Fighting for African American Lives

Prostate cancer doesn’t play fair. If you are an African American man, your risk of developing this disease is higher than for any other population in America. Your cancer is likely to grow and spread faster. And compared to a white man, you are twice as likely to die from it. 

“In the cancer world, this is the longest-standing and most perplexing disparity we continue to see,” says Scarlett Lin Gomez, PhD, MPH, a professor of epidemiology and biostatistics. Researchers have known about it for decades, she says. Yet despite extraordinary advances in cancer science and care, they have so far failed to find a simple cause or solution. 

UCSF experts recognize that the problem is complex, and solving it requires a complex approach. Together, they are working to identify its root causes, translate that knowledge into better patient care, and scale their successes to help tackle similar disparities around the world. 

This multifaceted approach cuts across diverse disciplines, from “cells to society.” At the cellular level, for instance, Franklin Huang, MD, PhD, studies gene mutations in prostate cancer tumors. Some of these mutations may cause a tumor to grow more aggressively, metastasize, or respond to different treatments. Huang, an oncologist and assistant professor of medicine, has found evidence that prostate cancer cells in African American men may acquire a different spectrum of mutations than similar cells in white American men. 

Those genetic differences may help explain why the disease affects the two populations differently, Huang says. He believes that in the future, clinicians will be able to use this information to better match patients with the most effective treatments. 

Biology, however, is only one piece of the puzzle. Another is quality of care, as Nynikka Palmer, DrPH, MPH, has found. “We know that African American men with prostate cancer are not getting the most appropriate treatment for their diagnoses,” says Palmer, an assistant professor of medicine. “Why?” 

Palmer’s research examines interactions between patients and physicians in order to identify gaps where communication and understanding break down. For example: How do oncologists explain diagnoses and treatment options, particularly to African Americans? How do patients make treatment decisions? Palmer plans to use what she learns to improve clinician training and to develop a peer-mentorship program for prostate cancer patients. 

Gomez, meanwhile, views the problem from the level of society. “I’m thinking more about structural forces – things like structural racism, residential segregation, and other adverse experiences over the lifetime,” she says. By pooling information from diverse sources – including patient surveys, census data, and redlining maps – she aims to better understand how social factors may drive prostate cancer disparities, how those factors interact, and how they impact other factors like genetics. 

The hope is that these insights will transform the standard of prostate cancer care, not just for African American men but also for all families touched by this disease.