Studies Need to Include More Minorities to Improve Treatments

Researchers recently found that further efforts are needed to implement personalized medicine among all ethnic and racial groups.

In a study published in Health Affairs, researchers state that minority-focused research, community-based participatory research, and gene-environment interaction studies could improve the understanding of chronic conditions affecting patients of all races and ethnicities. They also outline ways to decrease disparities through new policy efforts.

Genetic and molecular knowledge has grown regarding breast cancer and chronic kidney disease, according to the study. However, racial and ethnic disparities continue to slow down new progress.

The researchers recommend that future studies enroll non-white patients for more complex diseases. They also state that community-based participatory research would promote genetic literacy, and encourage more patients to enroll in research, according to the study.

Additional funding for research about gene-environment interactions, and educating patients and providers about benefits, risks, and limitations of research could aid progress.

“We need to collect more data from groups for whom we currently have insufficient information so that we can improve care for all individuals. If we don't expand our efforts, the quality and effectiveness of genetic research and services will be limited in ways that can perpetuate health disparities,” said senior author José M. Ordovás, PhD. “The Precision Medicine Initiative for one will be a big step forward in this endeavor and is to be commended for including community-based health provider organizations in its network to attract volunteers. Increasing diversity in research and testing will help maximize the possibilities of precision medicine.”

Researchers believe that their recommendations would increase the amount of information in genetic databases, reduce inadequate treatment options, and increase understanding disease mechanisms. Expanding research to patients of African-American and Hispanic would likely improve genetic knowledge for breast cancer, since the typical genetic sequence of BRCA1 and BRCA2 genes is based on women of European and Ashkenazi Jewish descent, according to the study.

African-American and Hispanic women are also less likely to receive genetic counseling, or be tested for hereditary breast cancer, making genetic databases incomplete. Previous studies have also shown non-Hispanic black women are more likely to develop breast cancer without family history, compared with white women.

Genetic markers could potentially account for the differences in this type of cancer, but a small number of tumor samples from this population does not provide enough information to individualize treatments, according to the current study. Among African-American women, it has been established that they are affected by variants of the APOL1 gene, which can significantly increase the risk of kidney disease.

However, effective treatments cannot be created due to a lack of understanding of the molecular mechanisms of the gene.

“Ultimately, we want the knowledge gained from a reduction in health disparities to lead to an increase in treatments for people who are most at risk. If we understand the aggressive breast cancer subtype that more frequently affects black women, we might be able to expand treatment options,” said first author Caren E. Smith, DVM. “We want to look at environmental factors as well as tumor biology to know how they contribute to the disease, and how we might then attack it.”