Our Story:

South Carolina has some of the worst health indicators in the United States. For a number of cancers, we have the highest incidence rates in the world. Due to a combination of a tendency toward very aggressive disease and poor access to good health care, South Carolinians die of cancer at alarmingly higher rates than people elsewhere in the country and the world.

Much, though not all, of what drives our high rates of diseases in relation to other areas of the United States are the marked disparities evident in African Americans in comparison to their European-American counterparts. While some of the differences are related to socioeconomic factors that determine access to care, we are pretty much in the dark regarding many of the true, underlying causes.

The Cancer Prevention and Control Program (CPCP)’s founding (and current) director, Dr. James R. Hebert, was recruited to the University of South Carolina in late 1999 to lead the Department of Epidemiology and Biostatistics. He came with a strong track record of research and service in cancer epidemiology and in the dietary causes of illness. After three years, he decided that in order devote his full attention toward the cancer-related health disparities so starkly apparent here, he would have to step down from the chairmanship of the department. The CPCP was created in 2003, shortly after his transition, in order to address issues ranging from:

• the genetic, lifestyle-related, and environmental causes of cancer; to
• screening for early detection and primary prevention of certain cancers; to
• access to care; to
• cancer survivorship.

In an effort to describe the magnitude of the challenges we face in addressing cancer-related health disparities, the CPCP spearheaded the August 2006 symposium issue of the Journal of the South Carolina Medical Association.^1-8 This represents collaboration among every major organization dealing with cancer in South Carolina. The seven scientific articles dealing with the epidemiology and prevention of breast, cervix, colorectal, esophagus, lung, oral cavity, and prostate cancers; three editorials; and four response pieces by community members were authored by a total of 47 authors from around South Carolina including academicians, practicing physicians, and community activists. Of the 36 authors of the seven scientific articles, ten are junior faculty CPCP members at the University of South Carolina and eleven are current or former students of USC’s Arnold School of Public. This issue is unprecedented in a number of ways, including inviting community members to author opinion pieces in a peer-reviewed medical journal.

Virtually all of the University of South Carolina’s epidemiologic cancer research is conducted in the CPCP, which defines as part of its mission linking to the basic science laboratory, the clinic, and the community through community-based participatory research (CBPR). Our program is dedicated to discovering the underlying causes of some of the largest cancer disparities in the world, especially those in African Americans in comparison to their European-American counterparts. Much of the work of the CPCP focuses on modifiable risk factors, primarily those related to diet and physical activity; gene-environment interactions; circadian biology; and social deprivation.

In the processes of discovery, education, and service, CPCP members collaborate and publish with hundreds of scientists at institutions around the country and the world. We also realize that no matter how well-meaning, research conducted elsewhere - or spearheaded by scientists based elsewhere - will not lead to practical advancement of knowledge as to why rates of many cancers are so much higher in South Carolina than in other places. Because African Americans in South Carolina represent a population genetically more similar both to the “progenitor” West African population and to the 55% of African Americans who reside in the Southeastern United States,9 research conducted here may have profound implications for high-risk populations in this region and beyond. The CPCP’s aim in discovery is to inform people and organizations who are willing and able to make a difference in the fight against cancer. Because cancer is but one (albeit an important one) consequence of risk factors that determine an array of health outcomes, as we make progress against this terrible set of diseases there will be many other benefits to the communities and families whose members are afflicted with cancer.

The discrepancy between cancer rates among African Americans and findings from epidemiologic studies conducted elsewhere that purport to tell us about their “causes” clearly indicate that we must dig deeper to understand the real causes of cancer. Therefore, a major goal of CPCP research includes designing and carrying out epidemiologic studies. We also realize that accumulation of new knowledge cannot be our only goal. We must work with communities to disseminate successful programs that can alter the community’s likelihood of getting, or succumbing to, cancer – such as tobacco cessation, cancer screening, and community-based dietary and physical activity programs. Currently, the CPCP supports and conducts projects in each of these areas. With additional resources, our reach and overall effectiveness would increase.

CPCP leadership strongly believes that competent research can and should be conducted as part of serving our constituency, which includes improved access to both preventive services and curative care. A goal, of course, is to address the full range of prevention (from primary prevention to palliation of symptoms and reduction of suffering). Another goal is to go beyond outreach. Our intention is to engage; we begin from an understanding that no one person or group has all the answers. It is our collective intelligence and wisdom that will meet the challenge of reversing these cancer disparities. A central tenant of community-based participatory research (CBPR) is that the community engages with the researchers, as equal partners. The CPCP and its South Carolina Cancer Disparities Community Network, one of 25 centers funded through the National Cancer Institute’s Community Networks Program and the major portal for community involvement in cancer research, education and training, was designed specifically to employ CBPR in addressing our cancer disparities by engaging those individuals and communities at greatest risk of getting and dying of cancer.

As the supporting documents indicate, the CPCP has made rapid progress in its short existence. Our goal now is to enhance our effectiveness with a strategic application of resources that buttress areas of strength while building additional capacity. Over the next two years we intend to make material progress in achieving these objectives:

1. Strengthening programs that provide services to the community while enabling and enhancing research opportunities to deepen our understanding of cancer causes – we are committed to providing support to communities that extends beyond what normally would be considered under existing sources of funding
2. Expanding a physical infrastructure that invites the community into the world of research – so much of what is done by biomedical researchers is done to people at risk rather than inviting them into a space in which community members can work with academicians and others interested in improving health
3. Providing support for faculty who choose to dedicate themselves to CBPR – this is a difficult area in which faculty are often discouraged because conventional funding sources and means for professional advancement are oriented away from the more “messy” world of the community and toward the simpler, though usually less effective, reductionist (usually high-tech) laboratory-based science
4. Developing a training program for African Americans that would range from baccalaureate to postdoctoral – our intention would be to provide role models, opportunities for research and service, and financial support for both formal programs of study and projects conducted in and with the community

None of these objectives can be supported using conventional means of funding. The CPCP is strongly committed to integrating service, education, and research and in engaging the community in each of the three and in their affective coordination and integration. Therefore, we are seeking funding to support a highly innovative program that has great promise for addressing some of the most serious health disparities in this country; indeed, in the world. We will use these resources to build stable support structures that will enable the kind of dialogue and working relationships that will be a model for individuals, communities, and institutions throughout the world.