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Population Science and Cancer Control

31 members across nine departments at UT Southwestern and two departments from the Dallas Regional Campus of the UT School of Public Health

The Population Science and Cancer Control (PS) Program seeks to generate research discoveries addressing cancer burden and disparities in the Simmons’ catchment area and beyond. The Program emphasizes research across the cancer continuum from prevention and early detection, through treatment and survivorship, working to translate discoveries to inform research across disease sites and across the three aims.

The PS Program specific aims are to: Identify and evaluate biomarkers to assess cancer risk, detect it early, and predict progression; Identify factors, at multiple levels, that are associated with cancer prevention and early detection, diagnosis, treatment, and survivorship care delivery, processes, and outcomes; and Develop and test interventions to improve implementation of evidence-based cancer prevention and control services, with a focus on underserved populations and safety-net healthcare systems. 

Identify and Evaluate Biomarkers to Assess Cancer Risk, Detect it Early, and Predict Progression

Blue strands with white lines and pentagons

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.

Identify Factors, at Multiple Levels, That are Associated with Cancer Prevention and Early Detection, Diagnosis, Treatment, and Survivorship Care Delivery, Processes, and Outcomes

Pink stained image with white gap

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.

Purple, red, blue, and green cells

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.

Develop and Test Interventions to Improve Implementation of Evidence-Based Cancer Prevention and Control Services, with a Focus on Underserved Populations and Safety-Net Health Care Systems

Someone holding a bottle of HPV vaccine with two gloved fingers

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.

Notable Publications

Singal, A.G. et al. International Liver Cancer Association (ILCA) White Paper on Biomarker Development for Hepatocellular CarcinomaGastroenterology 2021; 160(7):2572-2584. PMCID: PMC8169638.

Skinner, C.S. et al. Long-term Risk of Colorectal Cancer and Related Death After Adenoma Removal in a Large, Community-based Population. Gastroenterology 2020; 158(4):884-894.e5. PMCID: PMC7083250.

Wang, T. et al. Computational Staining of Pathology Images to Study the Tumor Microenvironment in Lung Cancer. Cancer Research 2020; 80(10):2056-2066. PMCID: PMC7919065.

Hughes, A.E. et al. Nativity, ethnic enclave residence, and breast cancer survival among Latinas: Variations between California and Texas. Cancer 2020; 126(12):2849-2858. PMCID: PMC7245543.

Tiro, J.A. et al. Blood-based biomarkers of human papillomavirus-associated cancers: A systematic review and meta-analysis. Cancer 2021; 127(6):850-864. PMCID: PMC8135101.

Leadership and Contact

Lindsay Cowell, Ph.D.

Lindsay Cowell, Ph.D.

Associate Professor, Peter O'Donnell Jr. School of Public Health