Abstract IA41: Precision medicine in cancer: Opportunities and challenges in Latin America
Authors: Llera Andrea S. 
Published: August 2020

Abstract
In the last few years, the importance of diversity in precision medicine has been highlighted. However, in many cases, the scientific focus has been put on the need of genetic studies in diverse populations, even when the very definition of precision medicine has included both genetic and environmental aspects that affect the development of a certain disease in an individual. In particular, cancer, like other complex diseases, is considered a result of how chronic exposure to etiologically relevant environmental factors (the “exposome”) impacts on the more or less susceptible genetic information of a subject. Studies on cohorts other than White have highlighted variations on cancer incidence, prognosis, and response to treatment that reinforce the need to establish the unique genetic and environmental characteristics that are present in geographically diverse populations. In particular, Hispanic/Latinos have been the subject of several initiatives in the US that try to discriminate the impact of the variations on genome and exposome in the incidence and severity of cancers. Among other findings, it is fairly clear now that Latinos tend to have overall better health indicators than those of other ethnic groups with whom they share demographic and socioeconomic characteristics; however, cancer incidence rates tend to increase in US Latinos with respect to those reported in Latin America. Registries of cancer are scarcely populated in Latin America and for this reason, differences in completeness of registries cannot be ruled out as a confounding factor in this generalization. Unfortunately, there are still very little data publicly available in Latin America to address the causality of these differences. Moreover, Latin America is in itself a complex mixture of genetic variation and geographical features, and in particular the South American admixture, which represents less than 15% of US Latinos, is hardly represented in the current precision medicine landscape. Thus, there is a compelling need to establish Latin American case and control cohorts that may help to discern the relevance of genetic and environmental factors in the characteristics of cancer in this population. A few regional initiatives try to address, at least partially, this lack of knowledge. An example of these initiatives is the Latin American Cancer Research Network (LACRN), which comprises a coalition of hospitals (mostly public); basic, translational, and clinical science investigators and institutions; and government officials from Argentina, Brazil, Chile, Mexico, and Uruguay. Its first study, sponsored by NCI's Center for Global Health (CGH) and regional partners, focuses in the molecular and epidemiologic characterization of a real-world cohort of breast cancer patients (the MPBC study, for Molecular Profile of Breast Cancer) and has currently 1,314 eligible patients who have been enrolled from 2011 to 2013 and have been studied and followed for &gt;5 years under GCP quality standards. As well, associated biobanks have been established to keep TCGA-quality biospecimens in optimal conditions for molecular studies. In my talk, I am going to address some of the difficulties that arise when these projects are developed in Latin America, especially when developed at the level of public health services. The success in these projects depends upon applying specific strategies to overcome the aforementioned difficulties so as to contribute to the knowledge of diversity in precision medicine in Latin America.
Citation Format: Andrea S. Llera. Precision medicine in cancer: Opportunities and challenges in Latin America [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA41.