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This content is from the “Advancing the Science of Cancer in Latinos: 2024 Conference Proceedings.”
Residence in a Latino Enclave and Clinical Outcomes in Texas Children with Acute Lymphoblastic Leukemia
Dr. Jeremy Schraw is an Assistant Professor in the Division of Hematology-Oncology, Department of Pediatrics, at Baylor College of Medicine.
Dr. Schraw began by pointing out the higher incidence of acute lymphoblastic leukemia (ALL) among Latino children, and the poorer overall survival (OS) following diagnosis. Social determinants of health likely contribute to these disparities. In fact, children living in Latino enclaves, defined as neighborhoods with a high proportion of Latino residents, recent immigrants, and linguistically isolated households, have poorer OS after diagnosis of ALL.

Dr. Schraw and colleagues set out to determine whether residence in an enclave is associated with certain outcomes after adjusting for clinical and demographic factors. The primary outcomes were clinical trials participation, minimal residual disease (MRD) at the end of induction chemotherapy, and OS. According to adjusted analysis, patients living in Latino enclaves were found to be less likely to be enrolled in a clinical trial than patients living in other neighborhoods (46.2% vs 65.4%, OR 0.55, 95%CI 0.11-2.82), more likely to be MRD positive at end-induction (24.1% vs 20.7%, OR 1.11, 95%CI 1.04-1.20), and more likely to die from their disease (1.4% vs 0.6%, OR 1.20, 95%CI 1.12-1.28).
These results demonstrate the association between neighborhood context and adverse outcomes across treatment, suggesting that early clinical events may mediate ethnic and socioeconomic disparities in ALL outcomes. Furthermore, the study highlights the importance of neighborhood social context for pediatric cancer and for health disparities in Hispanic or Latino people.
Unraveling Genomic Ancestry in a Hispanic/Latino Colorectal Cancer Cohort and Exploring Spatial Transcriptomics to Study the Tumor Microenvironment
Dr. Enrique I. Velazquez-Villarreal is an assistant professor in the department of integrative translational sciences at City of Hope.

Dr. Velazquez-Villarreal described a study performed with colleagues at City of Hope, analyzing clinical and genomic data from 82 Hispanic/Latino individuals with primary colorectal tumors in order to assess global and local genomic ancestry. The data was collected using the Oncology Research Information Exchange Network, and the genomic ancestry analyses estimated the proportion of Latino genetic makeup from five superpopulations: Admixed American, European, South Asian, East Asian, and African.
Global genomic ancestry analysis unveiled a significant population admixture, with high proportions of Admixed American (4.9 – 70%) and European (2 – 48%) components, followed by South Asian (4.5 – 26.1%), East Asian (0 – 24.5%), and African (0 – 7.4%) components. Patients with an Admixed American component were found to have a higher risk of early onset colorectal cancer. Each chromosome was also analyzed locally to identify genes of interest and determine ancestry.
In addition to this primary analysis, a secondary investigation involved two spatial transcriptomic colorectal cancer samples sourced from the 10xGenomics database in addition to the patient samples collected. The analysis of these samples involved quantifying gene activity relative to specific tumor locations. This approach represents a new technology for assessing how components of colorectal cancer are interacting in the tumor microenvironment within Latino patients.
Padres y Trabajadores de la Salud Unidos en la Prevención Del Cáncer: A Multi-Tiered Intervention Approach to Increasing HPV Vaccination
Dr. Jacob Martinez is an Assistant Professor in the college of Nursing at the University of Texas at El Paso.

Dr. Martinez described the process of developing a multi-tiered health literacy intervention with the goal of increasing human papillomavirus (HPV) vaccination among children aged 9-17 years in 3 underserved communities in El Paso County, TX. Interventions involved educating professionals and the public by providing HPV vaccination messaging, and facilitating access through community-based clinical services. Intermediate goals included reducing the number of missed clinical opportunities for recommendation and administration, increasing parental acceptance of the vaccination, and maximizing equitable access to vaccination services. The long-term goal was decreased rates of morbidity and mortality due to HPV-associated cancers.
Within the first 10 months of this initiative, several steps have been successfully taken. First, a bilingual comic has been developed to help with HPV vaccination education. A partnership has also been established with the American Cancer Society to train community health workers, and parent education sessions are being provided for cancer prevention education. Finally, partnerships with federally qualified health centers are in place to analyze missed opportunities and to strategize effective approaches to increased vaccination.
Barriers to this work are multitudinous and include vaccine shortages, accessibility of services, affordability and availability, provider missed opportunities, and difficulties in tracking vaccine administration. Factors that help mitigate these barriers, however, include interventions by community health workers, which can strengthen patient navigation and advocacy skills; transportation to and from federally qualified health centers; open dialogue with federally qualified health centers; and the identification of other vaccine providers for HPV and other vaccines.
Building a Primary Care Research Agenda for Latino Populations in the Setting of the Latino Paradox: A Report from the 2023 Latino Primary Care Summit
Dr. Miguel Marino is an Associate Professor of Biostatistics in the Department of Family Medicine at Oregon Health and Science University. Dr. John Heintzman is an Associate Professor of Family Medicine at Oregon Health and Science University, and an Affiliate Investigator at OCHIN, Inc. Drs. Marino and Heintzman are also Co-Directors of the Primary Care Research Equity In Latinos (PRIMER) Center.

Drs. Marino and Heintzman discussed the inaugural Latino Primary Care Summit, held in 2023. The main topic of discussion for the summit was the Latino Paradox, an epidemiologic phenomenon which describes the lower all-cause mortality rates among US-based Latinos versus their socioeconomic comparators. Discussion and recommendations were organized into 6 themes.
The first theme involved Latino paradox considerations, limitations, and implications, and included recommendations to regularly update a working definition of the Latino paradox. The need for research on how conceptions about the Latino paradox are used or misused by clinicians in health care systems was also noted.

The second theme covered data issues. Latino data is often disaggregated due to inconsistent definitions and questionnaires. Funders, researchers, and primary care clinics need to work together to address this issue while partnering with Latino communities.
The third theme focused on bridging the clinic and community. Research is needed to better understand how to support, utilize, and develop community health workers, and quantify their impact on Latino health.
The fourth theme, primary care challenges, emphasized the need for practice-based evidence on effective care to Latino communities, including payment reform and overall care design in primary care settings. New and ongoing research should also provide insights as to how the pandemic has impacted the Latino Paradox, primary care utilization, and their intersection.
Social needs were the focus of the fifth theme. Participants discussed the need to study the acceptability of social screening approaches in primary care workflows to understand implementation among Latinos. Importantly, these screening approaches should be culturally informed.
The final theme for the summit was workforce and academic representation, and inequities and innovation. When evaluating early-career proposals, funders should highly value innovative and exploratory research approaches that address the Latino community, in order to robustly address long-standing Latino health inequities and expand the Latino research workforce.
Clinical and Genomic Characteristics of Early-Stage Breast Cancer Tumors of Latin American Patients in FLEX Study
Dr. Marcela Mazo Canola is an assistant professor within the Division of Hematology-Oncology at The University of Texas Health Science Center San Antonio and a breast medical oncologist at Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center.

Dr. Canola began by explaining that the clinical and genomic characteristics of breast cancer can vary significantly across different ethnicities. In light of this, the FLEX study was used by Dr. Canola and colleagues to further understand the characteristics of early breast cancers in Latin American patients.
The first finding of note was the number of participants in the different cohorts, with 9738 non-Hispanic White participants and only 386 Latina participants. The Latina cohort was also found to be younger (mean age 55.58 vs 61.10), have more T3 and T4 tumors, and have a higher grade of disease. Furthermore, this group had higher rates of obesity and type 2 diabetes, and had more aggressive disease, with a statistically significantly higher percentage of MammaPrint (MP) High risk 2 disease. Although the Latina cohort showed less of the luminal A molecular subtype, a statistically significantly higher number of cases of basal type breast cancer was observed. A difference was also noted in the percentage of women receiving chemotherapy in the neoadjuvant setting, with 51.2% of the Latina group receiving chemotherapy compared with only 27.7% of the non-Hispanic White group.
These clinical characteristics, together with MammaPrint and BluePrint, reflect the high-risk features of breast tumors in Latin American patients. Along with the higher rates of chemotherapy treatment, these findings highlight the importance of real-world evidence cohorts like FLEX, and the value of increased clinical trial enrollment in the Latin American population.
By The Numbers
142
Percent
Expected rise in Latino cancer cases in coming years