Center to Reduce Cancer Health Disparities

ANNUAL REPORT FISCAL YEAR 2011
Cancer’s burden

 is not equally distributed.

There are differences

 in the incidence, prevalence,

 and mortality of cancer 

among specific populations 

in the United States.
The Center to Reduce Cancer Health Disparities (CRCHD) is the component of NCI 

dedicated to confronting these inequities, particularly in understanding how biological, 

environmental, social, and cultural factors contribute to differences in cancer prevention, 

care, and treatment. 

CRCHD is also central to the NCI’s efforts to train the next generation of competitive 

researchers in cancer and cancer health disparities, and in addition, is creating stateof-the-art regional networks/centers dedicated to cancer health disparities research, 

training, and outreach.

CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011
ii

A MESSAGE FROM THE DIRECTOR..................................................................................................................iv

INTRODUCTION...................................................................................................................................................1

REDUCING CANCER HEALTH DISPARITIES .............................................................................................. 1

NCI/CRCHD GRANTS AND CONTRACTS ................................................................................................. 4

MAJOR INITIATIVES AND PROGRAMS ................................................................................................... 7

PARTNERSHIPS AND COLLABORATIONS ................................................................................................ 9

MEETINGS AND TRAININGS .................................................................................................................14

PRODUCTS AND RESOURCES................................................................................................................19

RESEARCH..........................................................................................................................................................23

BASIC RESEARCH .................................................................................................................................23

Partnerships to Advance Cancer Health Equity...........................................................................................29

APPLIED RESEARCH..............................................................................................................................33

Community Networks Program Centers.......................................................................................................33

Patient Navigation Research Program ........................................................................................................51

DIVERSITY TRAINING ......................................................................................................................................55

DIVERSIFYING THE CANCER BIOMEDICAL WORKFORCE ........................................................................55

Continuing Umbrella of Research Experiences...........................................................................................56

Partnerships to Advance Cancer Health Equity ..........................................................................................70

Community Networks Program Centers ......................................................................................................76

CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011
iii

INTEGRATED RESEARCH, TRAINING, AND OUTREACH .............................................................................79

LINKING RESEARCH, TRAINING, AND OUTREACH ................................................................................79

Geographical Management of Cancer Health Disparities Program including 

Biospecimen Science......................................................................................................................................80

National Outreach Network...........................................................................................................................83

Linkage with NCI Community Cancer Centers Program.............................................................................87

APPENDICES......................................................................................................................................................89

DISPARITIES RESEARCH BRANCH .........................................................................................................90

DIVERSITY TRAINING BRANCH .............................................................................................................92

INTEGRATED NETWORKS PROGRAM.....................................................................................................94

ADMINISTRATIVE CORE ........................................................................................................................96

COMMUNICATIONS AND DISSEMINATION CORE ..................................................................................98

PERFORMANCE AND EVALUATION CORE............................................................................................. 100

LIST OF ACRONYMS ...........................................................................................................................102

Reducing cancer health disparities... 

It's possible.
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

iv

A Message from the Director

This past year marked the tenth anniversary of the Center to 

Reduce Cancer Health Disparities (CRCHD). As I reflect upon 

the Center’s past, present, and future, I am reminded of the words 

spoken by Martin Luther King, Jr., in his March 25, 1966 speech 

before the National Convention of the Medical Committee for 

Human Rights in Chicago: Of all the forms of inequality, injustice in 

healthcare is the most shocking and most inhumane.

Tremendous progress has been made in understanding cancer and 

delivering care. We have been able to bring advances in cancer 

research to African Americans, Alaska Natives, Asian Americans, Hispanics/Latinos, Native 

Americans, Native Hawaiians/Pacific Islanders, and other medically underserved communities. 

But much work remains to be done to eliminate cancer health disparities. More than 

forty years later, we still have not achieved a world where everyone has equal access to care. 

Disparities in cancer care and cancer outcomes continue to diminish the quality of life of some 

populations in this country, including the poor, racially and ethnically diverse groups, and 

those with limited or no access to healthcare. 

CRCHD was established with the sole purpose of confronting and eliminating these inequities. 

Over the past decade, the Center has tremendously broadened its focus and capacity. 

While our roots lie in community-based cancer health disparities research, that focus 

has been complemented with basic research, as the growing body of evidence has 

taught us that cancer is not a single monolithic issue but, instead, one to which many 

socioenvironmental and genetic factors contribute. This broader view has enabled a more 

complex picture of the roots of cancer disparities to evolve and, along with that, bettertargeted, more precise interventions.

As the nation’s population continues to grow more ethnically and racially diverse, it has 

become increasingly important to ensure that the science conducted encompasses diverse 

perspectives to address the health needs of all people. CRCHD is fully dedicated to training 

the next generation of competitive researchers from racially and ethnically diverse, and 

underrepresented populations in the cancer and cancer health disparities fields. CRCHD 

continues to lead the National Cancer Institute’s (NCI's) efforts in supporting research 

training and career development experiences beginning as early as high school and 

continuing through to tenured track appointments. 
v

CRCHD has spawned a broad range of research, training, and community outreach 

activities to address its overarching goal of eliminating disparities through a variety 

of programs: Continuing Umbrella of Research Experiences (CURE), Partnerships to 

Advance Cancer Health Equity (PACHE), Community Networks Program (CNP), 

and Patient Navigation Research Program (PNRP). The Center has also fostered an 

unprecedented, state-of-the-science, integrated network infrastructure and geographic 

system of program management to promote a multidisciplinary and transorganizational 

team science approach that will ultimately enhance cancer health disparities research, 

diversity training, and cancer care outcomes.

In this first report from the Center, we are pleased to share with you an overview of who we 

are, what we do, the impact of our programs, and highlights of our research and training 

from Fiscal Year 2011. NCI/CRCHD’s support, together with the tremendous motivation 

and efforts of our grantees, has resulted in significant strides in understanding cancer health 

disparities and real differences in people’s lives. 

We will continue to build upon these successes in the coming years. At the same time, we 

know we must work harder still to reduce the unequal burden of cancer that still exists in 

this country. CRCHD is unwavering in its commitment to moving us closer to the day when 

diversity is a given and disparities no longer exist.

Sanya A. Springfield, Ph.D.

Director

Center to Reduce Cancer Health Disparities 

National Cancer Institute
Expanding our 

understanding of 

the biological, 

behavioral, and 

socioeconomic roots 

of cancer 

health disparities 
1

INTRODUCTION

1

The National Cancer Institute’s (NCI’s) Center to Reduce Cancer Health Disparities 

(CRCHD) is pleased to present CRCHD's Annual Report on Cancer Health 

Disparities: Fiscal Year 2011. This first Annual Report describes who we are and what 

we do. But more importantly, we wish to share the impact of CRCHD’s efforts to enhance 

the understanding of the biological and nonbiological causes of cancer health disparities, 

increase the diversity of the cancer research workforce, and reduce the unequal burden of 

cancer in the United States. The report provides an overview of the CRCHD-supported 

research and training programs in this field, and highlights selected projects, investigators, 

and partnerships that represent the range of research addressing different cancers, training, 

and community outreach efforts supported by a variety of NCI grant mechanisms. 

Over the past decade, CRCHD has made significant contributions to advancing the science 

of cancer health disparities and diversifying the cancer research workforce. Today, as a 

result of CRCHD initiatives, access to quality care is increasingly available to communities 

experiencing an excess burden of cancer. Our understanding of the biological, behavioral, 

and socioeconomic roots of cancer health disparities is expanding, resulting in improved 

cancer outcomes. In addition, more cancer research training opportunities are available to 

those who, historically, have been underrepresented in the sciences. 

Yet, much work remains to be done to reach the ultimate goal of elimination of cancer 

health disparities, which continue to diminish the quality of life of some populations in 

this country, including the poor, racially and ethnically diverse groups, the disabled, and 

those with limited or no access to healthcare. A close look at cancer incidence and mortality 

statistics reveals that certain groups, such as African Americans, Alaska Natives, Asian 

Americans, Hispanics/Latinos, Native Americans, Native Hawaiians/Pacific Islanders, and 

underserved whites, are more likely than the general population to suffer disproportionately 

from cancer and its associated effects, including premature death.

CRCHD’s work in the future will continue to identify and foster new and innovative 

scientific training and research opportunities and build upon past successes, so that cancer 

health disparities no longer add to the burden of disease for anyone in America. 

INTRODUCTION

reducing cancer 

health disparities
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

2

About CRCHD 

CRCHD first began tackling the issue of cancer health disparities in 2001, when it was 

created as an expansion of NCI’s Office of Special Populations Research—an office that had 

been established in 1996 to manage research that addressed health issues relevant to racially 

and ethnically diverse, and underserved populations. CRCHD (“the Center”) grew over 

the next decade, particularly in its funding for population-based research, and expanded 

further when it merged with the Comprehensive Minority Biomedical Branch (CMBB) in 

2007. This merger helped provide the critical infrastructure needed to spawn new research 

examining the biological basis of cancer disparities. The combined resources and expanded 

focus enabled NCI, for the first time, to link cancer health disparities research and diversity 

training, thereby establishing a firm foundation for the development of innovative scientific 

programs geared towards improving outcomes in communities experiencing an excess burden 

of cancer. Now, in its second decade, CRCHD is poised to make an even greater impact on 

cancer health disparities reduction across the nation and the globe.

Who We Are 

CRCHD is one of the Divisions, Offices, and Centers (DOCs) within NCI, and the 

cornerstone of NCI’s efforts to reduce the unequal burden of cancer in our society. Since 

its establishment, CRCHD has tremendously broadened its focus and capacity. While the 

Center’s roots lie in community-based participatory research (CBPR)—a unique approach 

to examining and reducing cancer health disparities by actively engaging communities in the 

research process—that focus has been complemented more recently with basic research, as the 

growing body of evidence has taught us that different population groups may have biological 

differences associated with various cancers. This broader view allows a more complex picture 

of the biological, behavioral, and socioeconomic roots of cancer disparities, and sets the stage 

for better-targeted, more precise interventions and community outreach.

CRCHD is also dedicated to training the next generation of competitive cancer and cancer 

health disparities researchers from underrepresented populations, who otherwise are at risk 

of being lost from the training pipeline, and creating a workforce that reflects an increasingly 

diverse America. Funding and training opportunities are provided across the academic 

continuum, for those as young as high school students to those who have already achieved 

research independence. Their diverse perspectives are critically important in ensuring that 

science addresses the health needs of all people.
1

INTRODUCTION

3

What We Do 

CRCHD takes a comprehensive approach to carrying out its mission and 

conducts the following activities:

•	 Spawns, supports, and evaluates basic, clinical, and population-based 

research that shows the greatest potential for identifying biological, 

behavioral, and socioeconomic determinants of cancer health disparities

•	 Supports translational research that integrates cancer research findings 

into community practice 

•	 Promotes research that incorporates new technologies, such as 

genomics, proteomics, bioinformatics, biospecimen science, and 

nanotechnology to achieve improved cancer outcomes 

•	 Advises, engages, and supports researchers across a range of disciplines 

and theoretical frameworks

•	 Engages racially and ethnically diverse and underserved communities 

in the research process to ensure that research, outreach, and education 

efforts are culturally tailored to meet their needs

•	 Develops innovative and comprehensive training programs aimed at 

increasing diversity in the cancer research workforce 

•	 Promotes an integrated, multisite, transdisciplinary, team science 

approach to enhance research, training, outreach, and education in 

cancer health disparities 

•	 Forges long-term, comprehensive partnerships between academic 

institutions serving underrepresented populations and NCI-designated 

Cancer Centers to build research and training capacity and improve 

effectiveness of disparities research and outreach to underserved 

communities

•	 Advises NCI, the National Institutes of Health (NIH), the Department 

of Health and Human Services (HHS), other federal and nonfederal 

organizations, and the media on cancer health disparities research to 

reduce the disproportionate burden of cancer, and on training programs 

to achieve diversity among cancer investigators
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

4

In Fiscal Year 2011 (FY 2011), NCI invested $105,544,378 in health disparities research, 

training, and integrated networks projects via extramural grants (projects conducted outside 

of NIH), cooperative agreements, contracts, and supplements overseen by CRCHD. 

As indicated by the funding trend in Figure 1, the Center has seen a steady growth in 

expenditures since its inception in 2001 until 2009, with funding remaining relatively flat 

over the past two years. 

0

20,000

40,000

60,000

80,000

100,000

120,000

2001 2002 2003 2004 2005 2006 20072 2008 2009 2010 2011

$46,814

$57,614

$68,133

$73,218

$85,731 $88,141

$104,965 $106,328 $105,544

$94,844

$86,997

Dollars in Thousands

CRCHD Division-Controlled and RPG Actuals1 FIGURE 1 Across FY 2001-2011

CMBB Budget CRCHD Budget

1 Includes Division Controlled Awards, RMS, CRCHD Controlled RPG Awards, and NCI Controlled RPG Awards.

2

 Reflects merger of CMBB & CRCHD.

 

2011 Results

nci/crchd grants 

and contracts
1

5

The accompanying pie chart in Figure 2 indicates the distribution of funding by program 

and operations (Research Management Support [RMS]). Diversity training accounts for 

almost one-third of the budget, which includes the Continuing Umbrella of Research 

Experiences (CURE), as well as Research Project Grant (RPG) Diversity Supplements and 

P50s. An additional third of the budget funds the Partnerships to Advance Cancer Health 

Equity (PACHE) program (formerly known as the Minority Institution/Cancer Center 

Partnership program [MI/CCP]). PACHE supports both training and basic research through 

partnerships between NCI-designated Cancer Centers and institutions serving primarily 

racially and ethnically diverse populations. Nearly one-quarter of the budget is devoted to 

Community Network Program Centers (CNPCs), the basis of which are CBPR programs. 

INTRODUCTION

FIGURE 2 CRCHD FY 2011 Division-Controlled & Diversity Supplements

Partnerships to 

Advance Cancer 

Equity (PACHE)

35%

Specialized CURE 

Supplements, 

Careers, and NRSAs

18%

RPG Diversity 

Supplements 

& P50s

13%

Community

Network Program

Centers (CNPC)

22%

Integrated Networks Program (INP) 5%

RMS

6%

CRCHD 

Diversity 

Training 

Programs
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

6

Figure 3 provides a breakdown of the most recent addition to CRCHD’s programmatic 

portfolio, the Integrated Networks Program (INP), which accounts for 5% of the total 

budget. Almost two-thirds of the INP budget is spent on National Outreach Network 

(NON) programming, with the remainder supporting the Geographical Management of 

Cancer Health Disparities Program including Biospecimen Science (G/BMaP).

Figure 4 breaks down CRCHD’s diversity training programs by funding mechanism. The 

bulk of funding (39%) supports diversity supplements, followed by 36% of funding that 

supports career development awards. 

FIGURE 3 Integrated Networks Programs FY 2011

NON

Supplements

62%

G/BMaP

Supplements

38%

Diversity

Supplements

39%

Career

Development

Awards

36%

Specialized CURE Supplements 10%

 • Cancer Centers Supplements

 • Cancer Education Supplements

NRSA

12%

SPORES & Other Supplements 3%

FIGURE 4 CRCHD Diversity Training Programs FY 2011
1

INTRODUCTION

7

In 2011, CRCHD supported three types of programming: 

research, training, and integration of research, training, and 

outreach via multidisciplinary teams across regions. Each type 

supports CRCHD’s mission to reduce the burden of cancer and 

its related co-morbidities, and increase the diversity of the cancer 

research workforce. 

Research

CRCHD’s research portfolio is currently divided into two 

principal areas—basic research and CBPR. Investigators 

conducting basic research focus on biological variations 

across racially and ethnically diverse populations that either 

naturally or in conjunction with environmental exposures 

lead to differences in susceptibility to cancers and therapeutic 

responsiveness. Many of these basic scientists are integrated 

into CRCHD’s Partnerships to Advance Cancer Health 

Equity (PACHE) program, which builds linkages between 

academic institutions serving underrepresented populations 

and NCI-designated Cancer Centers. Others interested in basic 

science enter through the Continuing Umbrella of Research 

Experiences (CURE) training program, which offers an array 

of cancer research training opportunities for individuals from 

underrepresented populations. 

Basic research is a relatively new area of exploration for CRCHD. Historically, the 

Center’s strength lies in its CBPR paradigm and programs, including the Community 

Networks Program (CNP) and its expanded successor, Community Networks Program 

Centers (CNPC), designed to significantly improve access to and use of beneficial cancer 

interventions in disparity communities. Communities, in collaboration with trained 

researchers, participate in all aspects of research, training, and outreach, including helping 

to define their particular problems that lead to disparities and solutions that are culturally 

major initiatives 

and programs

RESEARCH, TRAINING, 

AND INTEGRATED RESEARCH, 

TRAINING, AND OUTREACH

Partnerships to Advance Cancer 

Health Equity (PACHE)

Continuing Umbrella of Research 

Experiences (CURE)

Community Networks Program (CNP)

Community Networks Program 

Centers (CNPC)

Patient Navigation Research 

Program (PNRP)

Integrated Networks Program (INP)

Geographical Management of Cancer 

Health Disparities Program including 

Biospecimen Science (G/BMaP) 

National Outreach Network (NON)

NCI Community Cancer Centers 

Program (NCCCP)
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

8

sensitive to their needs. A number of these research projects and associated grantees are 

featured within this report. Also described in these pages is CRCHD’s Patient Navigation 

Research Program (PNRP), which has been testing the theory that patient navigators—

experts in the healthcare system and its intricacies—can improve service access and quality, 

and cancer outcomes in underserved populations.

Training

In addition to sponsoring innovative research programs, CRCHD is committed to providing 

cancer research training to those from backgrounds underrepresented in the fields of cancer 

and biomedical science. Based on the belief that a diverse workforce is essential for advancing 

cancer knowledge and, particularly, cancer disparities knowledge, CRCHD developed two 

innovative and comprehensive diversity training programs—CURE and PACHE. CURE 

offers training opportunities for qualified, underrepresented individuals across the academic 

continuum, starting with high school students and extending to independent cancer 

researchers. CURE is particularly noteworthy in that it offers full funding to protect research 

time, incorporates important mentoring relationships with advanced researchers, and 

includes valuable networking opportunities. PACHE was developed to help expand highlevel training opportunities available to CURE trainees. The program fosters partnerships 

between NCI-designated Cancer Centers and academic institutions serving racially and 

ethnically diverse, and underrepresented communities. Profiles of trainees and partnerships 

are featured throughout this report.

Integrated Research, Training, and Outreach

The newest arm of CRCHD is the Integrated Networks Program (INP), which includes 

two network programs—the Geographical Management of Cancer Health Disparities 

Program including Biospecimen Science (G/BMaP) and the National Outreach 

Network (NON), and one collaborative initiative with the NCI Community Cancer 

Centers Program (NCCCP). Each of these programs supports a multidisciplinary, teambased approach to understanding and reducing cancer health disparities. G/BMaP is a 

national program that links CRCHD’s flagship programs—PACHE, CNPC, PNRP, and 

CURE—within six regional, disparities-focused networks for cancer health disparities 

research, diversity training, and resource-sharing infrastructure. NON is a program that 

bridges NCI-supported outreach and community education efforts with cancer health 

disparities research and diversity training programs by stimulating linkages among NCI, 

grantee institutions, researchers, and communities. CRCHD collaborates with NCCCP 

and provides technical support to the program’s health disparities efforts. INP’s preliminary 

accomplishments are outlined later in this report.

MAJOR INITIATIVES AND PROGRAMS
1

9

CRCHD has increasingly invested in building partnerships and fostering transdisciplinary 

collaborations. In FY 2011, the Center’s steadily growing foundation of partners allowed 

CRCHD to continue to leverage resources, recruit diverse talent, increase capacity, and 

improve access among underserved populations. As a whole, partnerships and collaborations 

provide the potential to accomplish much more than could be done by each partner 

independently—the ultimate criterion for a successful partnership.

NCI's Division of Cancer Biology

Since 2005, CRCHD has fostered a partnership with NCI’s Division of Cancer Biology 

(DCB) to strengthen CRCHD’s basic research portfolio and shed greater light on potential 

biological causes of cancer health disparities. DCB supports research in cancer cell biology, 

cancer etiology, cancer immunology, cancer hematology, DNA/chromosomal aberrations, 

structural biology, and tumor microenvironments—areas of basic science increasingly 

implicated in disparities. 

In 2011, in an effort to blend DCB’s basic research expertise and grantee base with 

CRCHD’s programmatic focus on disparity-experiencing populations, DCB and CRCHD 

created a basic science R21 Exploratory/Development Grant funding opportunity. This 

funding opportunity is designed to support pilot studies examining the interplay of 

race/ethnicity, and cancer biology, with a focus on novel techniques and issues such as 

biospecimens and ancestral markers. The collaboration has the potential to generate new 

insights into the biological determinants of disparities and direct otherwise disparate efforts 

toward one common goal. By combining their expertise, DCB and CRCHD can maximize 

their efficiency in illuminating the causes of cancer health disparities and the pathways to 

disparities reduction. 

INTRODUCTION

partnerships and 

collaborations
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

10

NCI’s Office of HIV/AIDS Malignancy

CRCHD has also forged a partnership with NCI’s Office of HIV/AIDS Malignancy 

(OHAM), enabling CRCHD grantees to expand their expertise to include HIV/AIDSassociated cancer disparities. In 2011, CRCHD and OHAM sponsored a supplement to help 

CRCHD’s PNRP, CNPCs, and U54 grantees investigate the role of HIV/AIDS in cancer 

health disparities. These projects benefit from cross-disciplinary partnerships that include 

a CRCHD principal investigator and his or her research team, an academic partner who 

conducts research on HIV/AIDS, and a community partner. 

NCI’s Center for Cancer Research

CRCHD also has a strong partnership with NCI’s Center for Cancer Research (CCR), home 

to 250 scientists and clinicians who conduct research intramurally at NCI. Increasing the 

diversity of this intramural research base, as a complementary effort to CRCHD’s attempts 

to increase the diversity of NCI’s extramural grantee research community, is an important 

component of CRCHD’s long-term training vision and CCR’s commitment to informing 

and empowering the cancer research community. 

As a result of this partnership, CRCHD encourages promising extramural trainees to 

apply for intramural NCI positions and training opportunities. These efforts are explicitly 

targeted at increasing the diversity of the intramural scientist population, encouraging a 

greater intramural focus on disparity questions, and enhancing the intramural community’s 

awareness of and ability to recruit and retain talented, underrepresented scientists. This 

partnership enhances the disparities research capacity of NCI as a whole and places NCI 

in a position to lead the nation in research workforce diversity and highly impactful cancer 

disparities research. 

NCI’s Division of Cancer Control and Population Sciences and 

NCI’s Division of Cancer Epidemiology and Genetics

Collaborations that combine research efforts and populations can expand the breadth and 

depth of the research each partner can perform. For example, by pooling data from multiple 

sites, investigators are able to analyze a larger cohort than would be possible if they proceeded 

individually. That is the goal of the multi-partner collaboration among CRCHD, CCR, 

NCI’s Division of Cancer Control and Population Sciences (DCCPS), NCI’s Division of 

Cancer Epidemiology and Genetics (DCEG), and extramural grantees such as MD Anderson 

Cancer Center; University of California, San Francisco; Vanderbilt-Ingram Cancer Center; 

and Wayne State University. Access to a large study cohort will enable these researchers 

to evaluate associations that would otherwise be statistically difficult, if not impossible, 

to examine in their studies of genetic contributors to lung cancer in underserved African 

American populations.
1

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National Institute on Minority Health and Health Disparities

CRCHD’s long-standing collaborative relationship with the National Institute on Minority 

Health and Health Disparities (NIMHD, formerly National Center on Minority Health 

and Health Disparities) is a natural fit, given a shared goal of eliminating health disparities. 

This aligned vision, complemented by CRCHD’s expertise in CBPR, brought CRCHD and 

NIMHD together to partner on an Intervention Research Phase Grant (R24) that funds 

CBPR initiatives to reduce and eliminate health disparities. In 2011, this R24 mechanism 

funded 14 CRCHD grantees. The potential for CRCHD and NIMHD to maintain and 

deepen collaborative efforts is strong, as both are committed to health disparities, albeit with 

CRCHD focused more strongly on disparities in cancer health. 

CRCHD also has partnered with NIMHD on the HHS-wide, globally attended health 

disparities conference, The NIH Science of Eliminating Health Disparities, co-chairing the 

NIMHD-led trans-NIH Planning Committee. In addition, CRCHD has participated in 

NIMHD’s Federal Partnerships Collaboration on Health Disparities, and in return, NIMHD 

has supported several CRCHD grantees. Through this partnership, both CRCHD and 

NIMHD can apply greater combined influence on the research agenda to include disparities 

issues and research workforce diversity. 

American Association for Cancer Research

One of the world’s premier 

cancer research organizations, the 

American Association for Cancer 

Research (AACR), has partnered 

with NCI/CRCHD for more than 

35 years. CRCHD has a special 

interest in supporting an adjunct 

group of AACR—Minorities 

in Cancer Research (MICR)—

founded in 1985. Originally a 

small group of physicians and 

researchers from backgrounds 

underrepresented in the biomedical 

sciences, AACR/MICR currently includes more than 4,000 members and continues to 

maintain a strong commitment to the issues of preventing and treating cancer in diverse 

populations, as well as training scientists from diverse backgrounds. 

INTRODUCTION
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

12

In an effort to promote the increased participation of underrepresented populations in 

cancer research careers, NCI and CRCHD help spotlight their contributions to science 

by co-sponsoring the AACR/MICR annual conference on the Science of Cancer Health 

Disparities. The conference brings together physicians, scientists, health professionals, and 

healthcare leaders working in a variety of disciplines to share the latest findings related 

to cancer genetics, epidemiology, and treatments; foster collaborative, interdisciplinary 

interactions and partnerships; and stimulate new research in cancer health disparities to 

better meet the needs of underserved populations.

As part of AACR’s Third Conference on the Science of 

Cancer Health Disparities in Racial/Ethnic Minorities 

and the Medically Underserved in 2011, CRCHD 

participated in the planning of a plenary session on 

global cancer research, an area in which the Center is 

seeking to be more active in the future. Global Cancer 

Research and Training: Collaborating Internationally 

to Improve Health Outcomes outlined the global 

cancer burden, as well as important differences in 

developing countries’ standards of care, clinical trials 

infrastructure, and research and training capacity. 

The plenary helped define challenges and goals for 

the next generation of cancer researchers who increasingly must engage with the impact of a 

globalized society on cancer and cancer health disparities.

CRCHD also sponsors the attendance of investigators from diverse backgrounds at 

the AACR Annual Meeting through R13 conference grants, in addition to early-stage, 

meritorious scientists from institutions serving underrepresented populations through 

the AACR Minority Scholars in Cancer Research Award. In 2011, CRCHD sponsored 

50 awardees. Part of the meeting is devoted to professional advancement topics such as 

grantsmanship and securing of funds, career development planning, publishing, laboratory 

setup, networking, and partnerships—all critical elements of the training process. These 

mutually beneficial sponsorships allow CRCHD to promote diversity training, as well as 

further AACR’s ability to spotlight the cancer health disparities work of its member scientists. 
1

13

American Cancer Society and Center for Medicare and Medicaid Services

One of CRCHD’s most prominent external partners is the American Cancer Society 

(ACS). Beginning in June 2006, CRCHD, ACS, and the Center for Medicare and 

Medicaid Services (CMS) collaborated to provide three annual training workshops for the 

organizations’ patient navigators. Collaboration was particularly important in developing 

these trainings. Each organization had recruited patient navigators—individuals who 

could help disparity populations better negotiate the barriers to accessing quality cancer 

care, such as those posed by low income, unreliable transportation, lack of insurance, and 

limited English and/or health literacy. However, the criteria for selecting patient navigators 

differed substantially across organizations in terms of professional experience, credentials, 

and biomedical familiarity. In addition, the parameters of a patient navigator’s work were 

unclear. Through their collaboration, these organizations developed a national standard for 

patient navigator competencies. 

The power and reach of the lessons learned at these training workshops were enhanced 

substantially through the creation of a network of associates at both the ACS/CRCHD 

organizational level and at the individual level among patient navigators with different 

affiliations and backgrounds.

Susan G. Komen for the CURE®

A new partnership with Susan G. Komen for the CURE® in 2011 resulted in an innovative 

session at CRCHD’s Cancer Health Disparities Program Meetings. The outreach and 

education session was designed to promote networking among National Capital Area (MD, 

DC, VA) health-related community outreach groups, NCI-supported cancer disparities 

researchers, members of the community, Komen, and NCI. Partnering with Komen enabled 

this unique gathering of a range of stakeholders to take place and gave individuals, who 

otherwise might not collaborate, the opportunity to work together in crossdisciplinary teams 

and brainstorm strategies to foster improved breast cancer care for at-risk and underserved 

women living in the National Capital Area. Building upon the success of this first joint 

effort, CRCHD is partnering with Komen again in 2012 on a community health expo 

promoting healthy lifestyles among racially and ethnically diverse communities.

INTRODUCTION
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

14

Cancer Health Disparities Program Meetings 2011 

(July 12-15, 2011)

CRCHD gathered more than 600 national and international cancer researchers, 

practitioners, trainees, students, and community activists to share new scientific advances, 

best practices, and resources at the 2011 Cancer Health Disparities Program Meetings. 

These Annual Program Meetings also serve to foster and expand creative and collaborative 

approaches to addressing cancer health disparities. Moreover, the meetings provide CRCHD 

grantees with the opportunity to interact with their colleagues, and with NCI staff and 

scientists. They also provide an opportunity for CRCHD staff to take stock of the Center’s 

many programs and the state of the cancer health disparities field. Participants at the 2011 

Program Meetings attended plenary sessions on new directions in disparities research, 

presentations of results from grantees’ studies, and individual programmatic meetings. 

PROGRAM 

CRCHD PROGRAM MEETINGS SIGNATURE

DESIGN OPTION 2, 3/23/2011

CRCHD PROGRAM MEETINGS SIGNATURE

DESIGN OPTION 3, 3/23/2011

meetings 

and trainings
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INTRODUCTION

15

Plenary Sessions

Plenary Session I – Basic and Translational Research 

for Cancer Health Disparities, moderated by Dinah 

Singer, Ph.D., director of NCI/DCB, focused 

on new developments in the understanding 

of biological mechanisms of cancer initiation, 

progression, and metastasis, as well as what the 

research can teach us about tailored community 

outreach and interventions. The session included 

presentations organized around three topics of 

discussion: genetics and epigenetics—biological 

differences; tumor biology and cancer health disparities; and imaging technologies, 

therapeutics, and tailored medicine.

Plenary Session II – The Influence of Cancer and Other Issues on Disparities Research, 

moderated by Robert Croyle, Ph.D., director of NCI/DCCPS, was organized around 

research that has examined co-morbid conditions and their influence on cancer and 

treatment practice. The session additionally focused on cancer as a growing cause of 

morbidity and mortality in Africa. The session addressed the following topics: co-morbid 

conditions, such as obesity and HIV/AIDS, in terms of their potential impact on cancer, 

treatment adherence, and delivery of care; obesity and cancer health disparities; and global 

health and Africa-U.S. cancer health disparities.

Plenary Session III – Envisioning Community-Based Participatory 

Research Strategies, moderated by Regina Smith James, M.D., 

Medical Officer, Division of Special Populations, National Institute 

of Child Health and Human Development; Cathy Meade, Ph.D., 

R.N., F.A.A.N., H. Lee Moffitt Cancer Center; and Dale Watson, 

M.P.H., Pinellas County Health Department, addressed community 

engagement and CBPR methods to ensure that culturally sensitive 

strategies are developed and implemented, and community trust is 

developed. Presentations highlighted the importance of including 

communities in key phases of research and community outreach/

education. The plenary session focused on the following three topics: 

acknowledgement of diversity and ethical issues in CBPR; CBPR 

strategies in action; and community involvement in research planning, implementation, 

design, evaluation, and dissemination phases.

CANCER HEALTH DISPARITIES PROGRAM MEETINGS 2011 
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Professional Development Workshop

Professional and career development skills are important aspects 

of becoming a successful investigator. Thus, an especially useful 

part of annual Program Meetings for CRCHD research trainees is 

the interactive Professional Development Workshop to enhance 

these skills. The 2011 Workshop was organized around the 

following topics: career path navigation for trainees and students; 

grantsmanship, including grantwriting and the grant application/

review process; and, new this year, extramural and intramural research 

opportunities at NCI.

As preparing a successful grant application is one of the most challenging aspects of being a 

successful health disparities researcher, CRCHD devoted a full afternoon during the 2011 

Professional Development Workshop to a mock review session. Mock reviews have proven 

to be a valuable tool for teaching scientists how to be successful in meeting the challenges 

of the grant application review process through learning about the criteria used for rating 

the applications. 

In preparation for the mock review, selected assistant- or associate-professor-level reviewers 

participated in two pre-mock review training teleconferences, during which they received 

training on how to recognize the qualities of a successful grant application and how to score 

applications. During the mock review itself, the panel scored actual R01 and R21 grant 

proposals written by the session participants.

The professional development component of the Program Meetings also included a poster 

competition—an opportunity for trainees to present their research among their peers.

Interactive Sessions

For the first time, CRCHD hosted hands-on sessions that offered participants interactive 

opportunities to increase their awareness and knowledge of the myriad scientific research 

databases (e.g., Human Gene and Mutation-Related Databases, Toxicology Network 

Database), online resources (e.g., Cancer Control P.L.A.N.E.T., Cancer Biomedical 

Informatics Objects), and tools and strategies (e.g., Health Disparities Calculator, 

AccrualNet) that are available across NIH/NCI and externally for professional 

enhancement and research. 

CANCER HEALTH DISPARITIES PROGRAM MEETINGS 2011 
1

INTRODUCTION

17

Meet-and-Greet Sessions

At the end of each day of the 2011 Program 

Meetings, CRCHD hosted a “Meet-andGreet” session that proved to be a valuable 

educational opportunity for participants, 

many of whom were early- and mid-career 

scientists. It was a chance to network with 

NCI, NIH, and other government agencies, 

as well as learn about available programs 

and related research and training funding 

options. Participating offices included the 

CCR, DCB, Division of Cancer Prevention, 

Division of Cancer Treatment and Diagnosis/Office of Cancer Complementary and 

Alternative Medicine, National Human Genome Research Institute/The Cancer Genome 

Atlas, National Institute of General Medical Sciences (NIGMS)/Minority Opportunities 

in Research, National Institute of Mental Health, NIMHD, Office of Partnerships and 

Dissemination Initiatives, Small Business Innovation Research (SBIR), Health Resources and 

Services Administration, Office of HIV and AIDS Malignancy, National Center for Research 

Resources, and Department of Defense.

Poster Sessions 

During the evening Meet-and-Greet sessions, participants had the opportunity to engage 

in interactive poster sessions with trainees, who presented their research covering a wide 

range of cancer health disparities topics, including novel cancer health disparities scientific, 

clinical, and training efforts; cancer health disparities 

applications in the community; and policy implications 

of various approaches across the cancer control 

continuum among diverse populations. Posters were 

judged on scientific content, clarity of presentation, 

innovation, thoroughness, as well as presenters’ 

responses to judges’ questions, and 10 winners were 

chosen.

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Komen Community Outreach and Education Session and Luncheon 

CRCHD partnered with Susan G. Komen for 

the CURE® to bring together NCI-supported 

disparities researchers and health-related 

community outreach groups from the 

National Capital Area for a community 

outreach and education session. Attended 

by approximately 80 individuals from more 

than 30 community organizations and 

research institutions, it was an opportunity 

to brainstorm and discuss issues of access, 

research participation, and biospecimen 

collection for breast cancer prevention and 

care among diverse populations. A three-person panel presentation, including Jean Ford, 

M.D., Johns Hopkins Bloomberg School of Public Health; Heather Patrick, Susan G. 

Komen Foundation; and a clinical trials participant/breast cancer survivor, offered varying 

perspectives on obstacles to breast cancer care and research in the National Capital Area. 

Following the panel presentation, participants engaged in roundtable discussions on barriers 

to accessing care, participating in clinical trials, and collecting biospecimens. Participants 

received a PinkLINK resource book that included descriptive and contact information about 

each of the participating organizations, designed to encourage networking and collaboration.

Kenneth C. Chu Award Luncheon

The Program Meetings concluded with a luncheon 

honoring Ken Chu, Ph.D., former Chief of the 

Disparities Research Branch at CRCHD, who retired 

December 31, 2010, after four decades of government 

service. His dedication to scientific excellence and 

compassion towards the underserved helped lay the 

foundation for, and spawn cancer health disparities 

research encompassing not only social sciences but also 

basic sciences. 

CANCER HEALTH DISPARITIES PROGRAM MEETINGS 2011 
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19

Minority Health and Health Disparities Report

Each year, every Institute within NIH must submit a report detailing its activities aimed at 

addressing health disparities in the United States. At NCI, the Minority Health and Health 

Disparities Report is based on a compilation of data submitted by each of the Institute’s 

DOCs. As part of CRCHD’s charge to advise NCI, NIH, and HHS authorities on the state 

of cancer health disparities in the nation, the Center plays a critical role in assessing the 

information submitted and recommends in the final report how best to strengthen NCI’s 

current disparities research portfolio. In 2011, the CRCHD-produced report continued to 

recommend diversifying NCI’s health disparities research and training portfolio. Historically, 

the portfolio has been stronger in clinical science research applications and weaker in 

basic science and outreach programming. CRCHD advised strengthening basic research 

to enhance translational research and the potential to transform scientific discoveries 

into clinical applications for cancer health disparities reduction. The 2011 report also 

recommended that NCI develop and enforce standardized procedures for collecting race 

and ethnicity data on its trainees and human research participants. By producing this report 

annually, CRCHD plays a major role in helping to shape both Institute- and national-level 

policies aimed at reducing cancer health disparities.

Other Government Reports

CRCHD is charged with providing the White House with the Department of Health 

and Human Services' Plan on Assistance to Historically Black Colleges and Universities; the 

White House Tribal Consultation Report; and the White House Report on Agency-Sponsored 

Historically Black Colleges and Universities, Tribal Colleges and Universities, and HispanicServing Institutions. 

In addition, the Center is asked to respond to Areas of Special Concerns Requests 

and other ad hoc items. In 2011, CRCHD produced the following ad hoc products: 

information for congressional hearings on prostate cancer and brain cancer; a briefing 

for the White House on HHS activities in Oklahoma (with a special emphasis on Native 

Americans/American Indians); a response on behalf of NCI to a congressional inquiry 

 INTRODUCTION

products 

and resources
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES 

FISCAL YEAR 2011

20

regarding NCI’s plans for addressing cancer 

health disparities among Pacific Islanders, 

Asian Americans, and Native Hawaiians; a 

response on behalf of NCI to a congressional 

inquiry regarding NCI’s activities addressing 

breast cancer health disparities due to access, 

education, and awareness issues; and a 

breakdown of FY 2011 funding for health 

disparities research by program for HHS’s 

Office of the Secretary. These standing and 

ad hoc requests help to expand CRCHD’s 

policy impact.

Communication and 

Dissemination Resources

In addition to various reports and briefing 

materials, CRCHD develops and disseminates 

a range of materials that includes information 

on cancer health disparities research, education 

and outreach efforts, and diversity training. 

A variety of culturally tailored print and 

electronic formats are produced, depending 

on the target audience, such as brochures, 

fact sheets, articles, and slide presentations, 

which are disseminated across CRCHD 

and to cancer health disparities researchers, 

racially and ethnically diverse and underserved 

communities, and the media to raise awareness 

and promote the importance of reducing 

cancer health disparities. 

The Center keeps grantees informed of NCI/

CRCHD-related disparities activities and 

training through regular programmatic 

webinars. During these webinars, information 

and guidance is shared on supplement 

and performance expectations, as well as 

community-based and clinical research 

activities and best practices.

OVERVIEW

Since 2001, the Center to Reduce Cancer 

Health Disparities (CRCHD) has served as 

the cornerstone of NCI’s efforts to reduce the 

unequal burden of cancer in our nation. 

MISSION

To reduce cancer health disparities, CRCHD 

seeks to:

• Stimulate research that identifies biological 

and non-biological determinants of 

cancer health disparities and validates 

interventions to reduce the disparities. 

• Achieve diversity in training researchers 

who conduct cancer and cancer health 

disparities research. 

• Promote multi-disciplinary, multi-site 

integrative science teams, which engage 

communities, in order to build capacity, 

leverage resources/strengths, and foster 

synergy between research, training and 

outreach for cancer disparities reduction.

PROGRAMS 

Continuing Umbrella of Research 

Experiences (CURE)

Launched in 1997, CURE is a national 

research training and career development 

initiative that focuses on building and 

sustaining a pipeline of diverse cancer 

investigators. Starting with high school 

students and extending to newly awarded, 

independent cancer researchers, CURE trains 

individuals who come from groups that 

have been shown to be underrepresented in 

biomedical science and cancer research.

The NCI defines cancer health disparities as “differences in the incidence, prevalence, mortality, and 

burden of cancer and related adverse health conditions that exist among specific population groups in 

the United States.”

Health disparities can occur due to the inequities experienced by racial and ethnic populations, and by 

marginalized groups such as the poor, rural, and aging populations.

The field of cancer health disparities is complex and affected by a multitude of health, biological, 

environmental, and social factors. To advance understanding of the multi-factorial causes of cancer 

disparities, including biological and non-biological bases of cancer incidence and progression, 

networking programs facilitate new and ongoing linkages between research, training, and outreach.

CURE is the first and only NIH program 

to offer long-term support to qualified, 

underrepresented students and 

professionals who are otherwise at risk 

of being lost from the training pipeline.

COMMUNITY NETWORKS PROGRAM (CNP) CENTERS

Overview

Building on the successes of the previous Community Networks Program, 23 NCI-supported CNP 

Centers launched in 2010 with the aim of using research, community outreach, and training to:

• Increase knowledge of, access to, and use of beneficial biomedical/behavioral procedures in 

cancer health disparities. 

• Develop and perform evidence-based cancer health disparities intervention research. 

• Train qualified cancer health disparities researchers in community based participatory research 

and promote their career development. 

A hallmark of CNP Centers is the community involvement in all phases of the Centers’ research.

Locations

Built as a partnership between an academic institution and various community organizations, the 

CNP Center is physically headquartered at the academic institution’s site. This Headquarters site 

coordinates the work of affiliated research, community outreach and training sites.

For a detailed listing of all CRCHD’s CNP Centers and the Centers’ principal investigators and 

research objectives, visit: http://crchd.cancer.gov/research/cnpc/project-listing.html.

CRCHD TRAINING AND CAREER DEVELOPMENT 

FUNDING OPPORTUNITIES

CRCHD provides funding opportunities for research training and career development of students 

and investigators from underrepresented racial and ethnic groups, individuals with disabilities, 

individuals from disadvantaged backgrounds, and for involving minority institutions in cancer 

research, research training, education, and outreach.

TRAINING OPPORTUNITY PURPOSE

HIGH SCHOOL

PA-08-190 – Research Supplements to 

Promote Diversity in Health-Related 

Research 

Improve the diversity of the research workforce 

by supporting and recruiting from groups that 

have been shown to be underrepresented in 

cancer and cancer health disparities research.

NCI Cancer Center Supplements for 

High School and Undergraduate Student 

Research Experiences (P30)

Engage the scientific curiosity and promoting the 

potential cancer research careers of promising 

young high school students and to take full 

advantage of the community outreach and research 

capabilities of NCI-supported Cancer Centers.

UNDERGRADUATE

PA-08-190 – Research Supplements to 

Promote Diversity in Health-Related 

Research

Improve the diversity of the research workforce 

by supporting and recruiting from groups that 

have been shown to be underrepresented in 

cancer and cancer health disparities research

NCI Cancer Center Supplements for 

High School and Undergraduate Student 

Research Experiences (P30)

Engage the scientific curiosity and promoting the 

potential cancer research careers of promising 

undergraduate students and to take full advantage 

of the community outreach and research 

capabilities of NCI-supported Cancer Centers.

GRADUATE/PRE-DOCTORAL

PA-08-190 – Research Supplements to 

Promote Diversity in Health-Related 

Research 

Improve the diversity of the research workforce 

by supporting and recruiting from groups 

underrepresented in cancer and cancer health 

disparities research.

PA-11-112 – Ruth L. Kirschstein National 

Research Service Awards for Individual 

Predoctoral Fellowships to Promote 

Diversity in Health-Related Research (F31)

To improve the diversity of the health-related 

research workforce by supporting the training of 

predoctoral students from diverse populations in 

biomedical, behavioral, social, clinical, or health 

services research.

R25T - Diversity Supplements to the NCI 

Cancer Education and Career Development 

Program 

Provide opportunities for individuals underrepresented in cancer research to be trained in cancer 

prevention and control, epidemiology, nutrition 

and the behavioral and population sciences.
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INTRODUCTION

CRCHD also communicates with 

grantees and the public through 

its cancer health disparities listserv, 

which currently has more than 1,500 

subscribers, and sends out eBlasts 

on a monthly basis. These eBlasts 

keep recipients apprised of funding 

opportunities, new positions in 

cancer health disparities research, 

training opportunities for students 

and researchers at all academic levels, 

and other updates to the Web site. 

By keeping in touch with current 

and past grantees, as well as members 

of the interested public, CRCHD 

systematically disseminates throughout 

the public and research communities 

research findings and culturally sensitive best practices and strategies to improve the lives of 

those disproportionately affected by cancer.

CRCHD has a strong Web presence. Its Web site, http://crchd.cancer.gov/, serves as a central 

clearinghouse for NCI-sponsored information on cancer health disparities and receives more 

than 4,000 unique visitors every month. The site provides updates on the Center’s programs, 

products, and initiatives; news about cancer health disparities research and researchers; a list 

of disparities-related tools and resources; information on grant and training opportunities; 

and availability of jobs. The Center also integrates social media technologies to enhance 

communication and dissemination activities, and links to NCI’s social media sites, including 

Facebook, Twitter, YouTube, and Flickr.

In addition, the Center produces an internal eNewsletter, the Inside Scoop, to provide 

CRCHD staff with a roundup of selected news articles on cancer and cancer health 

disparities research, training, and outreach activities.
Broad-based 

cancer research 

to pinpoint 

the causes 

of cancer 

health disparities
2

RESEARCH

23

The Center to Reduce Cancer Health Disparities (CRCHD) has begun to expand its 

research portfolio in recent years, steadily supporting more research around basic 

science contributions to cancer health disparities among racially and ethnically 

diverse populations. This new research direction comes from an increasing recognition 

that ethnic and racial disparities in cancer diagnosis, treatment, and outcomes cannot be 

explained fully by socioeconomic indicators. CRCHD’s support of basic science studies is an 

extension of the Center’s historical commitment to community-based participatory research 

(CBPR). A broader approach to research allowing a more precise picture of the roots of cancer 

disparities—be they genetic or socioeconomic—may result in better-targeted community 

outreach and medical interventions and, ultimately, a reduction in cancer health disparities.

CRCHD’s Expanding Research Portfolio

In 2010, CRCHD made a commitment to increase its focus on biological research by 

sponsoring two new funding opportunities developed in conjunction with the National Cancer 

Institute’s (NCI’s) Division of Cancer Biology (DCB). These were a R21 for pilot work to 

develop research in basic science related to cancer health disparities, and an U01 to support 

basic research testing new models, methodologies, and technologies in cancer disparities 

research. Together, these two funding opportunities received more than 60 applications. 

CRCHD also supported several basic research Challenge Grants, functioning as offshoots 

of the American Recovery and Reinvestment Act (ARRA), which were designed to spur 

economic growth by offering two-year “jumpstart” funds to highly promising areas of 

research. Together, these grants cover studies that fall within three topic areas: the role of 

tumor biology in cancer health disparities, epigenetic factors contributing to cancer health 

disparities, and genetic contributors to cancer health disparities.

RESEARCH

basic research
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The Role of Tumor Biology in Cancer Health Disparities 

The research of Patricia E. Berg, Ph.D., falls under the category of tumor biology. Berg and 

colleagues are investigating the importance of cell development processes that increase cell 

motility and appear to promote very aggressive breast cancers among African American women. 

With Berg’s work in the vanguard of tumor 

biology research, her proposal was selected from 

among 45 applicants to be funded by CRCHD’s 

R21 Exploratory Grant Award to Promote 

Workforce Diversity in Basic Cancer Research. In 

2003, Berg and her team reported that the BP1 

gene was active in 89% of the tumors of African 

American women, compared with 57% of the 

tumors of white women. High levels of BP1 also 

are associated with the larger, more aggressive 

tumors that more frequently occur in African 

American women, leading to their higher breast 

cancer mortality rates despite their lower incidence 

relative to white women. Berg conjectures that 

BP1 may enhance tumor aggressiveness by 

increasing the motility of malignant cells and, 

hence, leading to deadlier, more broadly metastasizing tumors. Berg hypothesizes that BP1 

enhances the epithelial to mesenchymal transition (EMT) through its upregulation of the 

Twist gene. Her R21-funded research is examining whether African American women’s breast 

tumors undergo EMT more frequently than tumors in white women, and whether these 

EMT processes are associated with high levels of BP1 expression.

Berg’s research has tremendous potential for exploring new approaches to treatment. If BP1 is 

linked to upregulation in these cellular transition processes, and if the transitions occur more 

often in the tumors of African American women than in the tumors of Caucasian women, 

then the genes involved could be targeted for therapies and possibly reduce or prevent the 

malignant metastases so common in black women’s breast cancers. Research like Berg’s, 

which examines whether there are biological differentiators in the tumors experienced across 

racially and ethnically diverse populations, complements and expands our understanding of 

cancer health disparities. While Berg’s work does not dismiss socioenvironmental issues, such 

as access to prompt screening, diagnosis, treatment, or follow-up, it does raise the issue that 

success in eliminating racial/ethnic disparities in survival potentially hinges on biological 

attributes, as well. Berg’s research points the way toward treatments that are tailored for the 

specific types of genes expressed in the cancer pathway—a pathway that may differ across 

race and ethnicity.

Patricia E. Berg, Ph.D.

Berg's research has tremendous potential for 

exploring new approaches to interventions in 

cancer treatment.
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BASIC RESEARCH

Epigenetic Influences on Cancer Health Disparities 

Breast cancer disparities are also being investigated—from a different perspective—by Maria 

Elena Martinez, Ph.D., M.A. With funding provided under a U01 grant, which promotes 

novel methodologies and approaches, Martinez is focusing on epigenetics—genetic changes 

that result from carcinogenic environmental factors. Her research specifically addresses how 

epigenetic changes associated with pregnancy can increase breast cancer risk, particularly 

among Hispanic women. These women, like African American women, have higher breast 

cancer mortality rates than non-Hispanic whites, despite the lower incidence of breast cancer 

among Hispanic women. 

Although multiparity appears to be protective in the postmenopausal years, cancer risk 

increases in the five to 15 years immediately following pregnancy for Hispanic women. 

Childbirth seems to cause important, albeit complex, changes in breast cancer risk. During 

this postpartum period, the types of breast cancers diagnosed 

in recent mothers are more aggressive and deadly. Martinez 

hypothesizes that this increased vulnerability relates to 

epigenetic changes in the epithelial cells of high-risk 

women—a vulnerability that evolves from, as yet, unknown 

genetic and environmental risks. Her research is based on 

the hypothesis that these risk-enhancing changes will leave 

a residual signature, visible in the genetics of postpartum 

breast tumors but absent in those diagnosed outside this 

period. Martinez’s research population—women of Mexican 

descent—is especially suited to this type of profiling, due to 

the population’s high average parity, younger age at onset of 

breast cancer, and worse survival rates following diagnosis.

Drawing from the ELLA Binational Breast Cancer study, 

Martinez has been profiling the epidemiology and genetics 

of ELLA’s stored tissue specimens. The aim of the profiling 

is to define both the postpartum and nonpostpartum 

populations’ risk factors and correlate them with the types 

and characteristics of tumors developed. In addition, 

Martinez hopes to document whether these risk factors 

are tied to the addition of methyl groups at certain DNA regions; methyls switch off the 

transcription and, hence, expression of crucial tumor-suppressor genes. Martinez’s research is 

unique in that it focuses on sporadic, early-onset breast cancers that disproportionately affect 

racial/ethnic minority women. Moreover, if her work demonstrates that cancers arising in 

Maria Elena Martinez, Ph.D., M.A.

Martinez is researching how 

epigenetic changes associated with 

pregnancy can increase cancer risk.
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

26

the postpregnancy period share a common set of silenced genes, it may be possible both to 

develop drugs targeting these specific DNA regions, as well as take steps to modify lifestyle 

factors that are associated with increased methylation.

The work of U01 grantees like Martinez highlights the intersection between CRCHD’s 

broader community-based research and its incorporation of basic science. Lifestyle choices 

and environmental exposures of different populations filter down and have an effect on 

biological makeup—and vice versa. It is clear that the interplay of myriad influences creates 

the varying risk profiles of different populations. Untangling these complex influences is the 

only way to understand and reduce cancer health disparities.

The Role of Genetics in Cancer Health Disparities

Mary Relling, Pharm.D., applied for and was awarded jumpstart funds, as part of an ARRA 

Challenge Grant to study the influence of genetics in acute lymphoblastic leukemia (ALL), 

the most common cancer in young children. While ALL is 

highly responsive to drug therapy, with cure rates rising to 

almost 85% in recent years, such cures are often less effective 

in patients of Hispanic ethnicity, where relapse rates are far 

higher than in any other demographic group. In past studies, 

Relling’s research team identified a genetic component to 

the poor outcomes experienced by Hispanic children; all 

of the relapse cases possessed genomic variations of Native 

American ancestry. However, children with these variations 

had the same low relapse rates vis-à-vis non-Hispanic whites 

when given alternative therapies, suggesting the important 

role of genome-drug interactions during therapy.

Relling’s RC4 grant seeks to determine how these genomic 

mechanisms function, in particular, which drug therapies 

exacerbate such negative interactions and which are best able 

to circumvent or overcome them in certain racial and ethnic 

groups. Drawing upon the genotype bank of high-risk ALL 

patients enrolled in the NCI-sponsored Children’s Oncology 

Group clinical trials, the researchers are correlating genetic 

ancestry with ALL relapse rates and documenting which 

therapies seem to promote better and worse outcomes. They also are attempting to specify 

exactly which of the genetic variations identified contribute to the differing ALL relapse 

rates. Teasing apart such genetic and nongenetic factors requires the application of highthroughput genomic analysis, an expensive and new scientific approach in cancer disparities 

research, making Relling’s work exactly the sort that ARRA Challenge grants were designed 

to promote.

Mary Relling, Pharm.D.

Relling's work in precision medicine 

may lessen the gap in cancer 

survivorship for children 

and adults of racially and 

ethnically diverse groups.
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27

BASIC RESEARCH

Moreover—and more pertinent to CRCHD’s aims of disparity reduction—Relling’s work 

is explicitly aimed at translational ends. Having identified genetic variations that seem to 

promote relapse, her work offers the possibility of precision medicine—a promise that 

impacts not only pediatric ALL patients but also the more than 20% of adult and pediatric 

patients who are treated with glucocorticoids, the class of drugs most commonly used in ALL 

therapy. The hope is that precision medicine will lessen the gap in cancer survivorship for 

children and adults of racially and ethnically diverse groups.

Cancer Stage, Treatment, and Survival 

in Cancer Health Disparities

CRCHD is committed to supporting cancer 

researchers in basic science across the training 

continuum. With the long-term assistance 

provided by CURE, many of the Center’s trainees 

have been able to attain successful independent 

research careers. 

While still in medical school at the University of 

California at San Francisco, Christopher Li, M.D., 

Ph.D., M.P.H., grew interested in learning about 

how to combine the principles of epidemiology 

with clinical practice. That interest brought Li 

to the University of Washington’s (UW’s) public 

health program, where, while pursuing his 

M.P.H., he developed an interest in research and 

biostatistics. After finishing his M.D. and M.P.H. degrees, he pursued this passion and signed 

on for the Ph.D. program in cancer epidemiology at UW. 

As a predoctoral student, he had the opportunity to be part of the Women's Health 

Initiative research team that reported a link between combined estrogen-progestin hormone 

replacement therapy and the national upsurge in rare, lobular, breast cancers among 

postmenopausal women. He also was involved in exploring the relationship between race/

ethnicity and breast cancer—research that points to an array of socioeconomic and lifestyle 

factors influencing access to, type of, and timing of treatment.

As a clinician with social science training, Li wanted to expand his research skills in 

molecular and genetic epidemiology, as well as use his clinical background to collaborate 

more effectively with breast cancer surgeons. To this end, Li applied for and received a K01 

Mentored Career Development Award for underrepresented populations, with the aim of 

researching the relationship between expression of biomarker HER2 in first primary breast 

cancers and the associated risk for developing secondary, contralateral breast cancers (CBC). 

Christopher Li, M.D., Ph.D., M.P.H.

Building on his CURE training, Li is 

investigating biomarkers and risk factors for 

second primary breast cancers among breast 

cancer survivors.
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28

Li’s research demonstrated that estrogen-regulated HER2 increased the risk for CBC among 

young females. In cases exacerbated by obesity, there was a 50% increase in risk; in cases 

exacerbated by alcohol use, there was a 90% increase in risk; and in cases exacerbated by 

smoking, there was a 120% increase in risk. These findings led to his conducting further 

research—as principal investigator for three R01-funded grants and three affiliated grants 

exploring hormone expression, radiation, and different types of breast cancer risk.

Li's R01-funded research has been focusing on potential carcinogenic effects of the DepoProvera injectable contraceptive (depo-medroxyprogesterone acetate), a drug more often 

prescribed to low-income African American women in the United States. His is the first 

large-scale U.S. study specifically designed to evaluate this relationship, and results indicate 

that recent use of the injectable contraceptive for at least a year was associated with a 

doubling of breast cancer risk in young women. However, the risk dropped to that of nonusers within several months of stopping Depo-Provera injections.

"Our hypothesis going into this study was that we expected to see an increased risk of breast 

cancer associated with Depo-Provera," says Li. This increased risk is most likely due to DepoProvera containing the same synthetic progestin used in the combination estrogen-progestin 

hormone replacement therapy tested in the WHI study that led to a 24% increase in lobular 

breast cancer risk.

Advancing from CURE’s K01 launching pad, Li has built a successful, high-profile career in 

basic cancer research that is on the cutting edge of the translational divide. He is a shining 

example of how CURE training opportunities can provide a springboard for talented 

investigators from diverse backgrounds. Li’s passion and academic preparation, combined 

with CURE’s training opportunities with established scientists, financial resources, protected 

research time, guidance from mentors, and networking opportunities accelerated his 

achievement of academic success that may not have been possible otherwise.

Small Business Innovation Research for Cancer Health Disparities

CRCHD also has developed several topic areas in Small Business Innovation Research 

(SBIR) that have relevance to cancer disparities. These topics are designed to stimulate the 

development of better tools and resources for cancer disparities research. 

One particularly exciting topic is the development of better molecular diagnostic assays to 

promote early detection of basal-like breast cancer, a highly aggressive, triple-negative type of 

tumor that does not respond to estrogen, progesterone, or herceptin, and is more common 

among black women in the United States. Of the five SBIR applications received, two were 

funded, both of which proposed to develop an increasingly sensitive and specific assay that 

could, at low cost, distinguish basal-like breast cancer from other subtypes in human cells, 

tissues, and body fluids. In addition to its preventive potential, the assay could be used as 

part of posttreatment monitoring to detect possible recurrences of the cancer. 
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29

BASIC RESEARCH

CRCHD’s long-standing program, Partnerships to Advance Cancer Health Equity 

(PACHE), provides funds to several innovative basic science investigations into cancer 

disparities. The program was designed to foster partnerships that expand diversity training 

and research opportunities within institutions serving underrepresented populations and 

enhance the research base and human capital of Cancer Centers seeking to do research with 

and about the cancer burden of underserved communities. 

PACHE PROJECT TITLE: Tissue Procurement Core

PARTNERSHIP: Ponce School of Medicine, Puerto Rico (PSM) and Moffitt Cancer Center (MCC)

GRANT TYPE: U56 

POPULATION: Hispanics/Latinos

One such partnership pairs an Hispanic medical school in Puerto Rico and an NCI Cancer 

Center in Florida in an attempt to generate a resource for the type of cutting-edge research 

neither could perform on its own. The population of Ponce, Puerto Rico is much different 

from that of San Juan, the archipelago’s capital, most populous city, and site of much of the 

territory’s biomedical research. By comparison, the people of Ponce are socially distinct and 

ethnically homogeneous—and, hypothetically, genetically dissimilar from the people living 

in the multicultural, multiethnic capital. The PSM-MCC partnership seeks to develop a 

tissue bank where its researchers can study whether these social and ethnic differences in the 

Ponce population contribute to distinctive tumorigenicity, and whether such differences can 

be capitalized upon in developing targeted cancer therapies. The partnership is especially 

important as it represents one of the first biorepositories devoted solely to Hispanic tissue. 

The homogeneity of the Ponce population is a unique attribute and, hence, their tissues have 

been included in several research projects being developed in concordance with the tissue 

bank. Samples of 30 tumors from a variety of cancer types were gathered in its first three 

months. Current R01s are investigating Src kinases and colitis-associated colorectal cancer, 

for which fresh colon samples are key to accurately determining the cancer’s origin. They 

also are researching heredity breast cancer genetic screening tools, for which access to a broad 

array of breast cancer tissues is necessary to develop an accurate tool. The program appears 

well on its way to achieving its long-term goal, that of assembling a critical tissue resource 

that promotes collaborative research in minority cancer molecular biology. 

basic research

Partnerships to Advance 

Cancer Health Equity
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

30

PACHE PROJECT TITLE: An Undersea Pipeline for 

Drug Discovery

PARTNERSHIP: University of Puerto Rico Medical Sciences 

Campus (UPRCM) and University of Texas 

MD Anderson Cancer Center (MDACC)

GRANT TYPE: U54 

Another Puerto Rican partnership—between the 

Medical Sciences Campus of the University of 

Puerto Rico at Rio Piedras and the MD Anderson 

Cancer Center—takes advantage of the natural 

resources surrounding the islands. The UPRCM-MDACC team seeks to find, identify, and 

study the potential pharmacologic properties of undersea organisms in hopes of finding 

biologically active molecules not yet documented. One of the team’s most promising finds 

is a compound called eupalmerin acetate (EPA), which is extracted from a species of coral 

abundant in the Caribbean and appears capable of targeting gliomas, the most common form 

of primary brain cancer. The UPRCM-MDACC partnership perfectly pairs the resources 

of both centers—the natural bounty surrounding the Puerto Rican shores and the analytic 

laboratories available at the University of Texas.

PACHE PROJECT TITLE: Optimized Nanoparticle Vaccines for Prostate Cancer

PARTNERSHIP: University of California at San Diego (UCSD) and 

San Diego State University (SDSU) 

GRANT TYPE: U54 

POPULATION: African American 

Back in the continental United States, researchers in San Diego 

have been attempting to use nanoparticles to deliver prostate cancer 

vaccines, hoping that a single-course treatment might surmount 

problems of noncompliance among males, particularly African 

American males who experience multiple barriers in access to and 

utilization of healthcare services. The UCSD-SDSU team has 

focused on using nanoparticles, tiny particles engineered to deliver their specific chemical 

contents to a targeted cell type, to provoke the immune system’s soldier cells (lymphocytes) 

to attack the tumor. A problem with cancer, however, is that it is composed of a person’s own 

cells, which a person’s lymphocytes are programmed not to attack. The San Diego team has 

been attempting to trick tumor cells into presenting certain non-self, foreign markers that 

will trigger the lymphocytes. 
2

31

BASIC RESEARCH

The investigators have taken three steps: packing nanoparticles with markers derived from 

prostate cancer-specific proteins, such as survivin and six-transmembrane epithelial antigen 

of the prostate (STEAP); designing the nanoparticles to find the tumor’s cells by targeting 

them to mannose receptors on the cell surface; and making the nanoparticles responsive 

to changes in pH, which allows them to more easily be brought inside the tumor cells, at 

which point their contents are released and transported to the cell surface, triggering an 

attack by cytotoxic T-cell lymphocytes. The results of this collaboration are promising; the 

researchers have had great success in generating the nanoparticles, and have provided training 

opportunities for undergraduates. The UCSD-SDSU partnership model is a testament 

to the effectiveness of PACHE in integrating training and research opportunities for 

underrepresented populations.

PACHE PROJECT TITLE: Molecular Profile of a Basal-Like Phenotype of Breast 

Cancer in African American Women

PARTNERSHIP: Howard University (HU) and Johns Hopkins University (JHU)

GRANT TYPE: U54 

POPULATION: African Americans

A long-standing PACHE partnership exists between Howard 

University in Washington, DC, and Johns Hopkins University in 

Baltimore, Maryland. Researchers at both institutions continue 

to investigate whether there is a correlation between tumor 

development and distinctive molecular changes. Focusing on the 

basal-like phenotype, a particular subset of breast cancers, the 

HU-JHU team is hoping to identify several unique molecular changes or “biomarkers.” 

If they can find specific biomarkers, their goal is to determine whether these biomarkers 

correlate with various clinical, pathological, and demographic features of the patient and his 

or her cancer. 

This HU-JHU team is learning the challenges of discovering correlations; very similarlooking cancers can be the result of very different genetic changes. Amplification and loss 

changes among the HER2, ER, and PR genes have been particularly difficult to correlate 

to any one population. Nonetheless, researchers, hoping to promote further biomarker 

research and collaborations, have been developing a biobank at JHU using 100 cases of 

African American breast cancers drawn from the HU archives. The HU-JHU collaboration 

exemplifies the types of partnerships PACHE is aiming to promote—collaborations between 

educational institutions serving diverse populations and larger universities with expanded 

research and training resources, thereby creating opportunities for innovative and culturally 

relevant research targeting underserved populations. 
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

32

PACHE PROJECT TITLE: Development of Micro-fluidic 3D Apoptotic Cell Arrays for Anti-Cancer Drug 

Screening and Apoptotic Signaling Profiling

PARTNERSHIP: City College of New York (CCNY) and Memorial Sloan Kettering 

Cancer Center (MSKCC)

GRANT TYPE: U54 

Many researchers have been attempting to develop and screen drugs targeting the apoptotic 

pathway; however, most have met with limited success. 

In a recent PACHE-inspired partnership, CCNY-MSKCC researchers have been 

concentrating on developing a library of cell lines that can effectively “report” to researchers 

whether apoptosis is occurring by their degree of fluorescence, drastically simplifying the 

screening measurements. The research team also is constructing a prototype of an artificial, 

three-dimensional, living environment for cell samples that will be the focus of an R01 grant 

and a patent application. The creativity and innovation shown by the CCNY-MSKCC team 

are due to the synergy that is generated and harnessed by partnerships to build technological 

and scientific solutions to the barriers affecting cancer research.
2

33

APPLIED RESEARCH

CRCHD’s Community Networks Program (CNP), now the Community Networks Program 

Centers (CNPC), grew out of the same commitment to expanding training and research 

opportunities that led to the PACHE program. However, its research base includes more 

than academic institutions and their staff; the community of interest and other organizations 

involved in alleviating cancer health disparities are also part of the research team. With 

this paradigm in mind, CNPC seeks to stimulate and develop innovative interventions by 

maximizing organizational resources and linkages, and mobilizing them to inspire broader 

community- and societal-level changes supporting improved health.

Partnerships

Building partnerships is essential to CRCHD’s mission. Whether partnerships are fostered 

between academics and the community, between the public and private sectors, or between 

mentors and their mentees, collaborations hasten progress in tackling cancer health disparities.

CNP/C PROJECT TITLE: Asian Hepatitis B/Liver Cancer Prevention 

and Intervention Program 

PRINCIPAL INVESTIGATOR: Grace X. Ma, Ph.D. 

CANCER TYPE: Liver

POPULATION: Asian Americans

LOCATION: Mid-Atlantic States

CNP, one of CRCHD’s flagship programs, features innovative 

partnerships among academic institutions, community 

organizations, and community-serving healthcare providers 

in an effort to overcome barriers encountered by underserved 

populations in accessing prevention services and cancer care. 

Partnerships can be particularly effective in reinforcing the 

delivery of health messages and ensuring that individuals 

receive quality cancer care and improved treatment outcomes. 

To this end, researchers from CNP-Atlantic Region assisted community organizations 

and clinicians in partnering to construct a network for Vietnamese, Korean, and Chinese 

community members, whose liver cancer rates are disproportionately high. 

applied research

Community Networks 

Program Centers
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

34

Through this partnership, the researchers and community mobilized and culturally tailored 

a comprehensive toolbox of approaches—from group education to patient navigation and 

bilingual physician visits—with the goal of building a network to promote hepatitis B 

screenings and follow-ups. As a result of this initiative, nearly 1,400 individuals were screened, 

more than 200 were vaccinated, and 100 were moved into treatment. The effects of the 

partners’ net stretched beyond the original mandate; not only did the communities experience 

reductions in the prevalence of hepatitis B infection, a major cancer risk factor, but they also 

demonstrated improvements in psychosocial health.

CNP/C PROJECT TITLE: Partnerships with the Witness Project

PRINCIPAL INVESTIGATOR: James R. Hébert, Sc.D., M.S.P.H.

CANCER TYPE: Breast, cervical

POPULATION: African Americans

LOCATION: South Carolina

In South Carolina, CRCHD researchers focused on 

forging partnerships to promote cancer prevention 

by linking rural African American churches with academics from CNP-South Carolina. 

Adapting American Cancer Society evidence-based “Witness Project” materials to the local 

South Carolina context, CNP researchers trained women, who had been recruited by their 

churches, to serve as witnesses who would discuss their cancer journeys, emphasizing early 

cancer detection, in meetings with other church members. Building upon its initial success, 

the program spread across upstate South Carolina to several additional churches, eventually 

reaching more than 900 women. The partnership facilitated outreach to the churches in rural 

communities and engaged trusted church members, rather than outsiders, to deliver health 

messages and effect change within the community. 

CNP/C PROJECT TITLE: Spanish Radio Station Broadcasts 

PRINCIPAL INVESTIGATOR: Beti Thompson, Ph.D., M.A.

CANCER TYPE: Breast, cervical, colorectal, lung, prostate, testicular 

POPULATION: Hispanics/Latinos 

LOCATION: Lower Yakima Valley, and Washington

Empowering local communities to assist in addressing their health needs is at the heart 

of CNP’s collaborative efforts. In Washington State, a team from the Lower Yakima 

Valley-CNP partnered with a local Hispanic radio station to disseminate cancer prevention 

messages. The radio station interviewed and held call-in question-and-answer sessions with 

Spanish speakers, ranging from physicians to cancer survivors, who had been identified by 

Cancer Center researchers. The station also worked with the community to develop more 

rch People Witness to Save Souls. At The Witness 

Project They Witness to Save Lives!

Saturday, January 30, 2010 

9:00AM—3:00PM 

Brookland Baptist Church Banquet and Conference Center 

1066 Sunset Boulevard, West Columbia, South Carolina 29169 

FUNDED BY: 

outheastern U.S. Collaborative Center of Excellence 

limination of Disparities at Morehouse School of Medicine 

The Witness Project®

ssons Learned and New Networks 

 Conference 

SPONSORS: 

na Cancer Alliance, Best Chance Network, National Cancer Institute/Cancer 

on Services, American Cancer Society, South Carolina Cancer Disparities 

Network, Clemson University, Second Chance, Lowcountry Affiliate of Susan 

thCCliCitBd Hlth StNtkd th
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APPLIED RESEARCH

than 60 advertisement-like information capsules, aired throughout the year, which discussed 

multiple forms of cancer and cancer prevention. By empowering the radio station to reach 

out to its listeners and allowing the community to be involved in shaping its messages, the 

partnership was successful in making cancer and cancer prevention topics of discussion in the 

community. In focus group testing after two years of programming, all advertisements and 

on-air interviews received 100% positive feedback.

Community-Based Participatory Research (CBPR) Interventions

CBPR interventions encourage partners to share effective resources and approaches in one 

environment and one population, allowing them to be modified and adapted for future use. 

Modification of evidence-based materials is part of the work of CNPs. It is also part of the 

creative process required to generate evidence-driven interventions.

CNP/C PROJECT TITLE: 

WALK: Feel Alive

PRINCIPAL INVESTIGATOR: 

Edward Partridge, M.D.

CANCER TYPE: Breast, 

cervical, colorectal

POPULATION: Rural and urban 

underserved African Americans 

LOCATION: Alabama Black Belt 

and Mississippi Delta

CNP-Deep South, in an attempt 

to develop social networks for 

information dissemination, 

adapted the “WALK: Feel 

Alive” heart health and fitness 

program originally developed by 

the University of Alabama at Birmingham and piloted throughout urban Alabama. In 

adapting the program for CNP-Deep South’s rural constituents, researchers used a Social 

Network Model. Community health workers and CNP members recruited community 

members, encouraging them to join a WALK team and participate in health-promoting 

physical exercise. While walking, team members were motivated by cancer awareness and 

screening messages. 
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

36

Rolled out in 22 counties, the program initially enrolled almost 1,900 walkers, retaining 

60% one year later. The WALK teams proved capable of changing not only lifestyles in 

that year but environments, as well. Rural residents from the Mississippi Delta successfully 

lobbied their county governments to develop walking trails—a testament to the empowering 

attitudes the WALK program instilled. Creative thinking about how to adapt a proven 

method for engaging communities and encouraging health behavior changes, such as 

physical activity and cancer screenings, allowed CNP-Deep South to modify “WALK: Feel 

Alive” to work across highly varied communities and environments. 

CNP/C PROJECT TITLE: Improved Access to Mammography through Food Pantries

PRINCIPAL INVESTIGATOR: Mark Dignan, Ph.D., M.P.H.

CANCER TYPE: Breast

POPULATION: Underserved and rural

LOCATION: Appalachia

Similar ingenuity was displayed by CNP-Appalachia, where researchers adapted evidencebased materials from the American Cancer Society’s “Tell-A-Friend” program, deploying 

them in 18 rural food pantries throughout Indiana County, Pennsylvania. Adapting the 

program’s three-contact approach that included information dissemination, one-on-one 

education, and phone calls, CNP researchers distributed promotional flyers in food bags, 

sent volunteers to visit each pantry to provide education 

and answer questions, and arranged for health workers to 

call every interested woman and provide information on 

scheduling a mammogram. 

Of the 379 women contacted, 302 were eligible on 

the basis of age. Half of the eligible women received 

mammograms, and three were diagnosed with breast 

cancer and entered treatment. At the community level, 

the use of no-cost breast cancer screenings increased by 

28% during the intervention year. Originally designed to 

help women speak with friends about breast cancer, the 

“Tell-A-Friend” approach was creatively tailored to a new 

demographic and a novel dissemination venue to increase 

breast cancer screening. CNP-Appalachia expanded and 

modified the program to include community interactions 

and target rural women who were otherwise at risk of 

missing important health behavior messages. 
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APPLIED RESEARCH

CNP/C PROJECT TITLE: Culturally Tailored Colorectal 

Awareness Program

PRINCIPAL INVESTIGATOR: Sora Park Tanjasiri, Dr.P.H., M.P.H.

CANCER TYPE: Colorectal

POPULATION: Pacific Islanders

LOCATION: Southern California

Depending on community need, CNPs may do more 

than simply modify resources to make them more 

relevant to the environment or target disease. CNPSouthern California in Fullerton, California set out 

to tailor educational resources to meet the needs of a 

specific ethnic group—Pacific Islanders, and specifically, 

Native Hawaiians and the Marshallese—of whom 

only about 61% receive any type of cancer screening 

exam. After a community working group identified a 

lack of culturally appropriate information resources as 

a reason for the low screening rates, researchers began 

with NCI’s “What You Need to Know About Cancer” series, and developed two videos, a 

bookmark, a colorectal information sheet, an educational flip chart, and a flyer outlining 

no- or low-cost screening opportunities. All of the resources were adapted to integrate with 

Pacific Islander local knowledge regarding health and illness, and each was translated into 

four Islander languages. The process produced a library of resources specifically designed to 

target particular Pacific Islander communities in which culturally accessible and appropriate 

information was scarce. 

This toolkit was supported in part by the National Cancer Institute Center 

to Reduce Cancer Health Disparities, grant number U01CA114591. 

Its contents are solely the responsibility of the authors and do not 

necessarily represent the official views of the National Cancer Institute 

Center to Reduce Cancer Health Disparities.
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

38

Prevention 

Within ethnically and racially diverse, and underserved communities, certain primary 

lifestyle factors are known to increase cancer risk, and these risks are frequently compounded 

by underuse of screening measures. Many of the CNPs’ evidence-based interventions and 

materials are focused on understanding and removing barriers communities experience in 

making environmental and lifestyle modifications, and using screening opportunities, which 

is accomplished by supporting and/or developing community outreach programs aimed at 

both primary and secondary prevention.

CNP/C PROJECT TITLE: Use of Smokeless Tobacco 

(Iqmik) in Yukon-Kuskokwim Delta Pregnant Women

PRINCIPAL INVESTIGATOR: 

Judith Salmon Kaur, M.D., M.A.

CANCER TYPE: All

POPULATION: Alaska Natives

LOCATION: Yukon-Kuskokwim Delta, Alaska

In rural Bethel, deep in the heart of Alaska’s 

Yukon Delta, CNP-Minnesota has been 

working to support primary preventive 

behavior change measures related to tobacco 

use. Alaska Natives in Bethel are known for making a chewing tobacco, known as Iqmik or 

Blackbull, from leaf tobacco combined with the ash formed when burning a tree fungus. 

Almost 80% of Bethel’s women use Iqmik and/or other forms of tobacco during pregnancy, 

to the detriment of both mother and fetus. 

Focus group discussions convened with adults and youth in the Delta region indicated that 

Iqmik was commonly perceived as a safe alternative to tobacco for pregnant women, as it 

was diluted with the fungus ash. To combat this misperception, a culturally tailored video 

was developed, which has been used while counseling pregnant women about tobacco 

use. In addition, the Minnesota group has begun storing biospecimens for potential use in 

biobanking or other proteomic research, with the collaboration of the Centers for Disease 

Control’s Arctic Investigations Program, which conducts a broad array of approaches 

designed to document, intercept, and investigate “carcinogenic” lifestyle choices.
39

2

RESEARCH

2

APPLIED RESEARCH

Overcoming Barriers to Healthy Behavior

Filipino women in the United States have the highest mortality rate due to breast cancer 

compared with other Asian Americans, even though they do not have the highest incidence 

of breast cancer. They also have low rates of mammography screening and are diagnosed with 

later stages of breast cancer than are Chinese and Japanese women, the two other major Asian 

groups in Hawaii. 

Working closely with the community to try to reduce these disparities, CNP-University of 

California Davis Cancer Center (UCDCC) conducted focus groups with physicians and 

Filipino women. Results indicated that the fear associated with a cancer diagnosis could be 

addressed by a broad-based educational campaign employing print, radio, and television 

media that targeted Filipino women. Messages about the importance of early detection and 

its relationship to survivorship were disseminated through a variety of means, including 

brochures in physicians’ offices, newspaper articles, posters on bus routes, radio and TV 

public service announcements and interviews, training of key leaders, and community 

gatherings. Partnerships became an important way to extend the reach of this campaign to 

promote breast cancer screenings, and were developed with the American Cancer Society, the 

Hawaii Cancer Information Service, the State of Hawaii Department of Health, the Hawaii 

Breast and Cervical Cancer Control Program, and many Filipino community organizations.

After four years of an aggressive marketing effort directed to Filipino women in Hawaii, 

CNP-UCDCC’s Asian American Network for Cancer Awareness, Research and 

Training (AANCART) demonstrated an increase in mammography screening rates from 

38% to 62% in Filipino women. AANCART’s efforts were also able to reduce the percentage 

of Filipino women who had never had a mammogram from 19% to 10% between 2002 

and 2008. With this significant improvement in the mammography rate, it is anticipated 

that Filipino women will be diagnosed at earlier stages of breast cancer, thereby lowering the 

mortality rate from the disease.

The strong impact this program has had exemplifies the success of CNP’s CBPR approach to 

understanding and addressing the barriers experienced by communities in making healthy 

lifestyle changes to reduce cancer disparities.

APPLIED RESEARCH SPOTLIGHT
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

40

CNP/C PROJECT TITLE: Healthy Colon, Healthy Life

PRINCIPAL INVESTIGATOR: Moon S. Chen, Jr., Ph.D., M.P.H.

CANCER TYPE: Colon

POPULATION: Vietnamese Americans

LOCATION: California, Hawaii, Washington State

In order to understand the barriers to, and best methods for increasing colorectal screening 

among Vietnamese Americans, researchers from CNP-Northern California evaluated 

two interventions: one offering Vietnamese Americans culturally tailored brochures and a 

fecal occult blood-testing (FOBT) kit, and another combining the kit and brochures with 

telephone counseling. 

When evaluating the two interventions, it became clear that the intervention that used 

only the kit and brochures led to a significantly greater increase in the number of colorectal 

screenings compared to the intervention with added telephone counseling. This result was 

surprising: the more intrusive involvement on the part of the researchers (added telephone 

counseling) was not the best route for increasing screenings among Vietnamese Americans. 

This was a counterintuitive but important discovery that enabled CNP-Northern California, 

as well as other cancer interventionists, to promote more effectively screening in this 

particular Asian American population.

CNP/C PROJECT TITLE: Reaching the Hispanic Population in 

a Rural Setting—Colorectal Home Health Parties

PRINCIPAL INVESTIGATOR: Beti Thomspon, Ph.D., M.A.

CANCER TYPE: Colorectal

POPULATION: Hispanics/Latinos

LOCATION: Lower Yakima Valley, Washington State

By contrast, CNP-Lower Yakima Valley found 

that home health parties, which had a high level 

of intrusiveness, optimally addressed the 16% 

screening gap between Hispanic and non-Hispanic whites in this rural region. These parties 

consisted of a trained promotora (lay health worker) visiting a family and their friends in 

their homes to discuss the importance of colorectal screening. 

Over a six-month period, the parties reached nearly 70 age-eligible individuals, who were 

predominantly female. While only 12% of these participants had received an FOBT at 

baseline, this number had increased to more than 30% at the three-month follow-up point. 

A 6% increase also was seen in colonoscopy rates three months following the intervention. 

More importantly, by encouraging families to change their health behaviors, more than 70% 

of individuals found the parties enjoyable. 
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APPLIED RESEARCH

CNP/C PROJECT TITLE: Barbers Against Prostate Cancer

PRINCIPAL INVESTIGATOR: Cathy D. Meade, Ph.D., R.N., F.A.A.N.

CANCER TYPE: Prostate

POPULATION: Underserved

LOCATION: Tampa Bay, Florida

Secondary prevention messages need not be disseminated only in homes or via community 

health organizations. In an interesting twist, CNP-Tampa Bay trained barbers to deliver 

prostate cancer health education from the comfort of their barbershops. The intervention 

recruited eight barbers from four barbershops and ran for two months. 

During this time, 115 educational encounters occurred with clients. Three-quarters of 

those clients claimed they intended to pursue discussions with their primary care physicians 

regarding prostate cancer screenings. Self-rated measures of prostate cancer knowledge 

increased significantly, as well. The researchers indicated that community support and 

media interest were perhaps the most noteworthy indicators of the program’s success. This 

CNP’s innovative initiative clearly demonstrated that by bringing health messages into daily 

life, screening and prevention behaviors became normalized at both the individual and 

community levels.

Community Health Workers

As with the promotoras employed by CNP-Lower Yakima Valley, past research and experience 

indicate that one of the most effective ways to engage communities in health behavior 

programming is by developing cadres of health workers, drawn from the community itself, 

who can promote, model, and educate about the behaviors proposed by outside researchers. 

Community-to-health-worker interactions underpin the success of many of CRCHD’s 

programs, and community engagement is the fundamental principle upon which CNP and 

all of CRCHD’s CBPR programs are built. 

CNP/C PROJECT TITLE: Woman to Woman – Micronesians United 

Lay Educator Program

PRINCIPAL INVESTIGATOR: Clayton D.K. Chong, M.D.

CANCER TYPE: Breast, cervical 

POPULATION: Native Hawaiians

LOCATION: Hawaii

Micronesians represent the Hawaiian Islands’ newest 

immigrants. Many of them come to the United States 

from underresourced backgrounds, and few are aware of 

publicly available cancer screening and treatment sites. 
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

42

When researchers with CNP-Hawaii realized the lack of awareness of health resources and, 

specifically, that eligible Micronesian women were not using free mammogram and Pap 

smear programs, they began a training program for a small group of O’ahu’s Micronesian 

women. They taught the women to work as lay educators, equipping them with a toolkit of 

educational materials and providing them with a small stipend if certain program goals were 

met. 

In six months of outreach, 16 lay educators made 567 peer education contacts, representing 

half the female Micronesian population on O’ahu over the age of 40. Of these contacts, 

close to 150 made screening appointments, from which 10 breast cancers were detected. 

CNP-Hawaii’s results demonstrate the effectiveness with which individuals can spread new 

information and practices throughout their home communities, even if those practices seem 

alien to community members. 

CNP/C PROJECT TITLE: Breaking Free! Breast Cancer 

Awareness for Black Beauties

PRINCIPAL INVESTIGATOR: 

Paul A. Godley, M.D., Ph.D., M.P.P.

CANCER TYPE: Breast 

POPULATION: African Americans

LOCATION: Eastern/Central North Carolina

CNP-North Carolina trained individuals 

to work as lay community health workers/

advocates to reach young African American women. Eighteen Eastern and Central North 

Carolina beauty salon employees learned about breast self-examinations, routine clinical 

breast examinations, and the importance of mammograms, and were given information to 

allow them to make proper referrals to local healthcare providers. 

During the program, all 49 individuals who came in for screenings claimed to have come 

because trusted friends—their hairdressers—told them to do so. This result underscores 

the principle behind community health educators: individuals who are established, reliable 

members of a community’s life are perhaps the most effective advocates for encouraging 

health behavior changes.
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APPLIED RESEARCH

CNP PROJECT TITLE: From the Flying Deck, Get a Breast Check!

PRINCIPAL INVESTIGATOR: Daniel Blumenthal, M.D., M.P.H.

CANCER TYPE: Breast 

POPULATION: African Americans

LOCATION: Hartfield-Jackson Atlanta International Airport 

Community health workers can be found even at the world’s busiest airport—Atlanta’s 

Hartfield-Jackson International Airport—where CNP-Georgia developed a worksite breast 

health program for the community of more than 56,000 employees. Critical to the program’s 

success was its use of multicultural and multilingual community health advocates (CHAs), 

including particularly effective male CHAs who coordinated daily educational activities at 

the airport’s on-site clinic, held lunch-and-learn events, helped schedule appointments at 

the clinic, and arranged mammography referrals, both to primary care physicians and free 

community providers. 

Eventually reaching approximately 3,500 employees, the program conducted more than 

200 clinical breast examinations in the on-site clinic and referred upwards of 150 women 

for mammograms. By using community health workers to unify and engage the airport 

community, CNP-Georgia integrated prevention and care into the life of the airport. As a 

result of the intervention, health messages surrounded employees throughout their workday.

Clinical Trials 

Increasing awareness, recruitment, and retention of racially and ethnically diverse, and 

underserved populations to clinical trials are major goals of NCI’s and CRCHD’s community 

education and outreach efforts.

CNP PROJECT TITLE: Recruitment of African Americans to Clinical Trials

PRINCIPAL INVESTIGATOR: Steven Wolff, M.D.

CANCER TYPE: All

POPULATION: African Americans 

LOCATION: Tennessee

A CRCHD-sponsored Minority-Based Community Clinical 

Oncology Program (MB-CCOP) comprehensive partnership 

between Meharry Medical College and Vanderbilt-Ingram Cancer 

Center has had a major impact on recruiting African Americans 

to clinical trials using an innovative approach. MB-CCOPTennessee began collecting information on minority cancer 

patients immediately following diagnosis, assessing their needs 
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

44

and potential logistical obstacles (such as lack of transportation or insurance). The team also 

identified studies in which the patients would be eligible to participate, taking into account 

co-morbidities that frequently rule out racially and ethnically diverse patients. 

This information was presented to the patients’ physicians, so that by the time the physicians 

were ready to discuss treatment options with their patients, they had a full array of relevant 

clinical trials to present, along with solutions to any logistical impediments to participation. 

Participating patients were then assigned individual research nurses/navigators to help them 

navigate the vagaries of treatment and the clinical trials process. Over the project’s seven-year 

span, the research team worked with more than 1,000 African American patients newly 

diagnosed with cancer and managed to accrue 25% of them to clinical trials (of those, 68% 

were identified as eligible). Compared with national accrual rates of between only 2% and 

4%, the program was highly successful, due in large part to its combination of trust-building 

efforts, navigation, eligibility screening, and tailored information and options.

CNP/C PROJECT TITLE: Developing a Recruitment Model for 

Pediatric Hematology-Oncology Patients

PRINCIPAL INVESTIGATOR: Amelie G. Ramirez, Dr.P.H., M.P.H.

CANCER TYPE: Hematologic

POPULATION: Hispanics/Latinos

LOCATION: Lower Rio Grande Valley, Texas

CNP-Texas also experienced success in mobilizing 

communities to increase clinical trials participation 

using trained, bilingual patient navigators. 

Focusing on pediatric Hispanic/Latino populations in South Texas’ Lower Rio Grande Valley, 

CNP-Texas patient navigators provided patients and families with a full package of support 

for clinical trials enrollment by expediting paperwork and doctor/patient communications; 

assisting patients and families with concerns about nutrition, physical activity, and 

medicines; contacting and educating families in novel venues, such as summer water parks; 

and developing bilingual educational brochures. 

As a result of a multipronged approach, researchers saw a 48% increase in the number of 

Hispanic/Latino children accrued to local hematology clinical trials. Patient navigation 

appears to fill a niche need by providing the comprehensive support many populations 

need to encourage research participation. The strong success of the CNP-Texas approach to 

clinical trial recruitment was noted in NCI’s 2012 Annual Bypass Budget. 
2

45

APPLIED RESEARCH

PNRP PROJECT TITLE: Boston Patient Navigation Research Project Clinical Trials Supplement

PRINCIPAL INVESTIGATOR: Karen M. Freund, M.D., , M.P.H.

CANCER TYPE: Breast, cervical

POPULATION: Low-income, urban females

LOCATION: Boston

PNRP-Boston explicitly tested the ability of patient navigation to promote and facilitate 

clinical trials participation within underserved populations. In Boston, navigators screened 

individuals and prioritized suitable clinical trials. They also attempted to include providers 

in their outreach and education efforts. As a result of their efforts, the Boston research team 

increased the percentage of racially and ethnically diverse, and underserved individuals 

enrolling in clinical trials from 28% to 49% over four years. 

PNRP PROJECT TITLE: Denver Patient Navigation Research Project Clinical Trials Supplement

PRINCIPAL INVESTIGATOR: Peter C. Raich, M.D., F.A.C.P.

CANCER TYPE: Breast, prostate, colorectal

POPULATION: Uninsured, low-income urban residents

LOCATION: Denver

Meanwhile, PNRP-Denver patient navigators managed to increase clinical trials 

recruitment by also serving as community outreach officers and offering skill-based clinical 

trials education to local physicians. Both PNRP pilot projects indicated that, even when 

developed as an addendum to an established research program, patient navigation offers 

tremendous return on investment. The relationships patient navigators are able to build with 

communities and individuals can have an overwhelming impact on breaking down trust 

barriers between researchers and the community.

CNP PROJECT TITLE: Project CONNECT

PRINCIPAL INVESTIGATOR: Melissa Green, M.P.H.

CANCER TYPE: All

POPULATION: African Americans

LOCATION: North Carolina

Another project that supports research 

recruitment of racially and ethnically 

diverse, and underrepresented populations 

was developed by CNP-North Carolina. 

The researchers engaged their communities 

in education by partnering with local organizations and training individuals as community 

research advocates to serve as lay health advisors. They also implemented a statewide advisory 
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

46

board. The project’s efforts focused on developing, evaluating, and improving clinical trial 

communication tools, increasing diversity of participants in local clinical trials, and building 

local awareness and acceptability of research participation. As a result of the project, 716 

individuals enrolled in a statewide clinical trials registry, through which they could be 

contacted about studies for which they might be eligible, and 158 individuals reported 

interactions with community research advocates. 

Biobanking

An emphasis on increasing the diversity of clinical trials comes as a result of CRCHD’s 

commitment to expand its research portfolio to include basic science contributions to cancer 

disparities. This expanded focus has filtered down to several CNP projects. In addition 

to expanding the base of research participants, these projects are promoting biospecimen 

collection from diverse populations for use in research, examination of cancer co-morbidities, 

and evaluation of differences in pathogen exposure. 

CNP/C PROJECT TITLE: Community Attitudes Project

PRINCIPAL INVESTIGATOR: Graham A. Colditz, M.D., Dr.P.H., M.P.H., M.B.

CANCER TYPE: Breast, prostate, colon, lung

POPULATION: Underserved, low-income, rural, and/or African American 

LOCATION: St. Louis, Missouri 

There are frequently barriers involving communities in basic 

science undertakings. To better understand and potentially 

address distrust of basic research as opposed to community-based 

research, CNP-Missouri conducted a qualitative investigation in 

St. Louis to identify barriers to engaging African American men 

and women, and their physicians in research. 

After interviewing local community leaders and physicians, as well as focus groups within 

the African American community, the researchers uncovered three major barriers to 

participation. While the black community believed strongly in the importance of medical 

research, they simultaneously held a deep distrust for the healthcare establishment. There 

was, in addition, a great deal of fear of the unknown and of potential adverse effects from 

receiving undocumented treatments. Finally, the lack of reciprocal relationships among 

researchers, physicians, and the community also served as a barrier to constructing the sort of 

trusting interactions necessary for alleviating the community’s entrenched suspicions. 

While CNP-Missouri’s research indicates areas that need attention, it also reinforces the 

directions that NCI and CRCHD must pursue to increase research participation—building 

partnerships and relationships with communities and researchers, and providing culturally 

tailored educational outreach that addresses barriers.
2

47

APPLIED RESEARCH

CNP/C PROJECT TITLE: HPV in Lakota and Caucasian Women: 

Epidemiology and Risk Factors

PRINCIPAL INVESTIGATOR: Dedra S. Buchwald, M.D.

CANCER TYPE: Cervical

POPULATION: American Indians

LOCATION: Northern Plains

In an attempt to engage communities in basic research, CNPWashington State has begun epidemiological studies of the human 

papillomavirus (HPV) strains. The incidence of HPV is highest 

among Native American women of the Northern Plains at rates 

that top 20%. Comparing the strains of HPV found in two Native 

American reservations with that present in a predominantly white 

community led to several surprises. Among the Native American 

population, a significantly higher percentage of patients had experienced multiple HPV 

infections. Moreover, the viruses responsible for the infections came from very different 

subsets than those infecting patients at the white community’s tertiary hospital. While this 

work raises a plethora of further research questions, it is also critical in helping bring us closer 

to an understanding of the factors leading to the higher incidence and lower survival rates for 

cervical cancer in Native American women. However, further research will not be possible 

without the research participation of the Native communities themselves.

CNP/C PROJECT TITLE: Tissue banking

PRINCIPAL INVESTIGATOR: Clayton D.K. Chong, M.D.

CANCER TYPE: Cervical

POPULATION: Native Hawaiians

LOCATION: Hawaii

Biobanking is a key area of focus for CNPs interested in using their community networks 

more effectively to engage disparity-experiencing populations in basic research. Biobanks 

serve as central repositories where biospecimens are sorted, inventoried, and stored. 

For the biobank at The Queen's Medical Center in Hawaii, CNP-Hawaii is surveying and 

conducting focus groups with a broad swath of Hawaii’s four racial/ethnic communities—

whites, Hawaiians, Japanese, and Filipinos— while taking the necessary steps to open a 

biobank to determine local attitudes toward tissue collection and storage. The goal is to 

use the findings to develop educational interventions for staff collecting specimens and for 

patients being asked for permission to collect their tissues, as well as to establish protocols for 

collection and research with the tissue samples. 
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

48

CNP-Hawaii researchers know they are broaching ethically difficult territory involving 

issues of informed consent, anonymity, ownership, fear, mistrust, storage and disposal, 

and the public reporting of results. By engaging the community ahead of time in efforts 

to establish the biobank, CNP-Hawaii is helping to make such basic science interventions 

more acceptable and build a sense of local ownership, understanding, and commitment to 

biospecimen collection and basic research.

Education and Outreach 

Perhaps the most important step in tackling cancer health disparities involves taking 

knowledge gathered from both the lab and the community and translating it into concrete 

differences in the ways in which states, municipalities, and neighborhoods function.

Reducing—and, ultimately, eliminating—cancer health disparities requires the active 

participation of diverse communities. Education and mobilization of communities to present 

their concerns persuasively to local, state, and national stakeholders are critical to enhancing 

community influence on public agendas in cancer health disparities and changing disparityproducing power and resource-distribution structures. An important part of the CNP 

mandate is to engage communities in advocacy training to address structural barriers to cancer 

prevention, detection, and care. 

CNP PROJECT TITLE: State Legislation and Policy Addressing 

Clinical Trials Participation

PRINCIPAL INVESTIGATOR: Claudia Baquet, M.D., M.P.H.

CANCER TYPE: Prostate

POPULATION: African Americans, Hispanics/Latinos, 

Native Americans, rural and urban, low-income whites 

LOCATION: Maryland

CNP-Maryland has pursued this goal through legislative 

engagement; in 2007, it coordinated a group of community 

members, cancer survivors, and academics to testify before 

Maryland’s General Assembly about prostate cancer services 

for uninsured men. This testimony led to Maryland Senate 

Bill 283, which established a three-year program for prostate 

cancer screening, referral, and treatment for uninsured/economically disadvantaged men in 

rural Charles County, MD. 
2

49

APPLIED RESEARCH

Researchers also provided technical assistance and data to support the development and 

passage of Senate Bill 459, creating a task force to review physician shortages in rural 

areas of the state. CNP investigators were included in the task force and supported its 

conclusions, making provisions for a state-based physician loan repayment program. The 

inclusion of underserved communities and researchers in the legislative process facilitated the 

development of policies and laws that reflect the cancer health needs of rural communities.

CNP PROJECT TITLE: 

Biannual Legislative Briefings

PRINCIPAL INVESTIGATOR: 

Ronda Henry-Tillman, M.D., F.A.C.S.

CANCER TYPES: Breast, colorectal, prostate

POPULATION: Underserved and rural

LOCATION: Arkansas

CNP-Arkansas pursued a similarly civicoriented advocacy approach, promoting 

policymaker awareness of patient, physician, researcher, and structural barriers surrounding 

cancer health disparities. Through biannual briefings, researchers apprised state and local 

policymakers of the most up-to-date scientific evidence about cancer in Arkansas, drawn 

from their research collaborations. They also offered policy recommendations for reducing 

the health and economic burdens of cancer. 

As a result of a powerful 2008 presentation on the positive effects of an expiring pilot 

program for colorectal cancer screening among the underserved, CNP researcher-advocates 

were able to stimulate the development and passage of The Colorectal Cancer Prevention, 

Early Detection, and Treatment Act of 2009—legislation that places Arkansas at the forefront 

of cancer-preventing states in instituting no-cost, statewide, colorectal cancer screenings for 

those unable to pay. Efforts like these, which ensure that high-quality, community-based, 

and other relevant data are at hand when 

forming legislative policies, are critical 

to removing structural barriers to cancer 

care in underserved communities.
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

50

CNP/C PROJECT TITLE: Hawaii AANCART Legislative Advocacy

PRINCIPAL INVESTIGATOR: Moon S. Chen, Jr., Ph.D., M.P.H.

CANCER TYPE: Lung

POPULATION: Asian Americans

LOCATION: Hawaii

The Hawaiian team affiliated with CNP-Northern California has consistently been active in 

health policy in and around O’ahu. In addition to working with Filipino civic organizations, 

the Hawaii team has advocated for several pieces of Hawaiian legislation related to cancer 

control. One key bill is House Bill 895 HD2 (2009), which increases the tax on all tobacco 

products other than cigarettes to 80% of the wholesale price. A portion of the tax’s proceeds 

is then devoted to a special fund supporting community health centers, where screening for 

lung cancer commonly occurs. 

To support the bill, the Hawaii team coordinated testimonies from several Filipino 

community and healthcare provider organizations. These testimonies proved so inspirational 

that the bill, despite initially being vetoed by Hawaii’s governor, received an immediate and 

resounding two-thirds majority override vote in both houses of the legislature. CNP-Northern 

California served as an important and powerful conduit for bringing community voices and 

needs into the legislative arena.

CNP PROJECT TITLE: Community Mobilization around Disparities—

Use of Media and Outreach

PRINCIPAL INVESTIGATOR: Kasisomayajula Viswanath, Ph.D.

CANCER TYPE: Breast, cervix, colon, lung

POPULATION: Low socioeconomic status

Researchers at CNP-Massachusetts used community mobilization techniques and media 

advocacy to address structural barriers to cancer care. Working with the community, they 

trained members to become activists to influence the public agenda on health disparities. 

At the same time, they conducted media workshops to educate local media outlets and 

journalists about cancer disparities. 

These media workshops, as well as public screenings of a PBS documentary on 

socioeconomic and racial disparities in cancer health, reached more than 1,000 individuals 

in the Boston area. Such media advocacy stimulates critical reflection among journalists and 

media outlets, the general public, and disparities communities themselves about how social 

structures contribute to health. Moreover, it brings marginalized communities and their 

health concerns into the mainstream dialogue, where disparities need to be addressed.
2

51

APPLIED RESEARCH

Patient navigation interventions are designed to limit or eliminate barriers that prevent 

patients, particularly those from vulnerable populations, from accessing quality and timely 

cancer care. Trained navigators provide expertise in and assistance with negotiating the 

healthcare system, helping patients cope with financial barriers (e.g., insufficient or lack of 

insurance), communication barriers (e.g., based on language or culture), systemic barriers 

(e.g., fragmented medical care, missed appointments), psychological barriers (e.g., fear, 

distrust), and social barriers (e.g., lack of reliable transportation or childcare options).

Promising as they may be, navigation interventions have not been assessed rigorously. To 

determine whether navigation can actually succeed in mitigating patient access barriers, NCICRCHD supported the development and evaluation of patient navigation interventions at 

eight academic research sites across the country, with a ninth additional site funded by the 

American Cancer Society. 

Over the course of five years (the intervention concluded in 

September 2010), the Patient Navigation Research Program 

(PNRP) aimed to determine whether navigation can (1) improve 

the timeliness and quality of care from the point of a cancer 

screening abnormality through confirmed diagnosis and completion 

of therapy; (2) do this work cost-effectively; and (3) improve 

patients’ satisfaction with their care and resultant quality of life. 

In order to perform this evaluation, PNRP followed more than 

12,000 individuals who received abnormal results on breast, cervical, colon, or prostate 

cancer screening tests. These individuals were roughly evenly divided between the program’s 

control and intervention arms, and represented diverse, underserved populations including 

Hispanics/Latinos, African Americans, and low-income whites. 

PNRP sites collected information on patients’ demographics and cancer details, as well as 

on the navigator services they received and background characteristics of their navigators. 

A comprehensive data dictionary consisting of more than 800 patient data elements 

was developed and ratified by all nine principal investigators, ensuring consistency in 

measurement indicators across sites. In order to assess these collected data, the investigators 

were tasked with developing new tools and tailored metrics to measure PNRP’s key outcomes 

(timeliness of care, cost-effectiveness, and patient satisfaction). 

applied research

Patient Navigation Research Program
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52

One of the key tools developed by the sites was Patient Navigator Tracking Logs. Used at 

all of the PNRP sites, these logs allow navigators to record patient barriers to screening and 

cancer care—drawing from a predefined list—and to detail the actions they undertake to 

overcome those barriers. Generating common descriptions of barriers and actions allows 

PNRP principal investigators to compare barriers across the country, identify particularly 

intractable ones, and note actions associated with improvements. The plan is that, as with 

the other PNRP-generated surveys and tools, the Navigator Tracking Logs can be applied in 

navigation programs nationwide. 

PNRP PROJECT TITLE: Colorado Patient Navigator Training 

PNRP: Denver Health and Hospital Authority, Denver, CO 

PRINCIPAL INVESTIGATOR: Peter Raich, MD

POPULATION: Hispanics/Latinos, African Americans, and underserved 

CANCER TYPE: Breast, prostate, colorectal

The need for specialized navigator training is an important topic for several of the PNRP 

sites. At PNRP-Denver, researchers have put together a package of training courses for 

students, current navigators, and other healthcare professionals interested in learning or 

advancing their navigation skills. These courses are delivered several times a year, in both 

face-to-face workshops (for basic skills acquisition) and as an online training program 

(for advanced skills acquisition and specialized topics). Developing and maintaining these 

curricula promotes a standardized body of knowledge across the nation’s patient navigator 

corps, as well as allows navigators to access specific training as their needs dictate. 

PNRP PROJECT TITLE: Online Resource Guide and Professional Network for Navigators and 

Other Health Workers

PNRP: University of Texas Health Science Center, San Antonio, TX

PRINCIPAL INVESTIGATOR: Donald Dudley, M.D.

POPULATION: Underserved

CANCER TYPE: Breast, cervical

Online training tools also are being deployed at PNRP-San Antonio, where the University of 

Texas research team has developed an online Health Worker Network that provides networking 

and training opportunities for navigators and community health workers. The site has proven 

so popular since its launch in June 2010 that the San Antonio Community Worker/Promotora 

Association began using it as the main venue for interacting with its members. 

PNRP-San Antonio’s community health workers have additionally developed an online 

compilation of the resources most commonly used during their PNRP experiences. The site lists 

more than 115 local medical, social, and financial support options, including transportation 

services, utility assistance programs, affordable housing solutions, childcare resources, and 
2

53

food assistance programs. Developing these sites has allowed the San Antonio research team to 

increase both the reach and the effectiveness of their programs across South Texas.

PNRP has developed new statistical tools to measure primary outcomes and piloted 

innovative methods to assess secondary outcomes. Using scientifically valid and reliable 

methods, PNRP has helped to fill a gap, both in the literature and in practice, in enhancing 

our understanding of how to make patient navigation a successful intervention. Furthermore, 

the program has ensured that these discoveries and methodologies will be useful more 

broadly—in setting the standards for and encouraging further research into patient 

navigation interventions.

Empowering Patients "As a patient navigator, it is rewarding to help someone who 

otherwise would have been delayed in treatment because of barriers. 

It is equally rewarding to empower patients so that they can selfadvocate in matters of their healthcare and the healthcare of their 

friends and families."

Working With 

Healthcare Providers

"Doctors and nurses are happier with the care because they know 

what is going to happen next with the patient; there is a plan. Also, 

the doctors know that there is one person in charge of this patient 

regarding their abnormal results. In the past, there were different 

clinic staff calling the patient regarding the abnormal result, and 

now there is one central person—the patient navigator. This way 

is more organized. It is a big help to the providers, the doctors stay 

organized, and the patients stay on track."

An Unspoken Oath "Just as doctors take a medical oath, we, as navigators, have an 

unspoken oath to our patients based on their needs and current 

situation. In this job, you need to be flexible, yet have boundaries."

Addressing Barriers "There are many issues that patients face after receiving their 

diagnostic testing. The patient-patient navigator relationship 

enables constant and helpful communication that is of vital 

importance in the process."

Empathizing With 

Patients

"It is important to have patience and be understanding about 

what the patient is going through. Patients have so many fears and 

other things going on. Patience is needed with all patients because 

the fears are always there. It is important to take the time to listen 

and help."

APPLIED RESEARCH

FIGURE 6 CURE Continuum of Training and Career Development Opportunities

FIGURE 5 The Many Roles of the Patient Navigator

FIGURE 9 The G/BMaP Network
Nurturing a 

diverse workforce— 

a crucial component 

to the future 

of cancer health

disparities research 
3

DIVERSITY TRAINING

55

A fundamental component underpinning all Center to Reduce Cancer Health 

Disparities’ (CRCHD’s) training and research programs is attracting and training 

a cadre of talented students and trainees from underrepresented populations in 

biomedical research. A diverse workforce is crucial to the future of disparities research and 

a critical first step in reducing the burden of cancer for an increasingly diverse America. 

Diversity training ensures that cancer research opportunities and advances reach all 

individuals, especially those who otherwise might be excluded. Recipients of diversity 

training, in turn, are well-positioned to leverage community partnerships that develop and 

implement education and workforce development efforts. 

According to data released by the 2010 U.S. census, the United States is well on its way 

to becoming a “minority-majority” nation. However, the growth in diversity within the 

general population has not been coupled with proportional increases in representation 

among the biomedical scientific ranks. This disparity is apparent in the lower number 

of underrepresented students expressing an interest in science and mathematics in high 

school and extends all the way to fewer successes in doctoral programs and independent 

scientific careers. A recent publication by Donna Ginther et al.1

, for example,reports that 

the probability of black scientists securing NIH R01 grants was 13.2% lower than that of 

white scientists during the 2000 - 2006 fiscal years. Even after controlling for other factors 

that could explain the disparities, such as scientists’ demographic characteristics, education 

and training, NIH experience, and research productivity, and employer characteristics, 

black applicants were still about 10 points less likely than whites to receive R01 grants. The 

authors found that success rates for R01 awards for all applications submitted by Ph.D. 

investigators during this same period were 16.1% for blacks, 28.1% for Hispanics, 29.3% 

for whites, and 28.1% overall. 

The question then arises as to where the gaps are in the training pipeline through which 

talented individuals from underrepresented populations fall? 

1 Ginther, D.K., et al. Race, Ethnicity, and NIH Research Awards. Science, August 19, 2011; 333 (6045): 

1015-1019.

DIVERSITY TRAINING

diversifying the 

cancer biomedical 

workforce
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

56

For more than a decade, the NCI Continuing Umbrella of Research Experiences (CURE) 

program has concentrated on identifying and closing those gaps by offering training support 

to individuals from sociodemographic groups that are underrepresented in the biomedical 

and cancer research fields. Support is available at every point along the career development 

continuum, from the high school level extending through to the independent cancer 

researcher level. The goals of CURE are to (1) increase the size and diversity of the cancer 

research talent pool; (2) emphasize research areas of greatest need; and (3) expand and extend 

the training period for underrepresented individuals (Figure 6). 

High School &

Undergraduate Pre-doctoral Post-doctoral Early StageInvestigator

Increase the 

size of the 

talent pool

Emphasize strategic and

scientific areas of 

greatest need

Expand and 

extend the period 

of training

CONTINUING UMBRELLA OF RESEARCH EXPERIENCES

Continuing Umbrella 

of Research Experiences

FIGURE 6 CURE Continuum of Training and Career Development Opportunities

FIGURE 5 The Many Roles of the Patient Navigator

FIGURE 9 The G/BMaP Network
3

DIVERSITY TRAINING

57

Foundation in Diversity Supplements

Today, the CURE program has impacted positively not only the careers of individuals 

from backgrounds underrepresented in the biomedical sciences who have gone through 

the program, but also NCI and NIH as a whole through an expanded pool of competitive, 

diverse researchers.

The foundation of CURE is a chain of diversity supplements to existing NCI grants 

that bridges one challenging transition point to another, enabling underrepresented 

individuals to have the financial support they need to pursue cancer research training. 

Diversity supplements can be awarded at any point in an individual’s academic and career 

development beginning as early as high school, and can serve as an introduction to cancer 

research. Such supplements are an excellent means to draw talented individuals into the 

cancer research career pipeline to begin their journey toward research independence. 

In order to target specific points in the 

career development pipeline, CURE has 

developed a series of awards to complement 

these diversity supplements. The various 

awards span training during high school 

and college, across predoctoral levels via 

F31 National Research Service Awards, 

across both mentored (K01, K08, and 

K23) and nonmentored (K22) early-stage 

investigator awards, and exploratory/

development grants (R21). With each 

grant designed to expand research training 

and professional skill building to boost competitiveness and career progression, CURE 

is the first and only NIH program to offer long-term, continuous training support to 

underrepresented students and professionals. 

CURE has grown significantly since its inception. In FY 2011, 180 diversity supplements were 

awarded, of which 91 were new and 89 were noncompeting. Broken down by educational level, 

the following supplements were awarded: high school (2), undergraduate (10), graduate (70), 

postbaccalaureate (18), postmaster’s (5), postdoctoral (55), and junior faculty (20).

CURE’s reach into underrepresented populations has brought an increasing flow of 

individuals from these populations into cancer research. The more CURE-trained investigators 

who remain in cancer research and mentor new CURE trainees, the closer CURE will be to 

achieving the goal of building and sustaining a diverse cancer research workforce. 
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

58

High School and Undergraduate Training

CURE begins its outreach at an early stage by targeting underrepresented high school 

students and, via P30 supplements, enrolling them in research training and education that 

partner them with laboratories and scientists at NCI-designated Cancer Centers. The goal 

of CURE’s high school and undergraduate component is to stimulate and nurture young 

people’s curiosity about science and biomedical research.

CURE supports several innovative high school and undergraduate programs. Its latest foray, 

launched in 2009 and continuing through 2011, is the Emerging Technology Continuing 

Umbrella of Research Experiences (ET CURE) program, developed in partnership with 

the NCI Center for Strategic Scientific Initiatives. ET CURE funds research experiences 

for young people in elective areas centered on emerging and advanced technologies, such as 

clinical proteomics, nanotechnology, biophotonics, and genomics. 

One example of an NCI-designated Cancer Center that has used CURE funding to establish 

an ET CURE program is the University of California (UC), Davis. The Cancer Center forged 

a partnership among its Medical Center, the UC Davis National Science Foundation-funded 

Center for Biophotonics and Technology, and Sacramento 

High School—a local charter school with a predominantly 

underrepresented student population. The partnership is 

formulated as a year-long Research Academy that includes 

coursework, field study, and laboratory research in cancer 

science. Research Academy participants are encouraged to 

pursue degrees in medicine and research. 

Temesgen Woldeyesus, the son of Eritrean immigrants and 

a current ET CURE UC Davis student, has discovered 

a fascination with brain tumors and clinical medicine 

through his Research Academy experience. Woldeyesus’ 

research, which focuses on helping the chemotherapeutic 

drug, doxorubicin, target cancerous cells exclusively, has 

led to recognition and awards at undergraduate poster 

presentations across the country. He proposed a DNA 

“nanocarrier” made of iron oxide nanoparticles, which can 

be manipulated inside the body via electromagnetic fields, as 

a solution to the doxorubicin delivery problem.

The excitement of this cutting-edge research and the inspiration provided by his mentor, 

Lorenzo Berti, Ph.D., have clearly had an impact on Woldeyesus. That is precisely the 

aim of CURE program supplements—to foster an ability to envision an ambitious and 

successful career trajectory among promising young scientists from underrepresented 

Temesgen Woldeyesus and mentor 

Lorenzo Berti, Ph.D. 

"In a perfect world, having my own lab 

and practicing medicine, I’d like to 

prescribe a drug I discovered."
3

DIVERSITY TRAINING

59

backgrounds—and is made possible through their focus on 

unique and state-of-the-science research experiences.

Ruth L. Kirschstein National Research 

Service Award for Individual Predoctoral 

Fellowships to Promote Diversity in 

Health-Related Research (F31)

The next step in the CURE training progression is the 

predoctoral research experience. This is a particularly critical 

transition period and one in which many underrepresented 

trainees are lost from the pipeline. In response to this 

problem, CURE added the existing National Research 

Service Award (NRSA)(F31) to its mechanisms to support 

underrepresented students pursuing doctoral degrees or 

combined doctoral plus professional degrees. 

Student trainees at this stage have the commitment and 

potential to develop into independent and productive cancer 

researchers. Recipients of this highly competitive, peer-reviewed, F31 award pursue work in 

a variety of biomedical research areas, including basic cancer biology, tumor immunology, 

emerging technologies, and drug development, as well as behavioral, clinical, and health 

services research. Investigators with proven track records of mentoring success, in addition 

to CRCHD-based program directors, guide these trainees through the research process, 

technical skill-building courses, networking opportunities, and short- and long-term training 

and career plans. The guaranteed funding of the predoctoral F31 award ensures that these 

trainees can count on the resources and time to pursue their research while continuing their 

academic studies.

Michelle L. Stewart, Ph.D., of the Dana-Farber/Harvard Cancer Center, benefited from an 

F31 grant. Harnessing her cross-disciplinary training in chemistry, structural biology, and 

cancer medicine, Stewart discovered a new approach to disabling a key protein in cancer cells 

that otherwise enables them to resist cancer drugs.

By targeting the protein MCL-1, which helps cancer cells survive, and by using a sophisticated 

technique known as “peptide stapling,” Stewart figured out how to block MCL-1 activity, 

thereby allowing cancer drugs to kill tumor cells by apoptosis (programmed cell death).

“Stewart’s research has important implications for combating drug resistance in cancer 

patients,” said Stewart’s mentor, Loren Walensky, M.D., Ph.D., of the Dana-Farber 

Cancer Institute. “The discovery could help advance the development of new drugs to 

Michelle L. Stewart, Ph.D., and her mentor, 

Loren Walensky, M.D., Ph.D., at the 

Dana-Farber Cancer Institute
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

60

treat a broad range of cancers in which MCL-1 overexpression has been linked to cancer 

pathogenesis, including leukemia, lymphoma, multiple myeloma, melanoma, and some 

forms of poor-prognosis breast cancer.” Stewart’s F31-funded research, published as a 

cover article in Nature Chemical Biology, was also the basis 

of her Ph.D. dissertation at Harvard University. 

Manuel Ruidiaz, Ph.D., is another F31 recipient whose 

research has implications for improving patient care. While 

working toward his Ph.D. in bioengineering at the University 

of California, San Diego, Ruidiaz focused on the development 

of a device to provide rapid point-of-care analysis of the 

state of antibody drugs in cancer patients’ serum. He used 

the monoclonal antibody, alemtuzumab (anti-CD52), as a 

developmental model for assay refinement in patients with 

chronic lymphocytic leukemia (CLL). 

Leveraging research supported by his F31, Ruidiaz has 

published three peer-reviewed papers on further developing 

the technology to improve the reliability and sensitivity of 

this assay. With the assistance of the F31, Ruidiaz has been 

able to pursue his line of research that has the potential to 

facilitate targeted drug development efforts and make possible 

a therapeutic approach tailored to each patient’s unique cancer. 

Like Manuel Ruidiaz, Melissa Anderson was initially supported by a diversity supplement 

and subsequently received an F31 grant to support her research on Rhesus monkey 

rhadinovirus (RRV). RRV, a gammaherpesvirus, is a close viral relative of Kaposi sarcoma 

(KS)-associated herpesvirus (KSHV or HHV8) and the causative agent of three human 

malignancies: Kaposi sarcoma, primary effusion lymphoma, and multicentric Castleman’s 

disease. Anderson, a first-generation college student and doctoral candidate at the University 

of Virginia, has generated, in a two-step, sophisticated procedure, unique Rhesus monkey 

fibroblast (RF) cell lines that express the RRV tegument protein. 

As her research has progressed, Anderson has mastered numerous molecular biology 

techniques, allowing her to become proficient in retroviral/lentiviral constructs. In addition, 

she was selected for a coveted science teaching position for an undergraduate microbiology 

course at a local community college. Like Ruidiaz, Anderson is an example of the power 

of CRCHD’s F31 awards to open doors to productive cancer research careers for talented 

individuals from diverse and underrepresented populations.

Manuel Ruidiaz, Ph.D.

With the assistance of an F31, 

Ruidiaz's research has the 

potential to develop therapeutic 

approaches tailored to each patient's 

unique cancer.
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DIVERSITY TRAINING

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Career Development Awards (K01, K08, K22, and K23)

After earning a doctoral degree, postdoctoral training is often the next step on the career 

ladder to seeking biomedical research independence. In addition to diversity supplements, 

CURE offers four Career Development Awards that are differentiated based on the area of 

cancer research being pursued, background of the candidate, and mentored or nonmentored 

status. These awards provide funding and three to five years of protected time to support 

underrepresented individuals in intensive, mentored and nonmentored, cancer-related 

biomedical, behavioral, or clinical research career development experiences. 

Career Development Awards are a critical step in the CURE program; they prepare trainees 

to apply for and obtain NIH Research Project Grants (R01), the gold standard for research 

success, and/or equivalent grants from other funding organizations, leading to independent 

careers as cancer and cancer health disparities investigators.

In FY 2011, 58 career development grant 

applications were submitted and reviewed. Of the 

38 mentored applications (K01, K08, and K23), 

13 (34% success rate) were funded, and of the 20 

nonmentored applications (K22), six (30% success 

rate) were funded. In addition, 52 noncompeting 

Career Development Awards were funded. 

Of the 71 mentored and nonmentored career 

development grants in FY 2011, slightly more 

than half (54%) were awarded to female grantees. 

Broken down by race and ethnicity, grantees were mostly Hispanic/Latino (48%) and 

African American (45%). Whites and those who identified themselves as more than one 

race accounted for 3% each. Of the 71 grantees, only one (1%) was Native American. 

Clearly, a greater focus is needed on promoting biomedical research careers among Native 

Americans. Encouraging Native American awardees to continue to serve as mentors and 

role models to other Native Americans is a key part of this promotion.

As the accompanying pie charts in Figures 7 and 8 indicate, slightly more than half (52%) 

of trainees are engaged in basic research, with the most frequently studied cancer types being 

lung, breast, colorectal, hematologic, and prostate—cancers with the highest prevalence 

in racially and ethnically diverse, and underserved populations. In 2011, 104 publications 

resulted from these research efforts.
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

62

FIGURE 7 Career Development Awards by Research Area

Basic

52%

Translational

17%

Behavioral

20%

Clinical

(Patientoriented)

11%

FIGURE 8 Career Development Awards by Cancer Type

General

(nonspecific)

48% Breast

8%

Lung

13%

Hematologic

9%

Colorectal

8%

Stomach 1%

Liver 1%

Ovarian 1%

Glioma 1%

Cervical 3%

Head and Neck 3%

Prostate 4%
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DIVERSITY TRAINING

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Mentored Career Development Awards (K01, K08, K23) 

A critical component in the design of the Mentored Career Development Awards and a 

major contributor to recipients’ training is the mentoring received by candidates. The K01, 

K08, and K23 CURE mentor is both a programmatic resource—helping trainees plan, 

direct, and execute their research program, and a professional resource—modeling the 

behaviors, values, and skills necessary for biomedical career success. Mentorship is routinely 

cited by grantees as among the most valuable features of the K-series training awards. Many 

CURE trainees who flourish under the encouragement of their mentors go on to become 

mentors to a new generation of CURE trainees, applying the same methods and offering the 

same constructive combination of encouragement, guidance, teaching, and networking that 

their mentors so successfully provided to them.

The original, and one of the most common Career Development Awards received by CURE 

early-stage investigators with a research or health professional doctoral degree is the K01 

Mentored Research Scientist Career Development Award. The K01 offers support for three to 

five years of protected time that is free from teaching and other institutional requirements often 

linked to faculty funding. During this period, the early-stage 

investigator is expected to pursue an intensive basic research 

career development program, guided by an established mentor. 

The goal is to prepare these scientists to apply for independent 

research funding. 

Two additional K awards geared toward early-stage physicianscientists complement the K01 award: the Mentored Clinical 

Scientist Development Award (K08) for health professionals 

with a clinical degree and the Mentored Patient-Oriented 

Research Career Development Award (K23) for researchoriented clinicians. As with the K01, the K08 and the 

K23 awards are specifically designed to promote career 

development of scientists from diverse backgrounds who 

have a doctoral degree and are committed to a career in basic 

biomedical, behavioral, translational, or high-quality, patientoriented clinical research on cancer or cancer health disparities. 

These awards provide individuals with an intensive, supervised, 

research career development experience, including support and 

protected time, as they progress toward research independence.

Chyke Doubeni, M.D., M.P.H., is clearly a CURE mentored career development success story, 

having moved through the CURE pipeline from beginning to end. Doubeni’s initial diversity 

supplement documented declines in the use of mammography in breast cancer survivors over 

time, a trend exacerbated by low socioeconomic indicators. Interested in learning more about 

Chyke Doubeni, M.D., M.P.H.

As a CURE awardee, Doubeni 

was able to focus his research on 

socioeconomic issues related to 

colorectal cancer outcomes.
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

64

how socioeconomic factors might lead to disparities in access and treatment, he began focusing his 

research on issues related to colorectal cancer outcomes. Doubeni applied for and received an NCI 

Mentored Career Development Award in Clinical Science (K08). 

With 75% of his time protected for career development and research activities, Doubeni used his 

K08 to build a knowledge base in gastrointestinal and behavioral sciences. His research identified a 

potentially modifiable web of system-level factors that contributes to colorectal cancer disparities, 

including economic circumstances, minority status, accumulated risk, neighborhood location, 

educational background, type of health insurance, and even the specialty of an individual’s primary 

care doctor. All of these factors contribute to lower screening rates, increased cancer diagnoses, and 

poorer prognoses for African American populations. 

This research laid the foundation for his success in receiving his first independent R01 grant, 

which investigated the effectiveness of colonoscopy screening in reducing deaths from colorectal 

cancer in underserved populations. He also was successful in receiving a highly competitive 

American Recovery and Reinvestment Act (ARRA) Challenge grant to conduct a case-control study 

comparing the effectiveness of particular colonoscopy screening techniques for different cancer sites. 

Today, Doubeni is a fully established cancer researcher, with a laboratory at the University of 

Massachusetts Medical School in Worcester, MA. Like many other successful CURE alumni 

whose career trajectories continue to rise, Doubeni maintains his connections with the CURE 

program and continues to mentor trainees from diverse backgrounds. Doubeni’s story and 

passage through the CURE pipeline is a testament to the impact 

consistent support and mentoring can have on talented young 

scientists from underrepresented populations.

Roberto P. Benzo, M.D., represents another CURE pipeline 

success story. A clinically trained professional with a commitment 

to patient-oriented research, he used a CURE K23 award to 

successfully transition to independent researcher status with 

two current R01 grants and an R44 grant from NIH’s National 

Institute of Aging. He is currently working at the Mayo Clinic as 

an Assistant Professor of Medicine in the College of Medicine, and 

as a consultant in the Division of Pulmonary and Critical Care 

Medicine. 

Skilled in behavioral intervention science and evidence-based 

practices targeting diverse populations, Benzo focuses on innovative 

participatory behavioral intervention research directed at rehabilitation of conditions such as 

metastatic lung cancer and chronic pain syndrome. He uses disease self-management care models 

in which patients direct their own care. Another area of research interest for Benzo is the effect of 

mindfulness meditation on patient quality of life. 

Roberto P. Benzo, M.D.

"NCI's CRCHD K23 award has been 

the catapult of my academic career."
3

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DIVERSITY TRAINING

3

The Mentored Career Development Award is not only about instilling skills and supporting 

career development for the betterment of current CURE trainees, although this most 

definitely is its major focus. It is also about building a legacy for future CURE trainees—

struggling early-stage investigators whom these current CURE mentors and mentees will one 

day inspire and draw into the research pipeline, just as they, themselves, became entrenched.

As in the case of one multigenerational trio of women, CURE mentorship sometimes 

comes in threes. Cathrine Hoyo, Ph.D., M.P.H. (Duke University), is originally from Sierra 

Leone, where limited financial resources and research infrastructure had prevented her 

from acquiring background and skills in cutting-edge molecular biology and epidemiology. 

Hoyo’s K01 award provided her with protected time to concentrate on research and training, 

enabling her to update her knowledge and technical skills. Her K01 research demonstrated 

both genetic and environmental interactions in the transcription and deployment of tumor 

suppressor proteins, which helped explain the differing prevalence of certain esophageal and 

prostate cancers in African American and white populations despite similar rates of exposure 

to such risk factors as obesity and cigarette use. 

Hoyo tapped into the genetic and epigenetic background of her mentoring team both from 

Duke University and the University of North Carolina at Chapel Hill to guide her research. 

The relationship with Joellen Schildkraut, Ph.D. (Duke University), and the rest of her 

mentoring team helped her explore her research questions from diverse disciplinary angles 

and use an array of techniques, data sets, and laboratory equipment to construct a more 

comprehensive, nuanced picture of adenocarcinomas. 

SPOTLIGHT ON MENTORING:

Helping to Build a Legacy for Future CURE Grantees

Joellen Schildkraut, Ph.D., M.P.H. Cathrine Hoyo, Ph.D., M.P.H. Jennie Williams, Ph.D. 

DIVERSITY TRAINING SPOTLIGHT
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

66

Schildkraut is a long-time NCI grantee whose research 

focuses on genetic risk factors in women with ovarian 

cancer living in North Carolina. Her research seeks to 

understand the biological factors that elevate cancer 

risk among specific populations. With her strength in 

genetic epidemiology and mentorship, she had much to 

offer the young postdoctoral student. 

Hoyo credits her mentoring team’s ability to clarify the shortand long-term milestones she encountered along the way, and 

Schildkraut’s “knowing when to regroup and redirect efforts,” 

for teaching her important lessons about flexibility and 

adaptation in academic research.

From Schildkraut’s perspective, her job as a mentor is 

tailoring a training program to meet her mentee’s needs. In Hoyo’s case, this meant 

connecting her with coursework in molecular epidemiology, and skills training in writing 

and grantsmanship. She cautions that mentorship also involves knowing where to draw the 

line between offering advice and allowing space for a trainee to pursue research and career 

goals with increasing independence. The mentorship process proved successful in catapulting 

Hoyo’s career: she was awarded an R21 Exploratory Grant in 2006 and, in rapid succession, 

three R01 Independent Research Grants in 2008, 2009, and 2010. 

Hoyo, herself, has begun applying the lessons she learned from her mentorship with Schildkraut 

to her own mentee and K01 recipient, Jennie Williams, Ph.D. (Stony Brook University). 

Just as Hoyo expanded upon the research of her mentor, combining 

Schildkraut’s interest in genetic risk factors with environmental 

contributions to cancer in underserved populations, Williams 

is building upon Hoyo’s research. She is focusing on developing 

chemotherapy regimens, which are tailored to individuals’ genetic 

backgrounds, and that can affect the molecular pathways instigated by 

genetic and epigenetic factors. In 2010, Williams was granted her first 

R01 to investigate how chemotherapy affects colon cancer tumorigenic 

proteins in African Americans and whites. 

Now, with the same CURE commitment to pay it forward and 

strengthen the pipeline, Williams has begun taking on mentees herself—a local community 

college student, a chemistry undergraduate, and a group of Malverne High School AP 

Biology students.

"Mentoring is creating opportunities 

for a promising trainee."

- Joellen Schildkraut, Ph.D., M.P.H. 

"I learned tremendously 

from a group of people with 

diverse experiences." 

-Cathrine Hoyo, Ph.D., M.P.H. 

Williams is 

developing 

chemotherapy 

regimens 

tailored to an 

individual's genetic 

background.

DIVERSITY TRAINING SPOTLIGHT
3

DIVERSITY TRAINING

67

Nonmentored Career Transition Award (K22)

While the early K-series grants highlight mentored research experiences, an important 

transition step is learning to move out from under a mentor’s tutelage and begin autonomous 

research. To this end, CURE offers the NCI Nonmentored Career Transition Award (K22) to 

facilitate young researchers’ transition from the mentored stage of their careers to early-stage 

investigator positions or the equivalent. CURE aims to recruit and retain advanced postdoctoral 

and new investigators from its target demographic who are beginning research programs in 

their own independent labs. Previous CURE grantees, particularly recipients of mentored K 

awards, are highly encouraged to apply, thereby extending CURE’s pipeline of support. 

Nora Engel, Ph.D., fits the Career Transition Award criteria perfectly. After receiving her 

Ph.D. in molecular biology from the University of Buenos Aires, she pursued a Postdoctoral 

Fellowship at the University of Pennsylvania. In 2009, 

when Engel applied for K22 funding, she was an Assistant 

Professor in Biochemistry and Molecular Biology at the Fels 

Institute for Cancer Research, Temple University, PA, and an 

early-stage investigator just starting up her own lab. The K22 

award enabled Engel to establish herself as an independent 

investigator in the emerging field of cancer epigenetics. 

Studying mice in her lab, and focusing on the KCNQ1 

and CDKN1C domains, Engel is exploring the molecular 

mechanisms that regulate genomic imprinting by using gene 

targeting and transgenic technologies to generate mutations 

designed to disrupt imprinting. Her study of epigenetic 

mechanisms has the potential to open avenues of research that 

will improve our understanding of how the genome functions 

as a developmental blueprint and how disturbances of gene 

expression and imprinting patterns can lead to genetic diseases 

and cancer.

Nora Engel exemplifies the significance of the support afforded 

by this transition award. In 2011, two years after her K22 

award, she was able to secure an independent research R01 

grant to continue her important line of study. Among K22 recipients, 24% have competed 

successfully for R01 grants. 

Nora Engel, Ph.D. 

As a CURE grantee, Engel is 

exploring the molecular mechanisms 

that regulate genomic imprinting.
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

68

Another K22 success story, Robert Winn, M.D. (University of 

Colorado), received a Career Transition Award to study the role 

of WNT7A and Frizzled 9 (FZD9), an elaborate network of 

proteins, in non-small-cell lung cancer (NSCLC). Specifically, 

he evaluated the effects of this signaling pathway on mechanisms 

of tumor initiation and metastasis associated with lung epithelial 

cells. Winn’s research demonstrated that WNT7A is frequently 

lost in NSCLC and that the reestablishment of WN7A and 

FZD9 in lung cancer contributes significantly to the reversal of 

transformed cell growth seen in NSCLC. He went further to 

define the mechanism by which WNT7A and FZD9 are able to 

inhibit transformed cell growth by ERK5-dependent activation 

of the known tumor suppressor gene PPAR. 

In addition, Winn and his coworkers reported an association 

between the prostacyclin pathway and WNT. This work is 

particularly interesting given the recent finding that activation of 

the prostacyclin pathway has a positive effect on the prevention of 

early lung cancer in smokers. Winn and colleagues also published 

findings from a study showing that the effect of prostacyclin is 

independent of its receptor, but is dependent on the presence of FZD9. This finding suggests 

the possibility of future small-molecule targeted therapy for NSCLC. 

Winn, working with his team of multidisciplinary investigators, has competed successfully 

for several major NIH-funded research grants over the course of his career. This includes an 

NIH-funded R21 project and an R01 grant to further study the role of the WNT pathway in 

lung cancer. In addition, Winn continues to see and treat patients, and is active in numerous 

community-based activities aimed at attracting young people into research careers. 

Mechanisms like the K22 are increasingly important for developing and sustaining 

investigator independence throughout the CURE pipeline. The support offered at the 

K22 phase, including secure funds, protected time to allow for additional coursework 

and experience, and networking across institutions and disciplines, is essential to CURE’s 

harvesting and promoting of talent from underrepresented populations. 

Robert Winn, M.D.

Winn has competed successfully 

for several major NIH-funded 

research grants, including an 

R21 project and an R01 grant.
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DIVERSITY TRAINING

69

Exploratory Grant Award to Promote Workforce Diversity in Basic 

Cancer Research (R21) 

The R21 Exploratory Grant, the most recent expansion of CURE’s training opportunities, 

is intended for investigators from diverse populations with interest in research projects 

focused on the basic biology of cancer. The purpose of the grant is to close the gap that 

currently exists between new investigators and R01-funded investigators and ensure that 

those who have entered the research pipeline remain in the 

pipeline. The R21 funding mechanism also provides a bridge 

to investigators who have completed their training and require 

extra time to develop full RO1 proposals. 

Tonya Webb, Ph.D., (University of Maryland School of 

Medicine) is a former CRCHD K01 trainee who successfully 

competed for two R21 grants in August 2011. Her research 

under the K01 Mentored Career Development Award examined 

mechanisms to enhance immunity in cancer patients. Webb’s 

studies focused on expanding natural killer T (NKT) cells 

from healthy donors and cancer patients, and investigating 

their efficacy in an in vivo human melanoma/severe combined 

immunodeficiency (SCID) mouse model. 

“The K01 award has been instrumental in my retention in 

the biomedical research workforce and has greatly enhanced 

my career development,” said Webb. “I was offered a tenuretrack faculty position at the University of Maryland School of 

Medicine, due to my successful K01 application.” 

Building upon the K01, which helped her establish herself 

in the cancer immunology field, Webb transitioned to R21 Development Grants to gain 

additional support. One of Webb’s R21-funded projects is examining whether restoring 

NKT cell function may be a novel immunotherapeutic strategy for breast cancer. Her 

research characterizes immunosuppressive lipids shed by mammary carcinomas, which 

abrogate CD1D-mediated NKT cell activation, and determines whether inhibiting these 

lipids can restore NKT cell function. 

Webb’s other R21-funded work also explores NKT cell activity and examines how altered 

cellular bioenergetics influence NKT cell-mediated responses to lymphoma. Webb is hoping 

that the additional data these two studies are providing will strengthen her chances of being 

awarded an R01 grant and bring her goal of research independence within much closer reach. 

Tonya Webb, Ph.D.

"The K01 award has been 

instrumental in my retention in 

the biomedical research workforce 

and has greatly enhanced my 

career development."
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70

Partnerships to Advance Cancer Health Equity (PACHE) programs are located throughout 

the United States and increase opportunities for students and professionals from 

underrepresented populations to pursue careers in cancer and cancer health disparities 

research. PACHEs represent the collaboration of two bodies: an institution that works 

primarily with racially/ethnically diverse and/or underserved communities, and an NCIdesignated Cancer Center. These collaborations allow each partner to more effectively train 

diverse scientists and bring new cancer discoveries to traditionally neglected communities. 

As part of its training component, each partnership program invests in students at different 

academic levels, some offering training opportunities geared toward high school- and 

undergraduate-level students, and others aimed at master’s-, doctoral-, and postdoctoral-level 

students. While some partnerships have chosen to target specific professions and groups, such 

as nurses and population scientists, others focus on specialty curricula and experiential program 

enhancements, such as bioethics and hands-on laboratory experience. Each partnership 

enhances workforce diversity in ways best suited to the needs of its local population.

PACHE PROJECT TITLE: Providing Summer Research 

Experiences for Students and Science Educators

PARTNERSHIP: Bowie State University (BSU) and University 

of Maryland School of Medicine (UMSOM)

GRANT TYPE: P20

TRAINEES: High School Students

POPULATION: African American

In Maryland, the BSU–UMSOM Partnership’s

summer research program is encouraging high 

school students to consider careers in the biomedical 

and behavioral sciences. Using the successful 

undergraduate internship program as a model, the BSU-UMSOM partnership developed 

an eight-week, mentored, summer research experience for African American high school 

students from urban Baltimore. 

Partnerships to Advance 

Cancer Health Equity
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DIVERSITY TRAINING

71

The program offers participants hands-on laboratory experience, contact with research and 

clinical role models, and seminars on topics such as research safety and ethics. The goal is to offer 

promising young scientists a realistic understanding of the biomedical research environment, 

while fostering their self-confidence and belief that scientific careers are attainable.

PACHE PROJECT TITLE: High School Program in Medical Physics

PARTNERSHIP: University of Texas El Paso (UTEP) and University of Texas 

Health Science Center at San Antonio (UTHSCSA)

GRANT TYPE: P20

TRAINEES: High School Students

POPULATION: Hispanic

UTEP–UTHSCSA is another partnership that is encouraging 

high school students to pursue cancer research careers. UTEPUTHSCSA offers an outreach program designed to attract 

Hispanic high school students in El Paso, TX, to careers in 

medical physics and radiation oncology, with the larger goal 

of promoting diversity in the cancer research workforce, 

particularly among radiation oncologists. 

Through a novel “learning laboratories” approach, students learn the essentials of X-ray 

generation, detection, and use. The high school program is a key component of the 

partnership’s larger effort to carve an educational path that guides El Paso students through a 

master’s degree in medical physics at UTEP and a doctoral degree in medical physics in the 

radiation oncology department at UTHSCSA. 

PACHE PROJECT TITLE: Undergraduate Student Training in Cancer Research

PARTNERSHIP: New Mexico State University at Las Cruces (NMSU) and Fred Hutchinson Cancer Research 

Center (FHCRC)

GRANT TYPE: U54

TRAINEES: Undergraduate and postbaccalaureate students, and postdoctoral fellows

POPULATION: Hispanic and Native American

Focusing on the undergraduate/postbaccalaureate steps of the educational pathway, the 

NMSU–FHCRC Partnership offers Hispanic and Native American NMSU students either a 

nine-week summer internship (for those enrolled in undergraduate coursework) or a one-year 

internship (for those who completed their bachelor’s degrees) in cancer research. 
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

72

Both internships include mentorship by FHCRC faculty and postdoctoral fellows—an 

important learning experience for the fellows, as well; educational and research experiences 

in basic and clinical sciences, human biology, public health, or infectious disease; and 

the opportunity to present at a national conference. To date, six undergraduate and two 

postbaccalaureate students completed the program, with both postbaccalaureate students 

currently pursuing graduate training. 

PACHE PROJECT TITLE: Master’s Degree Program in Cancer Biology, 

Prevention, and Control

PARTNERSHIP: University of the District of Columbia (UDC) and 

Georgetown Lombardi Comprehensive Cancer Center (LCCC)

GRANT TYPE: U56

TRAINEES: Master’s students

POPULATION: African American

The master’s training period offers another opportunity to bring 

underrepresented students into cancer research. The UDC–LCCC 

Partnership targets Washington, DC-area master’s students, 

offering curriculum enhancements, such as workshops in 

technology and community outreach, lectures by distinguished 

experts, and mentorship opportunities to improve student 

retention and academic performance. The partnership also offers a six-week, paid, summer 

research intensive at LCCC. 

The program has successfully trained as many as 15 students per year and proposed a new 

Ph.D. program in cancer education at Georgetown University in 2010, with curriculum 

development supported by two R25 Cancer Education Grants—one from the National 

Institute of General Medical Sciences (NIGMS) and one from NCI.

PACHE PROJECT TITLE: Certificate and Postdoctoral Training in Cancer Research

PARTNERSHIP: San Diego State University (SDSU) and Moores Comprehensive Cancer Center, 

University of California San Diego (UCSD)

GRANT TYPE: U54

TRAINEES: Graduate and postdoctoral students

POPULATION: African American, Hispanic, and Asian

Aimed at graduate and postgraduate students, the SDSU–UCSD Partnership offers African 

American, Hispanic, and Asian sociobehavioral and population scientists the opportunity 

to study for a certificate or receive postdoctoral training in cancer research. The three-course 

advanced certificate program is available to graduate students in health and behavioral 
3

DIVERSITY TRAINING

73

sciences programs, as well as other interested graduate and postdoctoral students. The 

postdoctoral training opportunity places fellows in labs with highly productive mentors for 

two years of mentored research experience.

Beginning with only three participants in 2009, the program has grown to a total of 32 

trainees. The partners continue to refine and expand the program, developing still more 

supportive ways to promote cancer research to underrepresented investigators.

PACHE PROJECT TITLE: Training the Next Generation of Hispanic Cancer Researchers

PARTNERSHIP: University of Puerto Rico Comprehensive Cancer Center (UPRCCC) and University of Texas 

MD Anderson Cancer Center (MDACC)

GRANT TYPE: U54

TRAINEES: Undergraduates through professionals

POPULATION: Hispanic

In a different approach, the UPRCCC–MDACC Partnership for Excellence in Cancer 

Research aims to attract Hispanic scientists at any academic level to cancer research. The 

partners offer mentored cancer research assistantships, as well as a week-long cancer biology 

course for undergraduate and graduate trainees. STEP-UP, a summer internship program, 

is aimed at postbaccalaureate Ph.D. or M.D./Ph.D. candidates and focuses on developing 

their biomedical science 

background. Another 

summer program—this 

one for undergraduate 

and medical trainees—

provides mentored basic, 

clinical, or translational 

research experiences. 

In addition, an M.D./

Ph.D. dual-degree 

program is offered 

for those pursuing 

population sciences and 

translational research. 

In addition to increasing 

the Hispanic cancer research workforce, this partnership catalyzed the passage of a law 

funding increased infrastructure and recruitment of top-quality faculty to UPRCCC—one 

step toward helping it regain its distinction as an NCI-designated Cancer Center. 
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

74

PACHE PROJECT TITLE: Continuum of Undergraduate Research Training (COURT)

PARTNERSHIP: City College of New York (CCNY) and Memorial Sloan Kettering Cancer Center (MSKCC)

GRANT TYPE: U54

TRAINEES: High school through postdoctoral students

POPULATION: African American

CCNY–MSKCC is another partnership that trains students at several educational levels. The 

COURT program is designed to promote cancer-related research careers to undergraduates 

from underrepresented populations. Expanded in 2009 to reach more than 300 students, 

COURT has simultaneously broadened its curriculum to include translational research and, 

through an ARRA supplement, nanotechnology research, in collaboration with ET CURE. 

The eight-week Summer Clinical Oncology Research Experience (SCORE) is a new offering 

that employs female clinicians to mentor undergraduate and postbaccalaureate female 

students. By offering a range of training options, CCNY-MSKCC is helping to attract and 

train a diverse cancer research workforce. 

PACHE PROJECT TITLE: Nursing Research Training and 

Outreach Doctoral Program

PARTNERSHIP: San Francisco State University (SFSU) and 

UCSF Helen Diller Family Comprehensive Cancer Center 

(UCSF/HDFCCC)

GRANT TYPE: U56

TRAINEES: Master’s nursing students

POPULATION: African American, Latino, Filipino, and Asian

Unique among the partnership programs, the 

SFSU–UCSF/HDFCCC Partnership is training allied health professionals—specifically, 

master’s-level African American, Latino, Filipino, and other Asian nursing students—to 

pursue doctoral degrees focusing on cancer and cancer health disparities. The program, 

originally a pilot, achieved permanence, successfully winning $1.6 million in funding from 

the California Wellness Foundation, the California legislature, and SFSU. It has enrolled 23 

students, with three graduates planning to pursue their Ph.D. degrees. 

In addition to these programmatic successes, UCSF/HDFCCC also has been able to 

develop closer ties with its surrounding communities, resulting in increased enrollment of 

underrepresented groups in cancer prevention trials. These burgeoning community linkages 

demonstrate one of the underlying principles of diversity training—that researchers from 

underrepresented populations are better able than majority population researchers to liaise 

with their underserved communities.
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DIVERSITY TRAINING

75

PACHE PROJECT TITLE: Health Disparities, Bioethics, and Policy Course

PARTNERSHIP: Morehouse School of Medicine (MSM), 

Tuskegee University (TU), and University of Alabama at Birmingham 

Comprehensive Cancer Center (UABCCC)

GRANT TYPE: U54

TRAINEES: Undergraduate and graduate students in science 

and health-related studies

Some PACHEs, such as the MSM-TU-UABCCC Partnership, are focusing on specific 

areas of cancer research. At MSM-TU-UABCCC, the partners have devised a curriculum 

geared toward both graduate and undergraduate students that links the principles of ethical 

research, genetics, race/ethnicity, health disparities, institutional review, policy, and strategies 

to deal with potentially unethical events. Situated in a region with a large, historically 

underserved, African American population, this education program addresses a large range of 

ethical considerations that can arise between institutions serving majority and nonmajority 

populations, and between institutions and underserved communities. 
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CRCHD’s Community Networks Program (CNP), now the Community Networks 

Program Centers (CNPC), has been working to improve access to and use of beneficial 

cancer interventions in communities experiencing disparities through community-based 

participatory research (CBPR), education, and training. One of the key ways the program 

has been building capacity is through the development of strategic partnerships and 

collaborations that can enhance training efforts. All CNPCs also commit to mentoring 

new and early-stage investigators, providing individualized modeling, support, and 

encouragement to these young researchers. To date, 160 investigators have been trained in 

the use of CBPR techniques for community-based interventions.

CNP/C PROJECT TITLE: Increasing the Number of Latino Scientists Involved in Cancer Health Disparities

PRINCIPAL INVESTIGATOR: Amelie Ramirez, Dr.P.H., M.P.H.

CANCER TYPE: Breast, cervical, lung, colorectal, prostate, liver, and stomach

POPULATION: Hispanics/Latinos

LOCATION: Texas, California, New York, Florida

Both partnerships and mentoring were key components of CNP-Texas’s research that 

focused on improving training at key decision points in the academic career process 

for underrepresented researchers. By partnering with both major academic institutions, 

and public and professional organizations across the country, CNP-Texas has recruited 

master’s- and early doctoral-level trainees to join their research program, and monitored 

and nurtured their progress. 

Through these efforts, CNP-Texas provided training and mentorship to 81 individuals 

during its first four years, focusing particularly on Hispanic/Latino populations. In addition, 

the Texas researchers supported five master’s-level students to attend the Summer Institute 

at the University of California, San Francisco, which aims to increase the numbers of diverse 

applicants to doctoral programs in cancer research. Notably, the Texas team identified a 

critical point at which many diverse, early-stage investigators lose confidence and/or drop 

out of research careers—the transition from the master’s to the doctoral level. It is this type 

of evidence-based change, based on CNP research, which can help strengthen the training 

pipeline at its weak points.

Community Networks 

Program Centers
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DIVERSITY TRAINING

77

CNP/C PROJECT TITLE: ATECAR-Training & Mentorship

PRINCIPAL INVESTIGATOR: Grace X. Ma, Ph.D.

CANCER TYPE: Colorectal, breast, cervical, lung, prostate, and liver 

POPULATION: Asian Americans

LOCATION: Pennsylvania; New Jersey; New York City; New Jersey; Delaware; Washington, DC; Maryland

CNP-Mid-Atlantic is another example of shining success with mentorship. Over a threeyear span, senior researchers mentored more than 60 early-stage investigators and supported 

their mentees in developing 14 pilot studies related to the CNP’s activities, as well as several 

additional independent studies. These research projects, supported by various sources, 

including NCI, leveraged almost $10 million in funds. 

The clear success of these emerging researchers in project development can be traced back to 

their beneficial mentor/mentee interactions, which built confidence, developed skills, and 

ultimately, inculcated successful practices among the trainees. Mentorships, such as these, 

help build a critical mass of scientists focused on health disparities research.

CNP/C PROJECT TITLE: SCCDCN Recruiting 

and Training Students

PRINCIPAL INVESTIGATOR: James Hebert, 

Sc.D., M.S.P.H.

CANCER TYPE: Breast, cervical, colorectal, 

esophageal, lung, oral, and prostate

POPULATION: African Americans

LOCATION: South Carolina

In another approach, CNP-South 

Carolina used its training component 

to develop a seminar series for emerging 

researchers. As part of the series, 

these trainees, most of whom were 

African American, learned to write proposals and grant applications, use different research 

methodologies, and, through hands-on field-training sessions, apply CBPR strategies. 

In addition, the emerging researchers were given opportunities to network with leading 

cancer disparities researchers from across the state, and to collaborate with each other on 

manuscripts and presentations. The South Carolina research team invested in its students, 

promoting their success by improving their ability to access the intellectual, experiential, and 

human resources necessary for a successful career in cancer disparities research.
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An integrated 

network strategy 

that links 

disparate research 

disciplines, 

infrastructures, 

and resources
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INTEGRATED RESEARCH, TRAINING, AND OUTREACH

79

The field of cancer health disparities is complex and is affected by a multitude 

of biological and nonbiological factors. Despite the National Cancer Institute’s 

(NCI’s) continued focus on understanding and addressing cancer health disparities, 

substantial differences in the burden of cancer still exist within certain populations. This 

persistent gap suggests that a new approach may be needed to better understand and reduce 

cancer health disparities. 

To this end, the Center to Reduce Cancer Health Disparities has been developing, 

with initial support from American Recovery and Reinvestment Act (ARRA) funds, an 

unprecedented, integrated network infrastructure that fosters linkages, leverages resources, 

and ultimately, enhances cancer health disparities research, diversity training, and community 

outreach and education. This Integrated Networks Program (INP) is a conscious paradigm 

shift from a silo- to a partner-based approach for the study of cancer health disparities, 

using multidisciplinary and transorganizational team science. INP does not dictate how 

these collaborations are to proceed; rather, it facilitates the development and maintenance of 

networks to serve as the infrastructure for such collaborative opportunities to grow.

A network strategy offers multiple benefits, such as leveraging the strengths of people, 

programs, and resources to more effectively engage communities, and increase access to 

clinical trials participants and tissue collection from diverse populations. It also offers 

improved tracking and support of patients who move between jurisdictions for treatment 

and screening, as well as enhanced outreach and training opportunities, with seamless 

transitioning of students and trainees through advanced education in cancer and cancer 

health disparities. The latter, in turn, helps grow the talent pool of investigators and 

community outreach workers from underrepresented populations who are skilled in cancer 

health disparities research. 

INTEGRATED RESEARCH, TRAINING, 

AND OUTREACH

linking 

research, training, 

and outreach
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80

Geographical Management of Cancer Health Disparities 

Program including Biospecimen Science

The Geographical Management of Cancer Health Disparities Program including 

Biospecimen Science (G/BMaP), initiated in 2008, was the first of two programs established 

within INP. The program’s aim is to reduce cancer health disparities using a comprehensive, 

regionally based network approach to support and efficiently manage multidisciplinary and 

team-based disparities research, diversity training, and outreach and educational efforts. 

G/BMaP divides the United States and its territories into six regional, disparities-focused 

networks, many of which include NCI-designated Cancer Centers, in addition to 

other institutions currently receiving CRCHD support. By bringing together regional 

experts and resources, and fostering inter- and intra-disciplinary collaborations, 

G/BMaP is creating networks that bridge, support, and manage CRCHD’s cancer health 

FIGURE 6 CURE Continuum of Training and Career Development Opportunities

FIGURE 5 The Many Roles of the Patient Navigator

FIGURE 9 The G/BMaP Network
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INTEGRATED RESEARCH, TRAINING, AND OUTREACH

81

disparities research and diversity training flagship programs across six regions (Figure 9). 

The programs participating include the Partnerships to Advance Cancer Health Equity 

(PACHE) (formerly the Minority Institution/Cancer Center Partnership [MI/CCP]), 

Continuing Umbrella of Research Experiences (CURE), Community Networks Program 

Centers (formerly Community Networks Programs [CNP]), and the Patient Navigation 

Research Program (PNRP).

To ensure that these networks 

have the greatest impact on cancer 

health disparities research and 

resource capacity, each regional G/

BMaP hub focuses its work on key 

elective or specialty areas. Each 

of these electives—biospecimen 

science, bioinformatics, clinical 

trials recruitment and retention, and 

emerging technologies—represents 

a new horizon in cancer disparities 

research. The hope is that by linking 

disparate research infrastructures and 

resources, and applying these four 

electives, synergies will evolve that will increase efficacy, decrease redundancies, and speed 

progress toward the reduction of cancer health disparities. 

All six regions have focused on building infrastructure, capacity, and resources to support 

regional biospecimen collection, enhanced access to biobanks, and culturally sensitive 

biospecimen research. Within Region 3, two-thirds of its partnering institutions are 

fully prepared with standard operating procedures for collecting, processing, and storing 

specimens, and conducting biospecimen outreach and education activities. This region also 

produced a seminal article on the topic of using qualitative research to ascertain knowledge, 

beliefs, and attitudes about biospecimen research among diverse communities. 

The clinical trials-focused elective aims to improve recruitment and retention of diverse 

populations in cancer research and clinical trials. Additionally, education and outreach 

efforts are underway to address the barriers that have contributed to the disproportionate 

number of clinical trial participants from underserved populations. Partnering institutions 

across all six regions are actively involved in recruiting patients for clinical trials, with region 

5 reporting particularly strong capacity (11 institutions with 1,349 open trials). Region 4 

forged a partnership between New Mexico State University at Las Cruces and the University 

of Texas Health Science Center at San Antonio to collaborate on a project designed to assist 

Hispanics in making informed decisions about participation in clinical trials. The Clinical Trials 

Education and Outreach for Latinos project involves a two-stage intervention to test bilingual 

The partnering institutions across all six regions are actively 

involved in recruiting patients for clinical trials.
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82

clinical trial education and outreach 

modules, and a training program 

for community health workers to 

facilitate recruitment and retention of 

participants in clinical trials. 

Five of the six G/BMaP regions have 

at least some bioinformatics capacity. 

Region 1, which covers the District 

of Columbia, Maryland, Virginia, 

and West Virginia, has made 

particularly substantial progress; all 

nine partnering institutions within 

the region have bioinformatics 

support or access to biomedical 

informatics. Region 1 also has shown great promise in the area of emerging technologies. 

One of the key research advances emanating from partnering institutions in the region is the 

use of microarray/chip technology in genome analysis.

All regions are engaged in community-based participatory research (CBPR), resource sharing, 

and communication and outreach with their partners and communities. Region 6, focusing 

its efforts on colorectal cancer, conducted a large needs assessment of Comprehensive Cancer 

Control (CCC) Programs to gather information regarding the work they are doing around 

colorectal cancer and their willingness to partner on G/BMaP-related implementation activities. 

A key finding of the assessment was that the major activity of CCC Programs is community 

outreach and education, and that there is willingness to share their outreach resources with G/

BMaP. Region 2 is using a CBPR approach to deal with its obesity disparity. All six states in 

the region have a higher prevalence of obesity and overweight, which are known to be gateway 

conditions for chronic diseases, including cancer. Not surprisingly, the region is overwhelmed 

by cancer and other chronic disease disparities compared with the rest of the United States. 

Given the important health implications of obesity, Region 2 is testing the feasibility of using a 

team science approach to develop a faith-based obesity intervention for racially and ethnically 

diverse, and underserved populations. In addition, all regions are leading efforts in training 

students and junior investigators from underrepresented populations who will be part of the 

next generation of competitive investigators in cancer and cancer health disparities research. 

The G/BMaP Network now includes 75 partnering institutions, including 16 NCIdesignated Cancer Centers. To date, NCI has invested $4.9 million ($2.8 million in ARRA 

funds in FYs 2009 - 2010) in G/BMaP. Twelve pilot programs supported by these funds 

already showed preliminary evidence of successful regional capacity building in cancer health 

disparities research, training, and outreach. Eleven joint GMaP and 11 joint BMaP research 

proposals are in progress, and one bioethics supplement was awarded. In addition, two joint 

The G/BMaP network is made up of 75 partnering institutions, 

including 16 NCI-designated Cancer Centers.
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INTEGRATED RESEARCH, TRAINING, AND OUTREACH

83

GMaP and three joint BMaP research papers are in progress. In 

an effort to engage a wider network of disparities researchers, 17 

GMaP and 25 BMaP presentations were made at major national 

conferences, as well as at individual meetings with approximately 

300 disparities researchers and practitioners. 

CRCHD organized its first annual Geographical Management of 

Cancer Health Disparities (GMaP) Program Summit at the end of 

FY 2010 with the goal of exploring and generating new concepts 

and approaches to serve as the foundation of the GMaP network’s 

team science, transdisciplinary approach to cancer health disparities 

research and training for FY 2011 and beyond. Discussion topics 

included network science, emerging technologies, clinical trials, 

bioinformatics, biospecimens, communication and dissemination, 

and training, and attracted more than 100 researchers from 67 

institutions across the country. The ideas generated from the 

meetings helped shape GMaP’s continued growth and development. 

With infrastructure in place to support regionally based hubs and implementation plans 

based on comprehensive needs assessments already submitted, the regions have shown their 

clear support for the integrated network paradigm. All of this points to the strong potential 

of G/BMaP to make important strides toward reducing cancer health disparities in the 

United States.

National Outreach Network

The National Outreach Network (NON) is the second of two programs within INP and 

differs somewhat in approach from G/BMaP. Whereas G/BMaP concentrates primarily 

on improving horizontal connections across the research and training communities at the 

regional level, NON focuses on building a network that is structured at the local level, 

connecting at-risk and underserved individuals to community outreach groups and research 

institutions. NON’s cohesive network infrastructure promotes community participation and 

a greater voice for underserved populations in the research and cancer care decision-making 

process. This process of collaboration helps ensure that research and resources are culturally 

tailored to the needs and expectations of the target community, and that research advances 

reach racially and ethnically diverse, and underserved communities in a timely manner. 

Perhaps the most critical link in the NON network is the cadre of community health educators 

(CHEs) who network between the community, the NCI-funded cancer health disparities 

research institution, and NCI. CHEs essentially wear two hats—they are developers of tailored 

community outreach and education programs, as well as members of institutional research 

teams dedicated to reducing local cancer health disparities. CHEs are strategically positioned 

CHEs are strategically positioned 

between the community and 

academic research worlds.
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

84

between the community and academic research worlds—bidirectional conduits who bring the 

community voice to the research team and NCI, and vice versa. They identify community needs, 

provide the information to researchers, and disseminate research findings and health promotional 

materials. A key part of their communication and dissemination activities involves tailoring 

materials and messages according to the community’s culture and literacy levels, and delivering 

them through culturally appropriate media. CHEs also engage in coalition-building efforts 

with community-, civic-, and faith-based organizations to 

share and extend resources and outreach around cancer 

information, scientific advances, prevention, clinical trials 

participation, and biospecimen collection. 

NON has seen increasing growth in its CHE corps in 

the two years since its inception. There were 17 CHEs 

originally funded, attached primarily to sites already 

supported by current CRCHD community-based research 

grants. By the end of 2011, the corps had grown to 50 

CRCHD-supported CHEs operating at community and 

research sites. Of these, 23 are supported by CRCHD’s 

Community Networks Program Centers (CNPCs). To 

date, CHEs have conducted more than 700 community 

education and outreach efforts in cancer prevention, 

diagnosis, and treatment among at-risk populations. 

Some CHEs have expanded the content of their awareness and education efforts to include 

information on biospecimen research and collection (more than 24 CHEs), clinical trials 

participation (21 CHEs), and smoking cessation (seven CHEs). CHEs are focusing their efforts 

on a variety of cancers, including breast (28 CHEs), colorectal (28 CHEs), cervical (17 CHEs), 

prostate (15 CHEs), lung (13 CHEs), colon (two CHEs), and general (17 CHEs). Their work 

is directed toward racially and ethnically diverse, and underserved groups, including African 

American (32 CHEs), Hispanic/Latino (22 CHEs), American Indian and Alaska Native (19 

CHEs), white (15 CHEs), Native Hawaiian and other Pacific Islander (six CHEs), lower 

socioeconomic status (11 CHEs), and rural (three CHEs) populations. 

NON’s CHEs are an integral component of CNPCs, serving as resident experts on 

communities and messengers of communities’ perceptions of proposed interventions. 

This kind of seamless integration of the community perspective into the research 

environment is exactly what NON aims to facilitate. The program’s long-range goal is 

to develop a comprehensive and collaborative forum of voices that can reach a critical 

mass of researchers, stakeholders, and diverse community members. Such cross-cutting 

collaboration is at the heart of INP’s strategy—and at the heart of CRCHD’s vision 

to further integrate its three pillars of research, training, and outreach to underserved 

populations. Building upon this infrastructure, NON is now well-poised in 2012 to 

strengthen this paradigm of interconnectivity.

The goal of a CHE's communication 

and dissemination activities is to tailor 

materials to the community through 

culturally appropriate media.
85

4

INTEGRATED RESEARCH, TRAINING, AND OUTREACH

Creating Positive Change with Digital Storytelling

Laura Revels is a CHE at Native People for Cancer Control (NPCC), a Regional Native 

American CNP housed at the University of Washington’s Center for Clinical and 

Epidemiological Research. NPCC works with American 

Indian and Alaska Native communities in Washington, Alaska, 

Oregon, Idaho, Montana, Wyoming, and North and South 

Dakota. Revels, exploring innovative ways to tailor outreach 

and cancer prevention education to tribal communities, pairs 

traditional storytelling with new media, and using the blend 

of the two—digital storytelling—to create powerful visual 

narratives about cancer. 

Storytelling workshop participants, who include community 

members, leaders, and health workers, create their own digital 

videos focusing on major cancer-related turning points in their 

lives, using recorded voice, music, and images. Over the past 

four years, Revels has led 45 such workshops, each encompassing 

six to 12 attendees, across villages and reservations. 

Revels understands that she can’t just walk into a community, be immediately accepted, and 

start giving workshops. Her first task is penetrating the wall of mistrust Native communities 

often have towards researchers, whom they perceive as “empty baskets that come into our 

community, take things, and leave nothing behind.” Revels tries to reverse that perception by 

leaving behind tools for the community’s use. 

She openly shares information about her own personal experience of cancer to help open the 

door to an educational dialogue on cancer, a taboo subject in these communities. Breaking 

down the initial barriers helps Revels earn community members’ trust and acceptance, and 

paves the way for her to introduce digital media to the community, empowering individuals 

to continue cancer dialogue, education, and behavioral change on their own. “Some tribes 

say that to even use the word ‘cancer’ is to invite it into your life,” says Revels, “so, these 

stories are a way to ease communities into opening up and talking about cancer.”

Workshop evaluations with Alaska Natives indicated participants felt the storytelling experience 

enhanced their cancer knowledge, reduced their fear of cancer, encouraged them to make 

healthy lifestyle behavior changes, and empowered them to share their stories to help others 

reduce cancer risk. In a survey four months to a year after participating in a storytelling 

workshop, attendees reported sharing their digital stories, on average, five times to 26 people at 

community events in their villages and reservations to catalyze discussion of cancer issues. Some 

of the initial workshop participants now are returning to create second digital stories to describe 

the personal and community impact of sharing their cancer-related experiences.

4

INTEGRATED RESEARCH, TRAINING, AND OUTREACH

INTEGRATED RESEARCH, TRAINING AND OUTREACH SPOTLIGHT

Laura Revels
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Examining Attitudes and Beliefs about Medical Research 

among African Americans

When the Detroit Public Library chose The Immortal Life of Henrietta Lacks by Rebecca 

Skloot as its “2011 One Book One Community” reading selection, the wheels immediately 

started spinning for Jena Baker-Calloway, M.P.H., a CHE at The Southeast Michigan 

Partners Against Cancer Center (SEMPAC). “I thought about how to utilize the book 

and the Detroit Public Library's built-in audience as jumping-off points to raise awareness 

about human participation in medical research, biobanking, and bioethics issues,” says 

Baker-Calloway. 

Winner of several awards, the book tells the story of how scientists took 

cancerous cell tissue from an African American woman without her 

knowledge or consent and cultured it to create an immortal human cell 

line used in numerous medical research studies. 

Baker-Calloway, a public health professional at Karmanos Cancer 

Institute's Population Studies and Disparities Research Program, 

worked with SEMPAC to sponsor some of the book’s author 

readings. In addition, she and SEMPAC initiated panel discussions 

in and around Detroit for health professionals, medical students, 

and the general community on the many concerns the book raised, 

including myths and realities around clinical trials and biospecimen 

collection, patients’ rights, safeguards that are in place, and bioethics. 

The CNP also implemented a community education outreach project 

using Skloot’s book as a catalyst for discussion to examine attitudes 

and beliefs about medical research within Detroit’s African American 

community. They found that the community generally believes in the 

importance of medical research but distrusts researchers. The project 

staff also learned that people do not feel respected by the medical 

community nor do they feel they have benefitted from research. In general, people preferred 

to discuss participation in biomedical research with members of their own community.

"I thought about how to 

utilize the book...as a 

jumping-off point to raise 

awareness about human 

participation in medical 

research, biobanking, and 

bioethics issues."

INTEGRATED RESEARCH, TRAINING AND OUTREACH SPOTLIGHT
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INTEGRATED RESEARCH, TRAINING, AND OUTREACH

87

Linkage with NCI Community Cancer Centers Program

In addition to INP’s two network programs, G/BMaP and NON, a collaborative initiative is 

in place with NCI’s Community Cancer Centers Program (NCCCP). Since 2007, CRCHD 

has supported NCCCP’s work in health disparities by providing technical assistance in 

developing the NCCCP disparities program and a physical home for NCCCP’s disparities 

staff liaison. In addition, CRCHD has offered NCCCP the opportunity to partner with 

CRCHD’s CNP principal investigators and Patient Navigation Research Program (PNRP) 

patient navigators. 

NCCCP was piloted in 2007 as a public-private partnership among 16 hospital-based 

community cancer centers in 14 states. In 2010, with the assistance of ARRA funding, the 

original NCCCP pilot program was expanded to 30 centers in 22 states. With 40% of its 

NCI funding directed to reducing healthcare disparities across the cancer care continuum, 

NCCCP, administered by NCI’s Office of the Director, was developed to explore methods to 

enhance patient access to state-of-the-science cancer care and increase clinical trials accrual in 

community settings, where more than 85% of U.S. cancer patients receive treatment. 

NCCCP’s disparities-related efforts 

have focused on standardizing metrics 

for race and ethnicity data collecting 

as well as developing strategies 

for cultural competancy, training, 

community outreach and patient 

navigation. Evaluation of the three-year 

pilot project indicated a number of 

improvements in care outcomes for 

underserved populations. The number 

of screening events held across sites 

increased by 60%, as did the number of 

individuals who were screened (41%). 

In addition, the number of patients 

navigated increased by 164%. Clinical 

trial accruals by NCCCP member 

hospitals also improved: there was an 

84% increase in racially and ethnically 

diverse participants and a 220% increase 

in elderly participants. In addition, NCCCP-participating hospitals substantially expanded 

(150% increase) the number and variety of their partnerships with community groups 

focused on issues affecting the underserved.

NCCCP-participating hospitals expanded the number and 

variety of their partnerships with community groups focused 

on issues affecting the underserved.
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As a result of its success, NCCCP is now prepared to share best practices for helping hospitalbased community cancer centers and communities better focus their efforts on addressing 

cancer healthcare disparities. NCCCP is also developing disparities-related resources and 

tools that are applicable to a broad range of community-based cancer programs. CRCHD’s 

collaborative role has proven essential in achieving NCCCP’s goals of enhancing access 

to state-of-the-science cancer care, increasing clinical trials participation, and expanding 

research opportunities within racially and ethnically diverse, and underserved communities.

With the support of 2010 ARRA funding 

and CRCHD's collaborative input, NCCCP 

is supporting disparities projects focused 

on increasing partnerships, outreach, 

and coordination of care in racially and 

ethnically diverse, and underserved 

communities. Project 5 funds 15 NCCCP 

sites as they test new approaches to engaging 

community partners and providers in 

the development of targeted outreach 

programs. Project 6 supports research to 

improve coordination of care across 14 

NCCCP sites, focusing particularly on developing effective navigation strategies that 

track racially and ethnically diverse, and underserved patients who receive community 

screening or primary care referrals. Project 7 promotes linkages between CRCHD's 

CNP/CNPC sites and nine NCCCP sites, increasing community participation in 

primary prevention and early detection among racially and ethnically diverse, and 

underserved communities.
5

APPENDICES

89

Disparities Research Branch

Diversity Training Branch 

Integrated Networks Program

Administrative Core

Communications and Dissemination Core

Performance and Evaluation Core

List of Acronyms

appendices
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

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Disparities Research Branch

Description: 

The Disparities Research Branch (DRB) stimulates and supports research to identify 

and reduce the determinants of cancer health disparities by integrating the assessment 

of racial and ethnic differences in basic, translational, clinical, behavioral, sociocultural, 

and community-based participatory research. These interdisciplinary research activities 

spanning the cancer continuum through end of life are critical to understanding which 

population differences contribute to cancer health disparities and at which intervention 

points. Research findings will foster evidence-based diagnostic, prevention, and 

intervention best practices to reduce cancer health disparities. 

Goals/Objectives:

•	 Stimulate and support basic biomedical and behavioral research focused on identifying, 

validating, and reducing cancer health disparities.

•	 Stimulate and support translational research efforts focused on integrating racial 

and ethnic basic knowledge differences with clinical practice to reduce cancer health 

disparities.

•	 Stimulate and support clinical and applied research to assess evidence-based prevention, 

early detection, and targeted treatment options for racially/ethnically diverse and other 

underserved populations within communities and globally that focus on minimizing or 

eliminating differences that reduce cancer health disparities.

Strategies to Achieve Goals/Objectives:

•	 23 Community Networks Program Centers (CNPCs) throughout the United States

•	 9 Patient Navigation Research Program (PNRP) sites

•	 Investigator-initiated research (R21/U01)

Highlights/Accomplishments:

•	 Funded 23 CNPCs 

•	 PNRP

» Guided patients through the medical system

» Defined the metrics for measuring patient navigation research used by other patient 

navigation programs, including those of the American Cancer Society and the U.S. 

Health Resources and Services Administration

» Created analytic database of 12,000 participants
5

APPENDICES

91

Future Directions:

•	 Develop new programs to support basic, translational, clinical, and applied research in 

cancer health disparities. 

•	 Evaluate patient navigation. 

•	 Pursue basic, translational, and clinical research, as well as collaborative and 

crossdisciplinary research.
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Diversity Training Branch

Description:

The Diversity Training Branch (DTB), leads NCI’s efforts in the training of students and 

investigators from diverse populations who will be part of the next generation of competitive 

researchers in cancer and cancer health disparities research. Through the Continuing 

Umbrella of Research Experiences (CURE), DTB supports a number of training programs 

that increase the number of underrepresented individuals, including racially/ethnically 

diverse, socioeconomically disadvantaged, disabled populations, and those re-entering the 

research workforce. These activities will foster the next generation of competitive researchers 

in cancer and cancer health disparities.

Goals/Objectives:

•	 Establish and maintain the pipeline of investigators from diverse populations by 

expanding and extending the period of training and career development.

•	 Stimulate and support a cadre of investigators from diverse populations who can compete 

successfully for independent Research Project Grants (RPGs).

•	 Emphasize strategic and scientific areas of greatest need (e.g., basic, clinical, translational, 

behavioral, and population sciences, and emerging technologies).

Strategies to Achieve Goals/Objectives:

•	 Exploratory Grant Award to Promote Workforce Diversity in Basic Cancer Research 

(R21)

•	 Partnerships to Advance Cancer Health Equity (PACHE), (U54, P20)

•	 NCI Mentored Research Scientist Development Award to Promote Diversity (K01)

•	 NCI Mentored Clinical Scientist Research Career Development Award to Promote 

Diversity (K08)

•	 NCI Mentored Patient-Oriented Research Career Development Award to Promote 

Diversity (K23)

•	 NCI Transition Career Development Award to Promote Diversity (K22)

•	 Ruth L. Kirschstein National Research Service Awards for Individual Pre-doctoral 

Fellowships to Promote Diversity in Health-Related Research (F31)

•	 Research Supplements to Promote Diversity in Health-Related Research (Administrative 

Supplement)

•	 Research Supplements to CURE (P30, T32, K12, R25T)

•	 Supplements to Promote Re-entry into Biomedical Research Careers (Administrative 

Supplement)
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Highlights/Accomplishments:

•	 Developed R21 funding opportunity to promote workforce diversity in the area of basic 

cancer research.

•	 Assisted more than 1,000 students (high school, undergraduate, graduate) and trainees 

(postdoctoral and junior investigators) and hired 83 new faculty through the PACHE 

program.

•	 Achieved 20% success rate of R01 procurement in the Transition Career Development 

Awards

Future Directions:

•	 Develop new programs targeting middle school students to stimulate accelerated entry 

into science.

•	 Increase training opportunities in translational and cancer health disparities research.

•	 Expand the emphasis in promoting diversity training in the area of emerging 

technologies.
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Integrated Networks Program

Description:

The Integrated Networks Program (INP) focuses on promoting and facilitating new and 

ongoing linkages among cancer health disparities research, diversity training, community 

education and outreach, and information dissemination, emphasizing a transdisciplinary 

approach to reducing cancer health disparities. INP was created to help advance the 

understanding of the complex biological and nonbiological causes of cancer disparities. 

It supports two network programs—the National Outreach Network (NON) and the 

Geographical Management of Cancer Health Disparities Program including Biospecimen 

Science (G/BMaP), and one collaborative initiative, the NCI Community Cancer Centers 

Program (NCCCP). 

Goals/Objectives:

•	 Advance the science of cancer health disparities and reduce cancer health disparities using 

a comprehensive, regionally based network approach and team science.

•	 Contribute to the next generation of cancer health disparities researchers.

•	 Build and sustain an integrated NON for NCI-supported education, outreach, and 

research dissemination within community-based cancer health disparities programs.

•	 Disseminate culturally relevant cancer information adapted from NCI materials to fit 

specific needs and expectations of targeted, underserved communities and foster research 

participation.

•	 Develop appropriate models for community input into research agenda.

Strategies to Achieve Goals/Objectives:

•	 Develop opportunities for collaboration and partnerships among basic, clinical, and 

behavioral researchers, practitioners (including lay community practitioners), trainees, 

and community leaders. 

•	 Maintain and expand ongoing communication/dissemination linkages and foster 

dialogue with racial/ethnic and other underserved populations, to improve community 

outreach, cancer information dissemination, and cancer public education efforts.
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Highlights/Accomplishments:

G/BMaP

•	 Collected GMaP pilot data highlighting research/training capacity in biospecimen 

science, clinical trials, informatics, and emerging technologies in each of six regions

•	 Put into place one full-time equivalent (FTE) national GMaP coordinator, 12 FTE 

G/BMaP regional coordinators, and 17 CHEs

•	 Partnered with more than 67 participating academic institutions, including 13 Cancer 

Centers

•	 Provided G/BMaP grantees with “101” elective webinars on NCI resources in 

biospecimen science, clinical trials, informatics, and emerging technologies

•	 Held GMaP Summit to convene GMaP partnering institutions/regions across the 

United States

NON

•	 Supported 50 CHEs to conduct NCI-coordinated NON activities through supplements

•	 Held eight teleconferences and webinars for NON CHEs to share information on such 

topics as biospecimen collection 

•	 Conducted more than 700 community education and outreach efforts in cancer 

prevention, diagnosis, and treatment among at-risk populations via NON CHEs

NCCCP

•	 Provided guidance, direction, and technical assistance to NCCCP via three working 

groups, subcommittees, annual meeting, and site teams on health disparities program 

activities

•	 Consulted on identifying and implementing disparities vision and program priorities, 

namely, community outreach, patient navigation, and strategic partnerships to enhance 

NCCCP disparities research capacity 

Future Directions:

•	 Create sustainable regional networks in cancer health disparities research, training, and 

infrastructure for cancer health disparities elimination. 

•	 Establish network sustainability to foster community involvement in research that reflects 

state-of-the-science cancer best practices. 

•	 Design online social networking tools to help scientists identify potential collaborators.

•	 Create centralized databases of measures and instruments for team-based science.

•	 Pursue opportunities for public/private partnerships to contribute to long-term solutions 

to reduce disparities.
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Administrative Core

Description:

The Administrative Core provides coordination of administrative resources and services 

to the Center to Reduce Cancer Health Disparities (CRCHD). These services include 

development of effective and efficient business processes for administrative resources for 

scientific support, office organization, time and budget management, information technology 

support, human resources management, grants management, research assistance, facilities 

management, procurement and property management, printing and graphics support, 

communication and dissemination support, and mail and messenger operations. 

Goals/Objectives:

•	 Establish systematic structure and clear managerial guidelines, file and retrieve 

documentation, and maintain administrative resources to provide support to professional 

scientific staff. 

•	 Develop and implement standard operating procedures.

•	 Manage CRCHD project resources to achieve consistency with work plans, deadlines, 

and staff resources.

•	 Promote the development of skilled and productive administrative support staff.

•	 Promote clear and accurate internal communication and awareness of operational policies 

and procedures for project and personnel management issues.

•	 Assist in the production of high-quality reports and documents.

Strategies to Achieve Goals/Objectives:

•	 Use software to identify activities and monitor the status of tasks from assignment to 

completion.

•	 Establish a process for logging and communicating the receipt of applications, with 

future use of scan and receipt database.

•	 Host conferences and workshops that facilitate training for scientific and administrative 

staff. 

•	 Reorganize and maintain CRCHD shared drive.

•	 Revise CRCHD Central Calendar. 
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Highlights/Accomplishments:

•	 Reorganized shared drive

•	 Reviewed process effectiveness and development of process improvement and standard 

operation proceedures

Future Directions:

•	 Develop a committed, knowledgeable, results-oriented team of administrative support 

personnel focused on accomplishing CRCHD goals with the highest standards of 

excellence and integrity.
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Communications and Dissemination Core

Description:

The Communications and Dissemination (C&D) Core advances the mission of the Center 

by developing, coordinating, and disseminating cancer information, education, outreach 

efforts, and cancer health disparities research results to cancer health disparities researchers, 

as well as to racially/ethnically diverse and underserved communities, to improve the lives of 

those disproportionately affected by cancer. Working closely with CRCHD staff and NCIsupported cancer health disparities researchers, C&D uses state-of-the-science dissemination 

methods to reach diverse audiences and meet their needs for the latest culturally and 

linguistically appropriate, evidence-based cancer information, products, and programs. C&D 

is also responsible for strategic communications planning, messaging, materials development, 

and media relations for CRCHD.

Goals/Objectives:

•	 Promote best practice, audience-focused communication strategies to provide state-ofthe-science communications support across CRCHD, NCI, and cancer health disparities 

research community, and enhance message delivery and understanding of cancer health 

disparities research/training. 

•	 Use a systematic and coordinated approach for the identification, adaptation, and 

dissemination of culturally sensitive information, products, and programs for targeted 

audiences aimed at cancer health disparities reduction.

Strategies to Achieve Goals/Objectives:

•	 Work closely with CRCHD staff, as well as other Divisions, Offices, and Centers 

(DOCs) across NCI, to determine communications objectives, audiences, messages, 

channels, activities, and strategies for important CRCHD-related initiatives and to help 

promote cancer health disparities research. 

•	 Plan, prepare, and produce CRCHD-related resources, including Center and 

programmatic brochures, fact sheets, articles, slide presentations, webinars, talking points 

for interviews, CRCHD Welcome Packages, CRCHD Information Packages, special 

reports, clearance support, written correspondence, and other select publications, which 

are critical to understanding and reducing cancer health disparities.
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•	 Refresh CRCHD Web site, provide ongoing maintenance and, with technical assistance, 

design, develop, and update Web content, in addition to Web pages for special events, 

to support a systematic and comprehensive process for disseminating cancer health 

disparities-related information, researcher profiles, products, and programs to researchers, 

practitioners, and other key stakeholders, and to ensure and enhance CRCHD’s reputation 

as a definitive source of NCI-supported cancer health disparities research and capacity.

•	 Develop a brand for CRCHD print and electronic media.

•	 Produce bimonthly CRCHD eBulletin to rapidly disseminate findings from cancer and 

cancer health disparities research supported by the Center, so that they may be adopted 

for broadest impact on cancer health disparities outcomes.

•	 Disseminate monthly eBlasts to more than 1,500 subscribers to inform them of Web site 

updates.

•	 Produce Inside Scoop, featuring selected articles from the cancer/cancer health disparities 

research and NIH/NCI communities to inform CRCHD staff of new developments.

•	 Manage CRCHD exhibit program to support a CRCHD presence at national, regional, 

and local conferences and meetings to enhance understanding of cancer health disparities 

research.

•	 Host G/BMaP and NON webinars to inform grantees of NCI/CRCHD disparities 

activities and training.

•	 Link to NCI’s social media sites, including Facebook, Twitter, YouTube, and Flickr.

Highlights/Accomplishments:

•	 Developed a branding program that provided CRCHD with a unified presentation 

format to enhance overall visibility and consistent messaging with external audiences

•	 Received more than 4,000 Web site visits monthly

•	 Produced 25 eBulletins and 36 Inside Scoops, and exhibited at four conferences

•	 Disseminated eBulletin to 2,500 subscribers, and to associated programmatic listservs 

and distribution lists

•	 Hosted eight programmatic webinars for grantees 

Future Directions:

•	 Spawn research to fill gaps in communications and dissemination.

•	 Continue to integrate social media technologies to enhance communication and 

dissemination activities.

•	 Continue to evaluate effectiveness of communications and dissemination.
CRCHD'S ANNUAL REPORT ON CANCER HEALTH DISPARITIES FISCAL YEAR 2011

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Performance and Evaluation Core

Description:

The Performance and Evaluation Core (PEC) plans and coordinates the monitoring and 

evaluation of CRCHD program performance, effectiveness in achieving stated goals 

and priorities, and outcomes. PEC is responsible for developing program analytic plans, 

handling performance system reviews, and conducting evaluations of CRCHD programs 

and activities. In addition, PEC prepares and disseminates annual and ad hoc reports of the 

progress and impact of NCI/CRCHD programs and initiatives in addressing cancer health 

disparities. 

Goals/Objectives:

•	 Develop infrastructure and procedures for systematic monitoring and evaluation of 

the performance and outcomes of CRCHD programs aimed at reducing cancer health 

disparities.

•	 Use performance and evaluation information (constructive, data-based reviews and 

portfolio analysis) to increase understanding of successful interventions and determine 

continuation, modification, expansion, or termination of programs.

•	 Communicate and disseminate annual and ad hoc reports on the progress and impact of 

NCI/CRCHD programs and initiatives in addressing cancer health disparities coherently, 

concisely, and with transparency. 

•	 Strengthen problem-solving collaborations (within CRCHD and externally) and work 

together to improve performance management practices and outcomes within CRCHD 

and among CRCHD grantees.

•	 Conduct portfolio analysis and secondary data analysis to determine areas to target to 

reduce cancer health disparities. 

•	 Help to foster public trust and cooperation. 

Strategies to Achieve Goals/Objectives:

•	 Develop and maintain a central CRCHD database for storage, retrieval, and analysis of 

data on all CRCHD research and training programs.

•	 Identify performance measures and corresponding core data elements for all CRCHDfunded research and training programs to be included in the new CRCHD database, as 

well as develop standard operating procedures for entry, storage, retrieval, and analysis 

of data.

•	 Prepare all annual reports as required by law, in addition to ad hoc reports in response to 

congressional and/or NCI leadership requests.
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Highlights/Accomplishments:

•	 Developed CRCHD database and began populating the database with program-specific 

data

•	 Prepared annual reports of NCI’s Minority Health and Health Disparities activities and 

funding, and responded to several ad hoc congressional and NCI leadership inquiries

•	 Secured 1% evaluation set-aside funds to conduct feasibility of CNP evaluation

Future Directions:

•	 Automate the collection and storage of program data in the CRCHD database.

•	 Work toward real-time portfolio analysis and analytical capabilities to facilitate efficient 

evidence-based management decision making.

•	 Develop standardized outcome and performance measures for similar programs within 

CRCHD.

•	 Secure funding for longitudinal data tracking and long-term impact and outcome 

evaluations of CRCHD programs.

•	 Collect race/ethnicity data on research participants.

•	 Collect race/ethnicity data on trainees and junior investigators for tracking career 

development.
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LIST OF ACRONYMS 

AACR American Association for Cancer Research 

ACS American Cancer Society

ARRA American Recovery and Reinvestment Act

C&D Communications and Dissemination

CCR Center for Cancer Research

CMBB Comprehensive Minority Biomedical Branch

CMS Center for Medicare and Medicaid Services 

CNP Community Networks Program

CNPC Community Networks Program Centers

CRCHD Center to Reduce Cancer Health Disparities

CURE Continuing Umbrella of Research Experiences

DCB Division of Cancer Biology

DCCPS Division of Cancer Control and Population Sciences

DCEG Division of Cancer Epidemiology and Genetics

DOCs Divisions, Offices, and Centers

DRB Disparities Research Branch

DTB Diversity Training Branch

ET CURE Emerging Technology Continuing Umbrella of Research Experiences

G/BMaP Geographical Management of Cancer Health Disparities Program including Biospecimen Science

HHS Department of Health and Human Services

INP Integrated Networks Program

MB-CCOP Minority-Based Community Clinical Oncology Program

MI/CCP Minority Institution/Cancer Center Partnership

MICR Minorities in Cancer Research

NCCCP NCI Community Cancer Centers Program

NCI National Cancer Institute

NIGMS National Institute of General Medical Sciences

NIH National Institutes of Health

NIMHD National Institute on Minority Health and Health Disparities

NON National Outreach Network

NRSA National Research Service Award

OHAM Office of HIV and AIDS Malignancy

PACHE Partnerships to Advance Cancer Health Equity

PEC Performance and Evaluation Core

PNRP Patient Navigation Research Program

SBIR Small Business Innovation Research
http://crchd.cancer.gov/
NIH Publication 12-7547

http://crchd.cancer.gov/