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- New JNCCN research highlights negative impact of continued exclusion of racial groups from cancer genomics research
Researchers call for better inclusion of people in Africa and of African descent in studies on inherited genetics to help address disparities in prostate cancer outcomes
PLYMOUTH MEETING, Pa., March 13, 2023 /PRNewswire/ -- New research in the March 2023 issue of the JNCCN—Journal of the National Comprehensive Cancer Network highlights how the lack of genomics research for people of African descent, particularly those in the sub-Saharan region, is hampering efforts to reduce disparities for people with cancer. In a one-of-a-kind study, researchers evaluated the molecular genetic results of 113 black South African men diagnosed with advanced prostate cancer for evidence of potentially unique major genetic testing recommendations.
The researchers note that, according to the GLOBOCON 2020 studies, the regions of the world most impacted by prostate cancer mortality include populations with significant African ancestry, such as the Caribbean and sub-Saharan African regions, with mortality rates of 3.4 and 2.5 times greater than that reported for the United States, respectively. Within the United States, African-American men have between 2.3 and 5 times the risk of death associated with prostate cancer than their non-African-American counterparts.
"Although men of African descent have the highest incidence rates of aggressive prostate cancer and associated death globally, due to the lack of available data, personalized testing criteria for such higher-risk populations have not been established." noted lead investigator Kazzem Gheybi, MD, PhD, of the University of Sydney in Australia. "This study opens the door to begin establishing new criteria, giving men of African descent hope that germline testing can change current disparities in clinical outcomes."
"The African diaspora is very diverse, so I caution against the most genetically diverse population in 'single' terms," added lead researcher Vanessa M. Hayes, PhD, also from the University of Sydney and the University of Pretoria in South Africa. "What is required is a concerted effort for inclusion that takes a grassroots approach. We need to create criteria based on population-specific knowledge. We encourage cancer care and germline screening providers to establish an arm of research and development designed specifically for African inclusion. We need to move away from a one-size-fits-all model for prostate cancer care; African solutions must address relevant African disparities in prostate cancer outcomes."
The study included a careful examination of 21,899 single nucleotide variants, 4,626 small insertions and deletions, and 73 structural variants in 20 genes from the 113 patients. After initially excluding variants known not to cause cancer, they found 38 mutations in 52 patients. A total of 17 potential pathogenic (4) and oncogenic (13) variants were identified. The 5.6% rate of cancer-causing rare variants in this population was significantly lower than the established rate of 11.8% for non-African patients with confirmed metastatic prostate cancer, suggesting lower sensitivity of gene panels. for risk assessment in this patient population.
"This study highlights the limited clinical utility (30%) of the currently most widely used germline testing panels in men of African descent, largely due to the minimal inclusion of these groups in panel development," Samuel said. L. Washington III, MD, MAS, Assistant Professor of Urology; Epidemiology and Biostatistics, University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, who was not involved in this research.
Dr. Washington, who is also a member of the NCCN Oncology Clinical Practice Guidelines Panel (NCCN® Guidelines) for the Early Detection of Prostate Cancer, continued: "This study emphasizes two crucial domains: 1) it provides evidence additional evidence of the need for greater inclusion in genetic panel development and 2) acknowledges that disparities in outcomes for men of African descent cannot be explained solely by findings in 113 black South African men. Although the NCCN Guidelines for the early detection of prostate cancer identify Black/African-American identity as a risk factor, the panel notes the contributions of poor access to care, social determinants of health/social risk, and hereditary genes to these observations I look forward to more research in this area that examines how the limitations of our current tools can be improved to reflect better the populations we serve.
To read the full study, visit JNCCN.org. Complimentary access to "Evaluating Germline Testing Panels in Southern African Males with Advanced Prostate Cancer" is available through June 10, 2023. Visit NCCN.org/harmonized to learn more about NCCN's global program, including resources designed specifically for people in sub-Saharan Africa.
About JNCCN—Journal of the National Comprehensive Cancer Network More than 25,000 oncologists and other cancer care professionals in the United States read JNCCN, the Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information on innovation in translational medicine and scientific studies related to cancer healthcare research, including quality care and value, bioethics, comparative cost-effectiveness and economics, public policy, and interventional research on supportive care and survivorship. The JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles that develop guideline recommendations, health services research, and case reports that highlight molecular insights in patient care. The JNCCN is a Harborside publication. Visit JNCCN.org. To see if you are eligible for a FREE JNCCN subscription, visit NCCN.org/jnccn/subscribe. Follow JNCCN on Twitter @JNCCN.
About the National Comprehensive Cancer Network The National Comprehensive Cancer Network® ( NCCN®) is a nonprofit alliance of leading cancer centers dedicated to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so that all patients can live better lives. The NCCN Oncology Clinical Practice Guidelines (NCCN Guidelines®) provide transparent, evidence-based, and expert-consensus recommendations for cancer treatment, prevention, and support services; They are the recognized standard for clinical direction and policy in cancer treatment and the most comprehensive and frequently updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert information on cancer treatment to inform and empower patients and caregivers, through the support of the NCCN Foundation®. NCCN also promotes continuing education, global initiatives, policy, and collaboration in research and publication in oncology. Visit NCCN.org for more information.
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