Center for Genomic and Precision Medicine, Texas A&M University
ealth disparity is defined as the unequal burden of disease in a population due to race, ethnicity, gender, education, socioeconomic status, disability, geographic location, sexual orientation, or cultural or religious beliefs. In this article, the term Latino includes individuals that migrated from Mexico, Central, and South America, and from Latino members of the Caribbean population. These individuals have a diverse racial makeup and heterogenous genetic ancestry that must be considered when studying Latino populations at various levels including clinical trial outcomes.
Effective Precision Medicine Strategies Depend upon the Population Studied
Clinical research outcomes fall into well-defined categories: a) no benefit and no toxicity, b) no benefit and toxicity, c) benefit and toxicity, and d) benefit and no toxicity. Regulatory approval is usually based on c) and d), and these groups usually are the larger percentage that present benefit outcomes. The above categories are applicable to all ethnic and racial groups, with some variations among them within each group. Responses to treatment (as well as diagnoses) are the result of the genetic and epigenetic composition of ethnic and racial groups and their intrinsic variability. These responses to treatment are the result of various degrees of genetic modifications of drug-metabolizing enzymes that affect how drugs are processed (via oxidation, hydroxylation, reduction, or hydrolysis, among other reactions) and excreted from the body.
Disparate Populations Often Have Distinctive Mutant Alleles
Government-Sponsored Trials Need to Be More Proactive in Enforcing Their Policies
Meetings and Outreach to Advance the Science of Cancer in Latinos
Regional and community hospitals can prove to be a substantial resource for patients, particularly for trials that might be less technologically challenging. Patients stand to benefit the most if the reach of science touches those that have been almost forgotten by the modern world. These patients will adhere to a clinical trial if they participate at the local level along with their physicians. Physicians from these local community hospitals are favorable to these trials and are familiar with the issues of their patient populations. For them, issues of acculturation, diet, comorbidity, and other factors that are studied in an academic setting are the bread and butter of everyday life; they practice medicine by addressing cancer health disparities every day. In addition, efforts to include Latin American countries in US-initiated clinical trials have merit, as the inhabitants of these countries have the same characteristics as the US Latino population. The success of US clinical research, including clinical trials, will increasingly be defined by the appropriate representation of all US subpopulations, thus preventing the need for rework due to inadequate representation that is discovered after the studies are completed.