The Cancer Prevention and Control Program (CPCP), under the guidance and leadership of Marc Goodman, MD, MPH, and Stephen Freedland, MD, investigates cancer etiology through genetic and epidemiological risk with the goal of using new knowledge to reduce incidence and mortality in diverse populations. Additionally, CPCP seeks to understand the side effects of cancer and its treatments to improve cancer survivorship. These objectives involve preclinical work, translational research, population level research and clinical trials to develop and test novel approaches for cancer prevention as well as to improve cancer survivorship. Emphasis is placed on the cancer care continuum so new knowledge and reduction of risk and mortality are disseminated rapidly and effectively to our patient community.
CPCP focuses on three themes:
- Determine how inflammation and anti-tumor immunity modulate cancer risk and progression,
- Determine how coexisting metabolic diseases alter cancer risk and progression and
- Assess how genetics explains differential risk, function and clinical outcomes. Each of these themes is rooted in the catchment area.
Los Angeles County has an ethnically and racially diverse population, with a particularly high percentage of an National Institutes of Health–designated health disparity group: Hispanics. The rising hepatocellular cancer (HCC) burden in Hispanics has been attributed to the rising obesity pandemic. CPCP investigators have developed multicenter clinical trials in cirrhotics and early-stage HCC patients, and a prospective clinical cohort study of adult patients with liver cirrhosis who are waitlisted for a liver transplant at Cedars-Sinai or UCLA.
Hispanics also have a high burden of early-onset colorectal cancer (CRC) and advanced disease compared to non-Hispanic whites. The molecular and genetic basis for these differences in CRC incidence is being explored through several observational studies as well as the long-standing Colon Cancer Family Registry.
CPCP investigators have shown that African-American men are more likely to have prostate cancer and then develop high-grade cancer after surgery. Tumors from African-American men are also more likely to have higher expression of adverse molecular markers. There appear to be differences between races in tumor inflammation, genetics and metabolic diseases, including tumor processing of cholesterol, all of which are active areas of funded research within the CPCP.
Los Angeles also has a higher proportion of Asian populations than the national average. CPCP has observed high incidence rates of thyroid cancer, a rapid increase in breast cancer incidence rates and relatively high rates of advanced colorectal cancer in Koreans. CPCP is leading the development of a national study of thyroid cancer that will focus on etiology and predictors of aggressive disease, and the program has launched community outreach activities regarding CRC in the Korean community. Finally, there are discussions about the possibility of establishing an Asian- or Filipino-specific cohort to enable us to conduct more informative studies of these populations.
Another population overrepresented in Los Angeles County is Ashkenazi Jews with BRCA mutations. CPCP has a long-standing interest in hereditary ovarian and breast cancers, and the Gilda Radner Hereditary Cancer Program—established before the discovery of BRCA genetic mutations—has served as the basis for several beneficial projects.
Finally, advances in genomics technologies for population screening have been leveraged by CPCP investigators to engage in multidisciplinary science for discovery and clinical translation. The genetics underlying population diversity and disease heterogeneity is a theme common to several projects within the CPCP research portfolio, including leadership in collaborative studies of ovarian cancer etiology and prognosis, non-coding genomics of cancer drivers and functional genomics to identify resistance pathways.