Population Science and Cancer Control

Program Discoveries Regarding Biomarkers for HCC Led to a Change in Practice Guidelines

Professional organizations recommend abdominal ultrasound alone for HCC surveillance, but in a multi-center study, Jorge Marrero, M.D., and Amit Singal, M.D., found ultrasound quality was often insufficient for HCC exclusion, particularly in those with obesity or nonalcoholic steatohepatitis, two major groups in North Texas. Further, poor ultrasound quality leads to “unnecessary” diagnostic testing given indeterminate results, resulting in excess screening-related physical harms. In a recent systematic review and meta-analysis of cohort studies, they concluded ultrasound alone has insufficient sensitivity for early stage HCC, failing to detect >50% of early stage HCCs.

Identified failures at several steps in the CRC screening process continuum including initial screening, repeat screening, and diagnostic follow-up of abnormal screening results

Cancer screening is a complex process that involves: repeat screening for patients with normal tests, diagnostic evaluation and surveillance for abnormal results, and treatment of detected lesions. Through the first NCI PROSPR Consortium, we have identified failures across the CRC screening process, including failure to complete repeat FIT, inadequate follow-up of abnormal tests, and underuse of surveillance colonoscopy in patients with polyps. Dr. Singal; Caitlin Murphy, Ph.D.; Ethan Halm, M.D.; and Celette Skinner, Ph.D. discovered wide variation (16-80%) in repeat FIT completion across health systems, with the highest rates of completion occurring in systems that offered systematic population outreach rather than opportunistic outpatient clinic screening. They were the first group to apply “proportion time covered” as a novel measure of cancer screening adherence, which more accurately captures breakdowns in the screening process than cross-sectional adherence.

Prevalence of Prior Cancer Among Persons Newly Diagnosed with Cancer: An Initial Report From the Surveillance, Epidemiology, and End Results Program

Using SEER-Medicare data, Sandi Pruitt, Ph.D., and David Gerber, M.D., co-leader of Simmons’ Experimental Therapeutics Program, showed all-cause survival among early-stage lung cancer patients with cancer history was no different than those without cancer history. Further, lung cancer-specific survival was better in those with prior cancer. Findings suggest that prior cancer history as an exclusion is unwarranted. Caitlin Murphy, Ph.D., Pruitt, et al. reported the growing demographic of individuals > 65 years have a three-fold prevalence of prior cancer than younger counterparts (15% vs. 5%). Removal of prior cancers as a trial exclusion criterion addresses a major driver of low trial participation among older adults.

Discoveries to improve HPV vaccination among adolescents seen in the Parkland pediatrics clinics

In 2015, Jasmin Tiro, Ph.D., conducted a CPRIT-funded randomized controlled trial testing HPV vaccine-specific brochure and telephone reminder calls targeted to parents of adolescent patients. The intervention effect of the brochure was significantly moderated by race/ethnicity, such that it was effective for increasing vaccination first doses only among Hispanic, but not African American adolescents. The telephone reminder calls increased completion of second and third doses for all race/ethnicities, compared with usual care. Parent interviews revealed many were hesitant about the vaccine and, even those with low literacy could articulate their concerns.