How your genes can mean inevitable health trouble if you’re black
If you’re a black man, when it comes to your health, the decks are stacked against you.
Scientists and researchers have known this for years — that many diseases, such as cancer and diabetes — just seem to hit blacks earlier and harder than they do other races. Diabetes, for example, is 60 percent more common in blacks than in whites. Blacks have nearly twice the stroke risk.
Then there’s prostate cancer. Black men are twice as likely to die from the disease as white men.
“Although many people have theorized as to what factors may contribute to it, we still have almost a blank page as to understanding why there is a disparity,” Dr. Steven Clinton, director of genitourinary oncology at The Ohio State University Comprehensive Cancer Center, said last year.
Research has long suggested that genetics play a big part, but there’s still much to understand. Scientists are working to get there, by constantly studying the issue. The more they learn, the more they understand how to best diagnose and treat these inevitable diseases.
Although it’s true that yes, black men are more at risk for some serious diseases, it doesn’t mean hope is lost, says Dr. Luisel Ricks-Santi, director of Hampton University’s Cancer Research Center (HUCRC). By knowing the possibilities, “there are things you can do,” she says.
“If they’re predisposed, it’s not that they should be worried, but that they should talk to their doctor,” says Ricks-Santi, whose research focuses on studying how genetics plays a role in cancer. She and her team look at how genetics could be contributing to disease and how that information could be used to develop targeted therapies.
Black Men Are at Increased Risk For Certain Diseases
Diabetes is diagnosed in blacks nearly twice as much as in whites in the United States. In addition, blacks are more likely than others to suffer from complications from the disease — up to 2.5 times more likely to suffer a lower-extremity amputation and up to 5.6 times more likely to suffer kidney disease. According to the National Institutes of Health, the racial disparity has been growing over the past 30 years.
A study done at Northwestern University several years ago found that biological risk factors — including weight and fat around the abdomen — were primarily responsible for higher rates of diabetes for black Americans compared with white Americans.
Black adults are two to three times more likely to be hospitalized or die of asthma than whites. And black children are six times more likely to die from asthma than their white or Hispanic counterparts, according to National Center for Health statistics.
A study led by researchers at the University of Illinois at Chicago College of Medicine found that blacks may be less responsive to asthma treatment and more likely to die from the condition in part because they have a unique type of airway inflammation. The findings suggested that different targeted therapies be researched as treatment options for blacks, who may not benefit by just increasing regular corticosteroids.
A once-rare fibrotic disease that can cause lung scarring, sarcoidosis made headlines when it was named responsible for the death of former NFL star Reggie White at age 43. Blacks are 2.5 times more likely than whites to develop sarcoidosis and have a 3 percent lifetime risk of getting the inflammatory disease, which often remains untreated. The disease is 16 times more deadly for blacks than for whites.
Because of varied symptoms, including coughing, wheezing and chest discomfort, sarcoidosis can sometimes be misdiagnosed as asthma. The American Osteopathic Association (AOA) suggests that the rising incidence of sarcoidosis among blacks might be because they tend to have more granulomas — small areas of inflammation — in their lungs, potentially causing their disease to be more severe. Black women are the most at risk for developing the disease.
Black men are 50 percent more likely than white men to get lung cancer — despite lower tobacco exposure. But a fairly new study found a potential clue, and it’s in the genes. Researchers at the National Cancer Institute (NCI) Center for Cancer Research found that certain gene expression patterns may be different in the tumors of some blacks as opposed to the tumors of white men. They also found that different biological pathways may be involved.
A big takeaway from the study? That different therapies based on racial/ethnic groups could make a difference in treatment, according to Dr. Brid M. Ryan, who led the NCI study.
Blacks have nearly twice the first-time stroke risk of whites, while strokes kill four times more 35- to 54-year-old blacks than whites. The National Stroke Association (NSA) calls the disparity staggering, and says it’s not clear why the risks for blacks are so much higher.
However, there are a number of risk factors for stroke that happen to be high in the black population. For example, the number one risk factor for stroke is high blood pressure, which affects 1 in 3 blacks. The chance of having a stroke is also higher in those with diabetes and sickle cell anemia, which is a common genetic disorder among blacks.
High blood pressure
Although blacks have the same or lower rate of high cholesterol than whites, they’re more likely to have high blood pressure. Blacks also tend to develop high blood pressure earlier in life — and with much higher blood pressure levels — than whites.
Leading research known as the CARDIA Study (Coronary Artery Risk Development in Young Adults) tracked nearly 4,000 adults for 30 years and showed that blacks were up to two times more likely to develop high blood pressure by age 55 as compared to whites. Many of the differences developed by age 30.
Black men have a 40 percent higher chance of dying from cancer than white men, while black women have a 20-percent higher cancer death rate than white women. Black women who are diagnosed with breast cancer tend to have the type that’s more difficult to treat, making them twice as likely to die. For men, the cancer that particularly strikes hard is prostate cancer. Prostate cancer is, besides skin cancer, the most common cancer diagnosed in American men, but black men are twice as likely to die as their white counterparts.
A huge $26.5 million study called RESPOND (Research Prostate Cancer in Men of African Ancestry: Defining the Roles of Genetics, Tumor Markers and Social Stress) is currently underway to try to understand why prostate cancer hits black men so hard. The study — a joint effort of the National Cancer Institute, the National Institute on Minority Health and the Prostate Cancer Foundation — intends to look at the social and genetic variants that contribute to the disease and how those factors interact with each other.
Hope for the Future
Research into all these diseases, including how and why they affect certain populations, has been ongoing for a very long time, Ricks-Santi says. Although scientists haven’t yet gotten to the bottom of why blacks are more affected by certain diseases, “we think it’s a combination of environment, diet and genetics,” she says.
Over time, studies have been done that look at different factors individually, but it’s only now that the factors are being studied in combination — like with the RESPOND prostate cancer study. Environmental factors, such as socioeconomic status and stress levels, may play as much a part as biology.
Cancer death rates among blacks have actually been dropping over the past few decades, according to the American Cancer Society, especially for lung, colorectal and prostate cancers. The overall cancer death rate was 47 percent higher for black men than for white men in 1990 versus 19 percent higher in 2016. Among women, the disparity decreased from 19 percent to 13 percent.
While centers such as the HUCRC are looking at the genetic basis for blacks being more at risk for diseases, looking at multiple factors can only help in the long run, Ricks-Santi says. Those at risk can be identified earlier, which can help personalize screening and treatment based on genetic and overall profiles.
“By getting at it earlier, it can mean good outcomes,” Ricks-Santi says. “We’re finding more and more that patients are getting younger and younger. That’s why it’s important to look at these things in combination. Our lives have been considerably different than our parents’ and grandparents’ — our exposures, our diet.”
New Guidelines, New Treatments
To be able to develop new screening tools and new treatments, HU’s Cancer Research Center is constantly doing clinical trials and holding focus groups. Getting participation in these studies — especially by those in at-risk groups — is important in order to have a wide range of people to study. It’s hard to adequately help find all the answers about a certain population if they haven’t participated in research.
Minority males, who are among the most underserved populations in research, are particularly being sought for focus groups to help the HUCRC further get the word out about why minorities are needed in research. As part of a Minority Men’s Health Initiative, all minorities — including black, Asian and Hispanic — are being asked to take part over the next year.
That information can help move research forward, to hopefully even eventually change guidelines for when black men and women need to be screened for diseases in the hopes of ensuring healthy, long lives. The U.S. Preventative Task Force offers guidelines for when people should get screened for various ailments, but doesn’t specifically say what black men should do. Or whether black women should be screened earlier than white women.
“There are diseases that can often be prevented,” says Ricks-Santi, whose own father was just 30 when malignant polyps were found in his colon. The general guideline for colon screening for men? Age 50. If her father had waited, he might not be here today. “The guidelines being used are based off the general population. The goal is to identify people sooner.”
Substantial progress is happening, and it’s gratifying, but more needs to be done, says Dr. Len Lichtenfeld, interim chief medical officer for the American Cancer Society.
“To continue this progress,” Lichtenfeld says, “we need to expand access to high-quality cancer prevention, early detection and treatment for all Americans.”
The Hampton University Cancer Research Center has ongoing research studies and clinical trials. To find out how you can take part, visit HUknowscancer.com or call 757-728-6034.