jones, PhD:

But that's not really what we found. But we wanted to do something in that population because we had been doing a lot with African Americans and had started to do a lot with Asians, and so it made for a good way in terms of the networks that we had built. So we worked with Fiesta camps to pick the women up and bring them here. They would first go over to Baylor, to Texas Children's, to get the T____ measurements done, and then they would be escorted over to Anderson to the Center to get their well-women tests and blood drawn and all the questionnaires that we needed to answer. And then they would come to the Center or for a while in the Prevention Center as well.

Tacey Ann Rosolowski, PhD:

And the Center being?

Lovell A. Jones, PhD:

Center for Research and Minority Health, to have the classes done in terms of nutritional classes. And there was also that was to show that these women, first of all, that you can enroll these women, because we had a high retention rate, high enrollment rate, didn't have a problem.

Tacey Ann Rosolowski, PhD:

Was that surprising?

Lovell A. Jones, PhD:

Well, you know, the literature and even today they talk about the difficulty in recruiting people of color, minorities, women, primarily minorities, in the clinical trials. And we had a process that we said if we go to them and we explain what we're doing and they see people that look like them involved in this study, that they'd be more apt to be involved. [unclear] led to the data, led to Kellogg's looking at how it could expand its marketing into South American countries, using what we were doing to recruit women into clinical trials. Also they paid for my way to go over to Australia a couple of times to talk to their group there with regards to the native population, Aborigines, that they were trying to work with in terms of nutritional studies as well. And it also laid the basis for us to become part of the national trial, the Women's Healthy Eating and Living Study, which was one of the largest national trials, to look at tertiary, and secondary and tertiary prevention of breast cancer, focusing on women who already had breast cancer and seeing whether or not we could prevent recurrence by nutritional intervention. And because of our experience in terms of the Tri-Ethnic Study and [unclear], we had the largest number of women of color enrolled in our study here. We jokingly said because we were the furthest east, furthest south study site, we were the control for the rest of the nation, because most of the other sites were on the West Coast in California, Arizona, and Oregon.

Tacey Ann Rosolowski, PhD:

Hmm. Very interesting. Now, I read somewhere that-was it the results of the national study that were so surprising? Because there were some surprising results from the low-fat diet and breast cancer connection. Was that the national study? Could you talk about that?

Lovell A. Jones, PhD:

What we ended up showing was that the intervention gave us the same sort of reduction in breast cancer occurrence as taking Tamoxifen-

Tacey Ann Rosolowski, PhD:

Wow.

Lovell A. Jones, PhD:

-that there were differences, interestingly enough, in that there was a reduction in recurrence in white females, significant reduction. There was also reduction in African American women, but that reduction was down to the level that the white women came in at. So there was a reduction, but it didn't bring both down to the same level.

Tacey Ann Rosolowski, PhD:

Do you have any idea why that is?

Lovell A. Jones, PhD:

I think primarily because there are differences biologically in some of the cancers. African American women have an early onset of breast cancer, and the early onset is a different type of breast cancer, not that the biological difference is between blacks and whites. It's age-related differences. So I jokingly say when people are saying that they're focusing on black women in terms of triple-negative, and I say, "œYou're focusing on black women in terms of triple-negative, but you also should be focusing on young women, because triple-negative is a disease of young women, and because black women have an earlier onset of breast cancer, that's why they have a higher incidence of triple-negative."

Tacey Ann Rosolowski, PhD:

I see. Now, when you're talking about young women, what age group are we talking about?

Lovell A. Jones, PhD:

Premenopausal, under forty-five, under fifty, forty-five. There's about a ten-year difference in mean onset between blacks and whites.

Tacey Ann Rosolowski, PhD:

Now, when I was reviewing some of the background materials, I read a couple of articles that talked about a study that showed that there was no relationship between low-fat diet and breast cancer. What was that about in the context of your findings?

Lovell A. Jones, PhD:

(laughs) Well, that, people said when we came out, when you looked at the entire study, if you took the entire group, there was no difference in the controls and intervention group, and, however, what the-and the newspapers jumped all over that. They said, "œOh, you know, diet is not-here's a major study where control and diet doesn't help." But if you take out subgroups, if you took out groups that both exercised and changed their diet, it was a significant reduction. That's where the 40 percent came in. If you looked at stage of disease and when we started, so there was a point that you can intervene, but it makes no difference in intervening. The disease already set its course. But we were truth-in-lending. We reported everyone that we intervened with as a group, and that's what we found. But what was failed to be picked up is the subsets where this was really applicable in terms of the individual.

Tacey Ann Rosolowski, PhD:

That seems very unfortunate.

Lovell A. Jones, PhD:

But that's media hype.

Tacey Ann Rosolowski, PhD:

Yeah, media. Media hype, yeah. Yeah. So, now, I assume that after getting these results, this was something you could really actively circulate back into your populations, I mean.

Lovell A. Jones, PhD:

Yeah, and that was one of the unique things that, as a Center, it was part-the research that was done in terms of community relations, which was part of it, and people asked us why we didn't call it community outreach or community engagement or some of the other terms that they use with regards to community programs, and we said, "œWe're in the business of relationships, and they are our clients." And having that [unclear] gives a connotation that-because when we were writing the grant, we didn't use "œcommunity relations" because nobody understood it. We put the standard flavor-of-the-month title into the grants. And one of our community people looked at it as we were putting it together. She said, "œCommunity outreach. You know, do you have a corresponding institutional in-reach?" She said, "œBecause you guys need more in-reach than you need outreach."

Tacey Ann Rosolowski, PhD:

(laughs) Good question. Yeah, yeah.

Lovell A. Jones, PhD:

It was pretty profound, yes.

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