Many studies suggest that low socioeconomic status (SES) and poor access to care are the major contributors of the high
GENERAL AUDIENCE SUMMARY Tobacco and alcohol use are the primary risk factors for the development of head and neck cancer (HNSCC). The rate of HNSCC is higher in the Black population compared to the White population. Similarly, poor survival rates are observed among Black patients compared to White. Many studies suggest that low socioeconomic status (SES) and poor access to care are the major contributors of the high rate and poor survival from HNSCC in the Black population. We and others have shown that while SES and access to care are major drivers of the observed racial disparity, other biological factors may play a role as well. Tobacco and alcohol are broken down by proteins in the cell which result in the accumulation of cancer-causing compounds. Chemotherapy drugs are also broken down by these same proteins. In addition, there are proteins in the cell which actively pump drugs and bi-products of chemicals from tobacco smoke from the cells where they may be further excreted from the body. Variations in the genetic make-up of these proteins can lead to differences in their function and could affect disease development as well as response to drug therapy. In many cases, the genetic make-up of these proteins differs according to race. Therefore we propose that these genetic factors and the environment work together to contribute to the observed racial disparities in HNSCC incidence and survival. We propose to use novel techniques to look for variations in the genetic make-up in these genes and will further compare Black patients with Black cancer-free controls to determine whether the noted variations contribute to an increased risk of HNSCC among patients. By measuring tobacco-related chemicals excreted in the urine, we will also compare genetic factors in Black persons (without caner) with their ability to break-down and excrete chemicals from tobacco smoke. For patients that receive treatment, we will compare the survival rates among Black cases with that of White cases to determine if a specific genetic profile among Black patients could explain the difference in survival between the two race groups. During this analysis, we will take into consideration each individual’s smoking behavior, cancer stage, SES and access to care, etc to ensure that both groups are compared with an equal distribution of characteristics. Our study will help to fill in the gap of knowledge related to HNSCC development and survival among Black populations. We anticipate that the findings from these studies will help to provide insight to the biology of the disease as well as factors that contribute to racial disparities and will improve early detection and cancer prevention interventions. Most importantly the survival information generated from these studies will help to provide insight that will guide treatment efforts through the development of personalized and successful therapies that will, in turn, reduce the vast survival disparity that currently exists.
