Latin America

In Latin America, cancer accounts for approximately one in five deaths. The number of annual global cancer deaths is estimated to reach 13.2 million by 2030 due to population growth and aging. Over 35% of these deaths could be prevented by reducing tobacco and alcohol use, improving diet, controlling infection, and improving and increasing access to basic cancer screenings, public health resources, and treatments.

The Global Cancer Program partners with the Instituto Nacional Cancerología (INCan) and the Instituto Nacional de Salud Pública (INSP) to form the UCSF-Mexico Cancer Initiative, with the aim of strengthening regional cancer research capacity and expanding the institutional cancer research portfolios and training activities in Mexico. Through seed funding provided by the UCSF Helen Diller Family Comprehensive Cancer Center (HDFCCC) and the Institute for Global Health Sciences, the UCSF-Mexico Cancer Initiative has launched projects focused on colorectal cancer screening policy and adaptation of UCSF genomic sequencing technologies to improve pediatric cancer diagnostics. These projects address issues that local investigators have identified as critical to cancer control in Mexico, and this work has encouraged scientific exchange and capacity-building across collaborating institutions. The UCSF, INCan, and INSP teams look forward to creating more opportunities for Mexican clinicians and scientists to study, prevent, and treat the specific cancer needs of populations in Mexico.

Current Projects: 

Early Onset Colorectal Cancer Among Latinx Populations

UCSF PI: Sor Piawah, MD, MCR, MPH, MS

The rising incidence of colorectal cancer (CRC) among individuals younger than 50 years (defined as young onset CRC) is alarming and disproportionately affects Latinx populations. Genetic predisposition accounts for only a small subset of cases. Diet/lifestyle factors have previously been associated with CRC in the general population; and in recent years, the gut microbiome—in particular a decrease in its alpha diversity and an increase in the relative abundance of bacteria such as fusobacterium—has also been implicated in CRC. Definitive studies establishing the role of these factors in young onset CRC among Latino populations in particular are lacking. We hypothesize that dysbiosis of the gut microbiome, in association with diet and lifestyle factors, is important in the development of young onset CRC. By leveraging our existing relationship with the Instituto Nacional De Cancerología (INCan) in Mexico City, we propose a cross-sectional study in which we explore these associations in a unique population of 50 Latinos with young onset CRC in California and in Mexico City. Using 16s sequencing and qPCR, we will assess for alpha diversity and relative abundance of bacteria (e.g. fusobacterium) in stool samples. We will compare the microbiome composition of participants living in Mexico versus those living in California, and we will examine the associations of diet/lifestyle factors with gut microbiome composition of participants using a validated diet and lifestyle questionnaire. We will also conduct a detailed chart review to examine associations of clinical and socio-demographic factors with the gut microbiome of participants. Through successful completion of these aims, we will generate novel and necessary data for the design of future studies in diverse populations, and for the identification of targets of intervention to curb the rising incidence of young onset CRC.

E-Health Sympton Management

UCSF PI: Hannah Leslie, PhD, MPH

Nearly 30,000 women develop breast cancer in Mexico annually, yet public health systems are poorly equipped to meet their needs. Current patients report receiving care that fails to provide the information, autonomy, and emotional support patients require. In high-income settings, incorporating patient-reported outcomes (PROs) into cancer care through electronic applications has demonstrated promise in reducing unmet needs, improving patient-centeredness of care, and decreasing avoidable hospitalizations. No such ePRO interventions have been implemented in public health care in Mexico despite a national commitment to digital health innovations and high population access to mobile phones and internet. The proposed study is a collaboration between Dr. Hannah Leslie, Assistant Professor at UCSF, and Dr. Svetlana Doubova, Head of Epidemiology and Health Services Research at the Mexican Institute of Social Security (IMSS). IMSS provides health services to over 70 million Mexicans, and the IMSS Oncology Hospital in Mexico City treats over 190,000 patients annually. We propose to design and test an electronic PRO (ePRO) intervention including a web-based application for patient reporting and clinical algorithms to guide responses to reported needs. Specifically, we aim to 1) design and program a web-based ePRO application for breast cancer patients, 2) assess usability and effectiveness of the ePRO intervention and trial feasibility in a pilot study of 50 women, and 3) develop a protocol for an embedded pragmatic trial of the ePRO intervention. In this 12-month study, we will demonstrate if an ePRO intervention can be feasibly and effectively implemented within IMSS, define how such an intervention can be acceptable and in alignment with organizational priorities, and build study team capacity in pragmatic clinical trials. We will establish connections with the UCSF-Mexico Cancer Initiative and leverage expertise within IMSS and UCSF to prepare a protocol for full intervention assessment and an R01 proposal to continue this work.

Translation of UCSF 500 Cancer Gene Panel Test for Pediatric Cancers in Mexico

UCSF Investigators: Alejandro Sweet-Cordero, MD; Roberto Ruiz-Cordero, MD

Mexico Investigator: Alejandro Mohar Betancourt, MD, ScD, Commissioner of the National Institutes of Health and High Specialty Hospitals of Mexico

UCSF 500 provides genomic sequencing for nearly 500 different genes, including the majority of known cancer genes, and it compares tumor cells and non-tumor cells to understand genetic variants in cancer. The results of this test are used at UCSF to clarify diagnoses and identify appropriate targeted therapies and clinical trials, thus improving patients’ cancer treatment. UCSF has partnered with Instituto Nacional de Medicina Genómica (INMEGEN) to develop an abbreviated gene panel test for pediatric cancers for Mexico. The gene panel for Mexico will test approximately 50 different genes.

Feasibility of a Colorectal Cancer Screening Program in Mexico City

UCSF Investigator: Michael Potter, MD

Mexico Investigator: Martin Lajous, MD, ScD, Instituto Nacional de Salud Pública

Colorectal cancer is the fourth most common cause of cancer mortality in Mexico, with the mortality rate rapidly increasing, especially in urban areas where there havebeen marked epidemiologal and nutritional transitions. Colorectal cancer is often preventable with screening and early detection, but in the absence of effective screening programs, colorectal cancer is usually diagnosed at advanced stage and associated with poor ourcomes. Growing availability of screening, diagnostic, and treatment resouces in Mexico confers an opportunity to develop Mexico's first colorectal cancer screening program. UCSF, INSP, and INCan have partnered to evaluate the feasibility of a colorectal cancer screening program in Mexico City. This project aims to determine the current capacity in Mexico City to provide colorectal cancer screening, identify potential barriers and facilitators to colorectal cancer screening, and evaluate the feasibility and scalability of incorporating mobile health technology for patient navigation to support completion of a colorectal cancer screening protocol.  

The California-Mexico-Puerto Rico (CAMPO) Consortium for Prevention of HPV-related Cancer in Populations Living with HIV

UCSF Investigator: Joel Palefsky, MD

Mexico Investigator: Jorge Salmeron, MD DrSc, Instituto Nacional de Salud Pública

Puerto Rico Investigator: Ana Ortiz, PhD, University of Puerto Rico Comprehensive Cancer Center

Human papillomavirus (HPV)-associated cancers are major causes of morbidity and mortality in the Latin American and Caribbean region. The Global Cancer Program at HDFCCC received a U54 award for a partnership with Mexico and Puerto Rico to reduce the risk of HPV-associated cancers in people living with HIV in Latin America.  The Global Cancer Program will partner with the Instituto Nacional de Cancerlogia and Instituto Nacional de Salud Pública in Mexico and the University of Puerto Rico, to establish The CAlifornia-Mexico-Puerto RicO (“CAMPO”) Collaboration for Prevention of HPV-related cancer in people living with HIV (PLWH).

Beyond universal HPV vaccination programs, cost-effective strategies are needed to enhance early detection and improve non-invasive management of precancerous lesions among PLWH. Little is known about the performance of newer screening technologies in women living with HIV (WLWH) in Latin America. The California-Mexico-Puerto Rico (CAMPO) Consortium will perform three clinical research studies focused on the prevention of cervical cancer among WLWH in Mexico and Puerto Rico. Study 1 will examine new screening algorithms for cervical high-grade squamous intraepithelial lesions (HSIL) in 4000 WLWH in Mexico and Puerto Rico. This study will evaluate triage strategies that include liquid-based cytology, point-of-care genotyping for high-risk HPV DNA, E6/7 oncoprotein expression, and viral and host methylation to detect cervical HSIL among WLWH. We hypothesize that a test with high sensitivity, followed by a test with high specificity, will provide for optimal sensitivity, specificity and predictive value for cervical HSIL in this population. We will also screen 1000 men who have sex with men (MSM) living with HIV for anal HSIL to identify men with anal HSIL for our HSIL treatment studies (Studies 2 and 3) and evaluate anal HSIL screening algorithms using the same tests as those being done in the cervix. Through the cases of cervical and anal HSIL identified in these screening studies, the CAMPO Consortium will also develop and implement two randomized placebo-controlled treatment studies for HSIL. Study 2 will evaluate the impact of anogenital probiotic use on anal and cervical microbiota profiles and the relationship to anal and cervical HSIL regression in 600 HIV-positive PLWH as well as reduction of high-risk HPV DNA persistence among those with no lesions. Study 3 will evaluate the safety and efficacy of a multivalent replication-defective adenovirus-based therapeutic HPV vaccine to treat cervical and anal HSIL in 300 PLWH and identify immune response correlates of HSIL regression. Together, CAMPO Collaboration will examine innovative approaches to cervical and anal cancer prevention among people living with HIV in hopes of advancing the field as quickly as possible. This U54 award is part of the National Cancer Institute Division of Cancer Prevention’s US-Latin American-Caribbean Clinical Trials Network (ULACNet) for Prevention of HPV-related Cancers in People Living with HIV.