Answering a Community's Call
Lucile Adams-Campbell, PhD, is matter-of-fact when it comes to the cancer mortality rate in Washington, D.C. Not only is it unacceptable to have one of the highest mortality rates in the nation, but in her view it is incumbent upon the only comprehensive cancer center in the city to do something about it.
"If we didn't reach out to a community that really has the most to gain, I don't think we could call ourselves successful in anything we do," says Adams-Campbell, an epidemiologist at Georgetown Lombardi Comprehensive Cancer Center who focuses on the disproportionately high rates of breast cancer in African-American women in the District of Columbia.
No one knows the statistics better. Black women in D.C. are 9 percent more likely to be diagnosed with breast and other cancers, compared to their white neighbors, and 49 percent of African Americans with cancer are more likely to die from their disease. D.C. has the second highest rate of breast cancer in the nation, and other cancers — cervical, prostate, colon, and lung — are also disproportionately high.
But few are more involved in bringing the cancer battle to the community than Adams-Campbell, who is associate director for minority health and health disparities research at Georgetown Lombardi. And her work just received an enormous boost from the federal government.
She, along with two other GUMC researchers, Chelsea Kidwell, MD, and Phyllis Magrab, PhD, were awarded a five-year, $6.1-million grant this summer by the National Institutes of Health (NIH) to establish the Center of Excellence for Health Disparities in Our Nation's Capital. Kidwell, director of the Georgetown Stroke Center, will lead research involving strokes. Magrab, director of the Georgetown University Center for Child and Human Development, will spearhead efforts within the overall P60 network to establish highly effective collaborations, such as that with Howard University.
And Adams-Campbell will lead research involving breast cancer with a focus on lifestyle intervention. This will bolster her current efforts enormously; Adams-Campbell is the force behind the creation of Georgetown's Office of Minority Health & Health Disparities Research in Washington.
That new office, at 1000 New Jersey Avenue, S.E., opened its door in the spring and is beginning to enroll women from the local community into a clinical trial funded by the federal grant. Part of this initiative, too, is the Capital Breast Care Center, another community outreach initiative of Georgetown Lombardi's that seeks to provide free mammography screenings and health education for women who could not otherwise afford these services.
"We have great research at Georgetown Lombardi, but we have to bring the science to the community so those at greatest risk of disease can benefit," Adams-Campbell says.
She can't wait to get the study underway — and Adams-Campbell knows the community is just as eager as she is. "Our neighbors have been asking about it. They are ready to start. We are too."
She's Walking the Walk
Since her start at Georgetown in 2008, Adams-Campbell has spent much of the time laying the groundwork for the efforts now underway in southeast Washington. She has met with minority and underserved women in churches, community centers, and housing developments — wherever and whenever she could — to talk about ways to lower cancer risk through community-based interventions that improve diet and exercise.
"She does much more than just talk the talk," says Howard J. Federoff, MD, PhD, executive vice president for health sciences at GUMC. At the disparities research office's ribbon-cutting ceremony in October, Federoff explained, "From the day she arrived at Georgetown four years ago, Lucile has demonstrated the singular focus and the determination to bridge the divide between the medical community and the real world by forming deep, lasting, meaningful partnerships across the city."
But Adams-Campbell has learned that it is one thing to bring the message of diet and exercise to the community, and another to make it possible for the community to engage in that behavior.
"It's not that the message isn't being heard in the community. It's that the behavior hasn't changed," she says. "Just because people are very knowledgeable about diet and exercise doesn't mean behavior will be directly correlated to what they know."
In other words, "just reading or hearing about something is not the same as being engaged," she says. "A lot of people don't participate in things because they are not asked to participate, or they are not offered the opportunity to participate. Just having this office in the community will be a major step towards addressing that issue."
The study that is funded by the new NIH grant, and which has begun enrollment, is testing whether exercise and nutritional counseling can reduce the incidence of breast cancer in women at high risk for the disease.
It will enroll 240 participants, who will be randomized into three separate study sections. One group will come to Georgetown's southeast office three times a week for 50 minutes of moderate exercise during each session. They will also receive nutritional counseling. The new office features an exercise physiology lab as well as rooms to research the impact of exercise through video games, and equipment for measuring body fat composition and bone density.
The second group will be instructed to exercise at home, to the same level. They will be given pedometers to wear with the goal of achieving 10,000 steps a day. "That will get you in great shape," Adams-Campbell says.
The last group of 80 participants will constitute a control group who will receive wellness information and who will be measured at regular intervals.
Participants must be postmenopausal and have metabolic syndrome (abdominal obesity and high cholesterol, for example) that has not resulted yet in diabetes. Many African-American women in D.C. fit that profile, Adams-Campbell says. The harder part will be finding women with metabolic syndrome who are at high risk of developing breast cancer — and who haven't yet been diagnosed with the disease. Adams-Campbell predicts that more than 3,000 African-American women in the community will need to be screened in order to find 240 participants for the study.
While the results of this clinical trial will not be known for some time, other studies have shown that exercise can reduce risk of breast cancer, and that proper diet and exercise can counter obesity, diabetes and heart disease — all conditions that disproportionately affect African Americans in D.C.
"If we can just improve the lifestyles of the communities that we serve, we can make a difference," Adams-Campbell says.
That would be a big leap forward, says Louis Weiner, MD, director of Georgetown Lombardi. The cancer center, like the medical center it is part of, has long sought ways of carrying out its mission of engagement and educational outreach to the surrounding community, he says.
"What inspired us to open the office is the vision of a city where everyone can have access to quality healthcare and information regardless of their race, their education level, their socioeconomic status, or their address," he said at the ribbon-cutting event.
Another speaker, Congresswoman Eleanor Holmes Norton, (D-DC), predicted that in this new evidence-based center, you will see a "turn around" in the alarming rates of death and disease in D.C.'s African-American population. Adams-Campbell takes it a step at a time. "When a community calls, we have an obligation to answer," she says.
(This research is funded by Grant #1P60MD006920-01 from the National Center on Minority Health and Health Disparities, part of the National Institutes of Health.)
By Renee Twombly, GUMC Communications
(Published November 09, 2012)