Population Science and Cancer Control 

Mission

To understand and impact factors associated with cancer risk in clinical, safety-net, and community settings, among diverse populations.

Overview

Dale Chihuly's blown-glass sculpture
Cancer burden and disparities in North Texas are the focus of research by the Population Science and Cancer Control Program.

Drawing from the large and diverse population that the Simmons Comprehensive Cancer Center serves, the Population Science and Cancer Control Program has a special focus on uninsured residents served by local public health systems. Studies are centered on cancer disparities among subpopulations of individuals who traditionally are medically underserved.

Research focuses on processes of care, with the goal of translating findings into improved cancer care in local health systems. The 25 members of the Population Science Program are based in five departments plus at the University of Texas School of Public Health’s Dallas campus.

Themes

  • Cancer prevention (including the study of biomarkers for colon and liver cancers, and of risk prevention behaviors)
  • Screening for early detection of colon, liver, and esophageal cancers
  • Cancer survivorship

Research Highlights

Parkland Health & Hospital Systems (12 Dallas-area clinics)
Parkland Health & Hospital System’s 12 Dallas-area clinics providing primary care (boxed crosses), along with the system’s women’s clinics (red crosses) and gynecologic specialty clinic (green circle), are hubs for PROSPR Center outreach plus colorectal and cervical cancer research.

Parkland-UT Southwestern PROSPR Center. Supported by the establishment in 2011 of the Parkland-UT Southwestern PROSPR Center, researchers in the Population Science and Cancer Control Program are identifying efficient strategies for increasing routine screening that will reduce colorectal cancer incidence and mortality, especially among under—and uninsured patients. Program members’ research has shown, for instance, that colorectal screening rates can be substantially increased among patients who receive mailed fecal immunochemical test kits compared with usual care or an invitation for colonoscopy.

Investigators also are tracking all aspects of the colon cancer screening process for a racially/ethnically diverse group of about 70,000 primary-care patients seen in Parkland Health and Hospital System’s 12 community-based clinics—from identification of need for screening through test outcomes, follow-up, treatment and surveillance, or return to a routine screening schedule. In 2014, the PROSPR Center’s funding was expanded to incorporate cervical cancer screening research, enabling investigators to follow a diverse group of about 178,000 screening-eligible women in the Parkland system, and to develop educational and routine practice interventions to boost HPV vaccination rates.

Ultrasound showing a liver cancer
Ultrasound shows a lesion (darker, round area near center) on a patient’s liver, which was determined on follow-up to be hepatocellular carcinoma.

Early detection of liver cancer. A thriving research effort is evaluating strategies to improve screening effectiveness and ensure that more people at high risk for hepatocellular carcinoma (HCC), the most common form of liver cancer, receive appropriate testing so tumors can be detected earlier and treated more effectively. Population Science program members are key investigators for the multi-institution Texas HCC Consortium, a $9.7 million initiative funded by the Cancer Prevention and Research Institute of Texas. Consortium projects include characterizing factors that predict liver cancer in a diverse group of patients with cirrhosis, evaluating novel biomarkers to increase sensitivity for early tumor detection, and a trial comparing interventions to boost screening rates in at-risk patients.

To Get Involved

The program seeks additional scientists and physicians with training in a broad range of population science disciplines to develop collaborative cancer prevention and control research projects.

Topics of interest include, but are not limited to, identification of risk factors across the cancer continuum; development and evaluation of interventions to improve health behaviors, health care practices, and patient-provider communication; and surveillance of cancer care delivery along the disease spectrum from prevention and early detection through survivorship.

Contact Dr. Tiro for more details about the program, meetings, and more. jasmin.tiro@utsouthwestern.edu

Selected Publications

Beaber, E.F. et al. Unifying screening processes within the PROSPR consortium: a conceptual model for breast, cervical, and colorectal cancer screening. J Natl Cancer Inst 107:djv120 (2015).

Bishop, W.P. et al. Effectiveness of a community research registry to recruit minority and underserved adults for health research. Clin Transl Sci 8, 82-4 (2015).

Chando, S. et al. Effects of socioeconomic status and health care access on low levels of human papillomavirus vaccination among Spanish-speaking Hispanics in California. Am J Public Health 103, 270-2 (2013).

Gerber, D.E. et al. Impact of prior cancer on eligibility for lung cancer clinical trials. J Natl Cancer Inst 106, dju302 (2014).

Guda, K. et al. Novel recurrently mutated genes in African American colon cancers. Proc Natl Acad Sci USA 112, 1149-1154 (2015).

Gupta, S. et al. Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved: a randomized trial. JAMA Intern Med 173, 1725-1732 (2013).

Kendzor, D.E. et al. Financial incentives for abstinence among socioeconomically disadvantaged individuals in smoking cessation treatment. Am J Public Health 105, 1198-205 (2015).

Koshy, M. et al. Prevalence and predictors of inappropriate delivery of palliative thoracic radiotherapy for metastatic lung cancer. J Natl Cancer Inst 107, djv278 (2015).

Kozlitina, J. et al. Exome-wide association study identifies a TM6SF2 variant that confers susceptibility to nonalcoholic fatty liver disease. Nat Genet 46, 352-356 (2014).

Laccetti, A.L. et al. Effect of prior cancer on outcomes in advanced lung cancer: implications for clinical trial eligibility and accrual. J Natl Cancer Inst 107, djv002 (2015).

Lee, S.J. et al. Assessing race and ethnicity data quality across cancer registries and EMRs in two hospitals. J Am Med Inform Assoc 23, 627-34 (2016).

Li, J.Z. et al. Chronic overexpression of PNPLA3I148M in mouse liver causes hepatic steatosis. J Clin Invest 122, 4130-4144 (2012).

Pruitt, S.L. et al. Residential racial segregation and mortality among black, white, and Hispanic urban breast cancer patients in Texas, 1995-2009. Cancer 121, 1845-1855 (2015).

Rhodes, R.L. et al. Initial development of a computer algorithm to identify patients with breast and jung cancer having poor prognosis in a safety net hospital. Am J Hosp Palliat Care 33, 678-83 (2016).

Rhodes, R.L. et al. Barriers to end-of-life care for African Americans from the providers' perspective: opportunity for intervention development. Am J Hosp Palliat Care 32,137-43 (2015).

Sher, D.J. et al. Comparative effectiveness of neoadjuvant chemoradiotherapy versus chemotherapy alone followed by surgery for patients with stage IIIA non-small cell lung cancer. Lung Cancer 88, 267-74 (2015).

Singal, A.G. et al. Outreach invitations for FIT and colonoscopy improve colorectal cancer screening rates: A randomized controlled trial in a safety-net health system. Cancer 122, 456-63 (2016).

Singal, A.G. et al. Racial, social, and clinical determinants of hepatocellular carcinoma surveillance. Am J Med 128, 90.e1-7 (2015).

Singal, A.G. et al. The effect of PNPLA3 on fibrosis progression and development of hepatocellular carcinoma: a meta-analysis. Am J Gastroenterol 109, 325-334 (2014).

Singal, A.G. et al. Early detection, curative treatment and survival rates for HCC surveillance in patients with cirrhosis: a meta-analysis. PLoS Med 11, e10011624 (2014).

Singal, A.G. et al. Failure rates in the hepatocellular carcinoma surveillance process. Cancer Prev Res 5, 1124-1130 (2012).

Singal, A.G. et al. Effectiveness of hepatocellular carcinoma surveillance in patients with cirrhosis. Cancer Epidemiol Biomarkers Prev 21, 793-799 (2012).

Skinner, C.S. et al. Development of the Parkland-UT Southwestern Colonoscopy Reporting System (CoRS) for evidence-based colon cancer surveillance recommendations. J Am Med Inform Assoc 23, 402-6 (2016).

Skinner, C.S. et al. Impact of risk assessment and tailored versus nontailored risk information on colorectal cancer testing in primary care: A randomized controlled trial. Cancer Epidemiol Biomarkers Prev 24, 1523-1530 (2015).

Spechler, S.J., Souza, R.F. Barrett’s esophagus. N Engl J Med 37, 836-845 (2014).

Tiro, J.A. et al. Promoting HPV vaccination in safety-net clinics: a randomized trial. Pediatrics 136, 850-9 (2015).

Tiro, J.A. et al. The CRC screening process in community settings: a conceptual model for the Population-based Research Optimizing Screening through Personalized Regimens consortium. Cancer Epidemiol Biomarkers Prev 23, 1147-1158 (2014).

Tiro, J.A. et al. Multilevel correlates for human papillomavirus vaccination of adolescent girls attending safety net clinics. Vaccine 30, 2368-2375 (2012).

Tosteson, A.N. et al. Variation in screening abnormality rates and follow-up of breast, cervical and colorectal cancer screening within the PROSPR Consortium. J Gen Intern Med 31, 372-9 (2016).

Wang, D.H. et al. Hedgehog signaling regulates FOXA2 in esophageal embryogenesis and Barrett's metaplasia. J Clin Invest 124, 3767-3780 (2014).

Yopp, A.C. et al. Establishment of a multidisciplinary hepatocellular carcinoma clinic is associated with improved clinical outcome. Ann Surg Oncol 21, 1287-1295 (2014).

Zhu, H. et al. A semi-stationary copula model approach for bivariate survival data with interval sampling. Int J Biostat 11, 151-73 (2015).