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A robust, multiyear, community-focused strategic plan to prioritize cancer interventions and research results in enhanced outreach and funding to erase cancer disparities.

When Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer, joined Cedars-Sinai in 2018, he launched a multimillion-dollar initiative to grow the size, reputation and impact of the center. As part of this undertaking, the center formed the Community Outreach and Engagement team and began identifying community needs and opportunities to implement best practices for research and care.

Before the team could identify community needs, they had to define the community. Los Angeles County is one of the most diverse communities in the nation in terms of race, socioeconomic status and gender. While patients come from around the world to receive care at Cedars-Sinai Cancer, 87% of our patients live in L.A. County, making it a natural catchment area for focused study and community-tailored care delivery.

To better understand the catchment area’s population makeup and cancer-related needs, the team launched an extensive neighborhood-level geospatial mapping project. With information from national and statewide surveillance and registry databases and local public health surveys, researchers set out to uncover specific disparities in cancer screening, diagnosis and prognosis among community subgroups—information that was not discernible through county-level data.

The results of the study, published in Frontiers in Oncology in 2022, revealed numerous practical opportunities to improve health outcomes and diminish disparities for cancer patients in L.A. County.¹

Prioritizing Target Populations

The center’s neighborhood-level geospatial mapping of cancer—paired with more than 3,200 survey responses about cancer-screening behavior, medical history and healthcare access—informed a portfolio of funded research targeting understudied populations and health disparities.

“These surveys help us understand barriers L.A. County residents face that prevent them from getting screened for cancer,” said Zul Surani, associate director for Community Outreach and Engagement at Cedars-Sinai Cancer. “By creating relationships with churches, health clinics, nonprofits and other community organizations, we are learning how to help people overcome these barriers with the use of mobile mammography and the deployment of community health workers.”

The researchers noted an increased concentration of late-stage breast cancer diagnoses among women in Koreatown, in part attributable to low mammography rates caused by lack of health insurance and not feeling sick.

With information about the disparity and some of its root causes, researchers were able to provide targeted outreach to Korean women in the county. The effort enhanced access to and uptake of mammography through a study called “Faith in Action!,” a church-based navigation model to increase screening.

Preliminary analyses suggest the culturally adapted curriculum grew adherence to breast cancer screening guidelines to 68% from a baseline of 0%.

The geospatial study also revealed that, contrary to trends among white people, melanoma risk is increasing among Latinos in California, and their melanoma-related mortality is higher than that of other racial or ethnic groups. Armed with these insights, scientists piloted a program using community health aides and culturally tailored health communication materials to reach recently diagnosed Latino individuals and their families and improve education, prevention and care navigation.

Other priorities include increased human papillomavirus (HPV) vaccination outreach in the LGBTQIA+ community, promotion of clinical trial participation among groups that have been historically underrepresented in medical research, and smoking-cessation support groups at community-based organizations and federally qualified health centers. The overarching goal is to better serve Cedars-Sinai’s catchment area through targeted care initiatives as well as inclusive, informative research designed to reduce disparities and improve outcomes.

Research to Fill Knowledge Gaps

In addition to addressing immediate neighborhood-specific care needs, the Community Outreach and Engagement team focused on facilitating research endeavors to help close gaps in knowledge related to diagnostic and outcome disparities as well as understudied tumors and populations.

In 2010, bowel, lung, leukemia and prostate cancers received more than 10 times as much national cancer research funding as bladder cancer, despite the high incidence of the latter. Breast cancer received nearly 30 times as much.² Before 2018, Cedars-Sinai Cancer investigators held no federal grants supporting bladder cancer research. As of 2022, Cedars-Sinai faculty have garnered 10 federally funded bladder cancer initiatives, including a U54 (specialized center cooperative agreement), a P01 (research program project) and five R01 (research project) grants.

The newly funded bladder cancer research programs as well as endeavors targeting other groups that have been underrepresented in medical research have already yielded results:

• A mouse model study published in Science Immunology revealed that male sex hormones interfere with the body’s ability to fight bladder cancer. The finding may explain the increased risk and mortality of bladder cancer among men. The research revealed that androgens limit the anti-tumor activity of CD8+ T-cells and suggests that androgen-deprivation therapy may improve efficacy of tumor immunotherapy.³
• Research published in Nature revealed that the loss of the Y chromosome over time may allow bladder cancer cells to evade the immune system by paralyzing the body’s T-cells that are tasked with destroying the tumor.⁴ Fewer circulating fighter immune cells may contribute to more aggressive bladder cancer cells that have lost the Y chromosome. However, these Y-negative cancers also respond better to immunotherapy, leading researchers to explore a “loss of Y” chromosome test for tumors to select assignment to immune checkpoint inhibitor treatment for men with such tumors.
• According to a Cedars-Sinai Cancer study published in Gynecologic Oncology, Black women with endometrial cancer were less likely to have a hysterectomy than white women with the same cancer.⁵ They were also less likely to survive their cancer. Cedars-Sinai researchers conducted the study using data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database. They will repeat the study using neighborhood-level data from the California Cancer Registry to get a clearer picture of socioeconomic and environmental factors impacting patients with endometrial cancer. Investigators are also exploring the possibility of different genetic pathways for this subtype of cancer among Black and white women to help improve treatment decision-making for each population.

As these seminal scientific discoveries address regional and national knowledge gaps, our clinical and research teams address identified disparities through innovative community pilot studies and outreach programs. Together, these efforts demonstrate Cedars-Sinai Cancer’s unique commitment to transdisciplinary cooperation and translational impact and result in practice-changing advances both locally and globally.