[00:00:00] Adam Walker: Join us as we celebrate Black History Month where we’ll honor Komen researchers dedicated to helping us reduce health disparities in Black women, encourage Black women to know their family history and risk factors, and empower Black women to share their personal stories. Together, we Stand for H.E.R. – a Health Equity Revolution.
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From Susan G Komen, this is Real Pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.
A range of factors can contribute to the development of breast cancer, a fact that Dr. Lauren McCullough, an Atlanta-based breast cancer epidemiologist, knows all too well. She studies a wide-range of contributing factors – from race and ethnicity, to genetics and other biomarkers. Black women are still diagnosed at later stages, with more aggressive tumors and are less likely to survive. But advances in research are leading to improvements in breast cancer care for Black women, and for all women. Here to tell us about her research and the advances we might see in the future is Dr. Lauren McCullough. Thank you for joining us; we’re so pleased to have you with us today!
Dr. McCullough, thank you for joining us on the show today. Thank you for having. Well, I’m, I think this is so important to talk about. Um, and I really appreciate you joining us today. So let’s start with what led you to get involved in breast cancer. Yeah.
[00:01:43] Dr. Lauren McCullough: So I’ve, I’ve always, I guess, had an interest in thinking about cancer.
My father was diagnosed when I was a sophomore in college and he used to come to his cancer pretty quickly. It was long. Um, and so from there I thought, you know, maybe I would go to med school and become an oncologist and. Um, when I got some, a Harriet medical college, I realized that many of the questions and thoughts I had about cancer, how it was diagnosed, how it was treated, how people were, you know, living, surviving their cancers.
Many of those questions and intriguing factors weren’t necessarily be being, you know, addressed in my anatomy and physiology classes. Um, and I thought about things like the social environment, you know, the, the built environment. Social and structural factors. Um, and so I decided that being a researcher was probably a better fit for all of my questions.
And in breast cancer, sort of emerged as an important cancer one because, um, I knew the disparities were just so great. It disproportionately affected African-American. Women. Um, but then also, because there are a lot of grassroots organizations that, um, you know, really have centered around breast cancer.
And so the availability of funding and the ability to really make an impact was also there for breasts. So that’s, that’s how I got into cancer. And then specifically in the breast cancer.
[00:03:07] Adam Walker: Oh man, I love your focus on making an impact and it feels like this is, this is great research and. Uh, for helping to make an impact for so many people.
Um, so I know you described your work as about, as being about exploring what goes on above the skin and below the skin. What do you mean by that?
[00:03:28] Dr. Lauren McCullough: Good question. Um, so yeah, that’s, that’s kind of my mantra. What I mean, is that typically when we think of ourselves as researchers or, you know, specialists in certain disease sites, you usually come at it from one angle, you know, either you’re biologically-based or you think more about the social assets.
But I think about it from a total person perspective and you can’t separate their biology from their social environment. And I think it’s, we have to, as, as researchers and scientists break out of the silos and these boxes that we tend to put ourselves in and start to think more holistically, you know, the way people live and interact and experience the world.
And so. Um, I think it’s important if we’re thinking about social constructs and factors, you know, you don’t just experience racism or discrimination or a poor food environment or lack of access that’s manifested in some way, biologically, whether it’s through immune response or inflammation. That actually drives cancer.
Cancer is a disease of sales. And so there has to be a biologic manifestation. And so really understanding how those typically brought up social factors get under the skin, um, is, is one of the important areas of our research group.
[00:04:44] Adam Walker: Okay. And so what have been some of the key findings from your disparities research so far?
[00:04:52] Dr. Lauren McCullough: Yeah. So our first big paper was published in 2019 and that really set the stage for all the work that we have done since then. And so what we were really interested in was just broadly understanding differences by race, by a number of different factors. And so a few highlights are there. We found that women with low stage breast cancer, um, still had big disparities.
So we know that black women are more likely to be diagnosed with late stage, which drives mortality, but even women with early stage disease, black women are more likely to end up dying. Another factor was that, um, women with ER, estrogen receptor positive disease, um, which really had. Effective treatments.
Um, black women are more likely to die. Um, whereas those that are estrogen receptor negative or triple negative, those tend to be more aggressive. Um, the disparities weren’t as great. And so really what we’re seeing are big disparities and disease, subtypes of breast cancer. That we have good treatments for.
And so, you know, from a very basic perspective, we shouldn’t be seeing differences if we have those treatments available in their effective. And then the last major finding was that, um, we know how much socioeconomic status or SES is related to almost every health outcome. What we found was that even women that lived in higher socioeconomic neighborhoods, black women worked twice as likely to die in their white counterparts, living in those same neighborhoods.
So, you know, that really is counterintuitive to, I think the paradigm that we’ve been existing under, which is, you know, get people in education, get them access, put them in better neighborhoods. They should have better outcomes. For breast cancer, at least in Atlanta, that just wasn’t the case. We still are seeing, you know, black women being twice as likely to die.
And so those three findings have really, um, propelled the research that we’ve done since that initial paper.
[00:06:54] Adam Walker: Um, so I know you may not have a definitive answer to this next question, but, but maybe, maybe you can give us a working theory or some thoughts, but why. Our outcomes for black women with breast cancer, much worse than their white counterparts, despite similar, like you said, socioeconomic statuses and other seemingly favorable factors.
[00:07:14] Dr. Lauren McCullough: Yeah. So all the working hypothesis, but you know, one of the things that I think we failed to do as a science is to really understand the structural. Um, barriers and thinking about health inequities. And I think the COVID pandemic really highlighted that, um, you know, racial and ethnic minorities experience, substantial barriers, um, in terms of, you know, comorbid conditions, um, sort of the long-term effects of, of, of racism and discrimination in this country and stress.
Um, the, the physiologic and psychologic effects of just being black in America and how that may impact a woman’s ability to navigate, navigate these systems during post-diagnosis. And so really going back to basics, um, and, and understanding how, you know, structures and policies. Impact breast cancer.
Mortality is kind of where we are. And when we’ve, we’ve seen some interesting things with redlining, you know, having an association with mortality, residential, racial segregation, um, and even things around social cohesion, just being around people that look like you and understand you, and they can relate to some of your experiences or things that we’ve never previously considered in research and, and, and are very important.
Um, when you consider the demographics. And so understanding that, and then again, how those things get under the skin, how are they biologically manifested? Um, we’re seeing changes and, and the epigenome, which is, um, a layer on top of your genome, which is now liable. Um, and other changes in biologic markers from some of these exposures.
So that’s where our research is moving and where I think the field is, is moving.
[00:09:03] Adam Walker: Hmm. Okay. So, so moving in a different direction here and onto another topic, um, we’ve talked on this show a lot of times with a lot of guests about clinical trials. And I’m curious, do you encourage black women to participate in clinical trials and why or why not?
[00:09:21] Dr. Lauren McCullough: Yes. So I think it’s, I think it’s really important. Um, we know that they have been systematically excluded from trials in the past, and I think that that actually has important implications for why we’re seeing disparities. Um, we’ve seen, for example, with certain, um, Certain, I guess, tests like Oncotype, where they use these tests to determine whether or not a woman shouldn’t get a certain therapy.
Well, those, those models weren’t creating. Using a representative sample of people. So they weren’t created with black women in those trials. And so those models don’t necessarily work for our population. And so I think it’s really important if we’re going to have, you know, predictive tests of recurrence or we’re going to have new treatments and those treatments need to be tested.
And vetted in women and all women that are going to receive them, irrespective of race, ethnicity, or, you know, the presence of a comorbid condition like obesity. Um, so it is really important because we don’t know how effective they are, unless they are rolled out in, in a very diverse population. So. It is important that we, we have, um, women of color participating in trials.
It’s also important that our providers and clinicians who are leading those child’s in running those trials, um, are, are aware of, of the barriers to participation in, are able to, um, communicate effectively, um, the potential risks, potential harms limitations, benefits, so that women are able to make an informed decision about whether or not, you know, that trial is.
[00:10:58] Adam Walker: Yeah. Yeah. That’s so important. So bring it more to you personally here. I’m curious. Has anyone in your life been diagnosed with breast cancer or some other type of cancer? And has that given you any insights from their experiences?
[00:11:13] Dr. Lauren McCullough: Yes. So, you know, I guess Sarah DigitasLBi I’m in cancer, um, because it’s a disease that affects my family.
So my dad. I was diagnosed with lung cancer. His father had prostate cancer. My uncles had prostate cancer. Okay. Two aunts with breast cancer and vaginal cancer. Um, and you know, I think the experiences that I’ve had with each of them beginning with my dad just navigating the cancer system. It’s overwhelming.
Um, so I did it as a 19 year old, back in 2002, and I bet it most recently in, in 2018, and it didn’t necessarily get any easier to site. All of this knowledge that I have about cancer and all this education I have when I’m trying to navigate the system with my aunt, it was still incredibly complex, even for a person that lives, you know, and, and works in an area in, in this space.
And so, um, really. Seeing some of the challenges and barriers up front and talk about delays, delays in treatment, and you know, non-adherence to long-term therapies. I can see why there are delays and non-adherence because the system is difficult to navigate. Um, and so some of those experiences has made me a real advocate for interventions, like having nurse navigators or patient navigators, just to help patients.
Remember the many medications they have to be on and the many treatments and dealing with the side effects and you know, all of these things. It really, um, unless you’ve been through it yourself or with someone firsthand, it really is a, it’s a tough thing to wrap your head around. And so. Um, when I’m thinking about disparities, I’m thinking about it from seeing my own loved ones, try and navigate those systems and the decisions that have to be made every day.
Like, do I really want to take this medicine? That’s going to make me feel really crappy. And then I can’t go to work and make money to put food on my table. Like those are real decisions for people. Um, and I think we have to be sensitive and aware of that, um, when, when we’re doing our research and, and when we’re treating.
[00:13:19] Adam Walker: Hmm. Yeah, that’s, that’s really important. I appreciate you, you just bringing that perspective and giving us that, that personal insight, um, So tell us then about your relationship with Susan G Komen. Yes.
[00:13:33] Dr. Lauren McCullough: So when I first arrived in Atlanta, um, in 2016, um, at Emory, there was a task force that was built around reducing disparities in Atlanta and Coleman was a representative on that task force.
So I met with the then director, um, Katie stone and, um, you know, Sort of created a friendship around our mission to, to improve outcomes and low income and minority women. Um, and from there, I just really got involved with Coleman Atlanta, you know, whether it was sitting on their sisters of promise advisory board or being at the walks and talking to women and their friends and caregivers about, you know, what is breast cancer?
What’s the latest research, just wanting to be a part of the efforts and, and wanting to not just be in the background, doing research, but also. Seeing the faces and put in the names to the data that we look at every single day. Um, and from there, you know, I became a co common scholar, um, submitted a research proposal to Coleman, and I was fortunate enough that it was funded.
And so continuing to do that research and, and being able to share with the common community has, has really been a highlight of, of my work cheering.
[00:14:44] Adam Walker: Wow. That’s fantastic. So last question, uh, Dr. McCullough, you are a researcher, so I would assume that that kind of makes you very forward-thinking right.
And so what do you think the future might look like in terms of breast cancer? What are you hoping for? What even seems possible.
[00:15:03] Dr. Lauren McCullough: Well, you know, I think one of the biggest things is around precision medicine. Um, can’t have a discussion about research and cancer and not talk about, you know, the precision medicine that’s coming up.
Some of the newer therapies and technologies where, you know, you can target. Specifically your cancer, you know, the genetics of your cancer, the makeup of your cancer. And I think, you know, thinking about the latest and greatest in terms of immunotherapy and there, right? The targeted therapy is, is all very important and is certainly going to be impactful for, for a lot of people’s lives.
Um, you know, my job is to make sure that, that those therapies. Equitably assessable. Right. Um, making sure that everybody has an opportunity to, to receive those. And, um, I do think we’re going to make a lot of headway and treating cancers that have traditionally been difficult to treat like the triple negative breast cancer.
Um, but also think this other piece of understanding, sort of the structural and social barriers that certain, um, groups, um, experiences is going to make a huge impact, um, is changing the way we think about treating our patients is changing the way we look at our own biases. Um, and, and I think that’s really going to be impactful for, for those individuals who have traditionally been left out of the four progress.
Um, and, and cancer work.
[00:16:26] Adam Walker: Hmm. Yeah, that’s right. Well, I’m very hopeful, uh, that your research will make a huge impact on breast cancer and really appreciate and value the work that you do for this community. So, uh, Dr. McCullough, thank you so much for joining us on the show.
[00:16:41] Dr. Lauren McCullough: Thank you so much for
[00:16:42] Adam Walker: having me.
Thanks to Ford Warriors in Pink for supporting the Real Pink Podcast. To learn more about their transportation grant program and other efforts to help breast cancer patients, visit ford cares dot com
Thanks for listening to Real Pink, a weekly podcast by Susan G Komen. For more episodes, visit RealPink.com. For more on breast cancer, visit Komen.org. Make sure to check out at Susan G Komen on social media. I’m your host, Adam, you can find me on Twitter @AJWalker or on my blog, AdamJWalker.com