Could Chicago’s segregated, high-crime and fast-food-heavy neighborhoods create such high stress that residents grow more susceptible to getting colorectal cancer?
Researchers at the University of Illinois at Chicago found what they believe is just such a link in a study published a year ago in Gut, an international medical journal covering diseases of the stomach, liver, pancreas and gallbladder.
They found that African-Americans who live amid “structural violence” – the kind that sustained stress causes – are more likely than whites who live without those stresses to get colorectal cancer. Structural violence includes constantly fearing crime and traveling long or complicated journeys to find healthy food and other resources.
The UI Cancer Center is able to do the community-focused research because it has won $6 million in grants from the National Cancer Institute. That’s particularly important because colorectal cancer – the focus of a national awareness campaign during March – is the second most common cancer (between lung and pancreas cancer) among both men and women in the United States, with an estimated 371 cases diagnosed each day. The American Institute for Cancer Research estimates that 47 percent of colorectal cancer cases could be prevented each year through healthy lifestyle changes. The institute also has found that colorectal cancer rates are increasing for each generation born since 1950, though no one knows why.
But one finding is clear: Diet and lifestyle play a major role in colorectal cancer.
The Colorectal Cancer Alliance provides resources on who should be screened, how to assess your risk, where to find financial help for screening and treatment, and where to join support-group chats online.
The UIC researchers found that African-Americans who lived with constant stress had higher levels of sulfide-producing bacteria in their guts than did white people who live in relatively safer, resource-rich neighborhoods. The higher the level of bacteria, the more likely the person may develop a colon polyp that could lead to colorectal cancer.
“It’s not proven that genetics is the cause (of the cancer). In fact, this is the first time we’ve shown this particular bacteria is very high in African-Americans and correlates with the onset of disease,” said Dr. Paul J. Grippo, associate professor of gastroenterology at the UIC College of Medicine. “We want to be armed with data – the data that will let us petition the government and say, ‘We need to reduce the violence in our communities – not only for families who’ve lost loved ones and who bear a financial burden – but because the health of all people in the community suffers, too.’”
The project goes beyond creating new scientific knowledge. That’s because UIC aims to give primary-care doctors its research results to help them recognize cancer risks with greater insights, said Dr. Robert Winn, who describes his job as director of the University of Illinois Cancer Center as “the best and the toughest job in America right now.”
Such research usually stays within the lab, rather than being applied to people who live in local neighborhoods, and doctors aren’t usually asked to help collect data on their neighborhoods, said Winn, who also is associate vice chancellor for community-based practice at UI Health and runs a lung-cancer detection clinic at the Jesse Brown Veterans’ Administration Medical Center. Winn co-hosts a talk show, “Doctor in the House,” on the first Sunday of each month on WVON Radio.
“For example, if we’re concerned about healthy and fresh food availability, now Englewood and South Shore doctors can start asking patients, ‘What is your food exposure? Your stress exposure?’ – and, as a result, they may do earlier colorectal screening [if they see a higher risk],” he said.
The goal is to figure out how best to intervene in Chicago’s 77 neighborhoods to help people live healthier lives by the end of the third or fourth year of the five-year research grant, said Winn, who said he feels a unique connection with the project since he was born to a 15-year-old mother on the east side of Buffalo, N.Y., and grew up in a tough neighborhood when the steel industry was dying.
Indeed, the U.S. Department of Health and Human Services estimates that, if everyone 50 and older got screened regularly, six of 10 deaths from colorectal cancer could be prevented.
The UIC experts are now doing in-person and animal tests to determine whether living in constant alert to violence and eating fatty, unhealthy food is linked to higher incidences of colorectal cancer. Each patient recruited to the UIC clinic is filling out questionnaires about his or her diet, whether he hears gunshots frequently in the neighborhood and the kinds of mental stress he or she endures from everyday life.
The data are starting to roll in. A separate study by Harvard University shows at least half – and perhaps as much as 70 percent – of colorectal cancers can be prevented by exercising regularly, maintaining a healthy weight and eating a healthy diet rich in calcium and green leafy vegetables.
“The most important thing to consider is to avoid high-fat, high-starch, fried foods and high-sugar ‘junk’ foods and beverages as much as possible,” said Dr. Edward Giovannucci, associate professor of medicine at Harvard Medical School and professor of nutrition and epidemiology at the Harvard School of Public Health.
The report found that eating about three servings, or 90 grams, of whole grains each day reduces the risk of colorectal cancer by 17 percent. The report analyzed 99 studies, including data on 29 million people, of whom over 250,000 were diagnosed with colorectal cancer. It identified risky foods, too, such as bacon, hot dogs and processed meats, and behaviors such as eating more than 500 grams a week of red meat such as beef or pork and drinking two or more alcoholic drinks each day.
Technology, too, is playing a role in preventing colorectal cancer.
Chicago-area researchers are developing a pipeline of new cancer vaccines – and they could be just a few years away from widespread use.
This game-changer in cancer treatment comes from spherical nucleic acid (SNA) technology that Northwestern University’s International Institute for Nanotechnology has patented based on research done with the Robert H. Lurie Comprehensive Cancer Center in Chicago.
Here’s how it works: The vaccine would use Northwestern researchers’ discovery of SNAs to boost a person’s immune system. The technology trains the person’s fighter cells – the T-cells – to hone in on certain kinds of cancerous cells and destroy them. The SNA immune stimulator would be paired with checkpoint inhibitors – the kind of drugs that former President Jimmy Carter took to stop his advanced melanoma – to ensure that the fighter cells kill the enemy cancer cells.
A separate promising development in stopping colorectal cancer before it starts comes from Japanese researchers who have used artificial intelligence to pinpoint benign cancer cells before they become malignant. The research, published in the science journal Inverse, involved using a database of over 30,000 images of pre-cancerous and cancerous cells to “teach” the artificial intelligence software to detect the difference between the two. The program spotted whether specific colon polyps were cancerous with an 86 percent accuracy rate, said Dr. Yuichi Mori, a specialist in the digestive disease center at Showa University in Yokohama, Japan.
The potential for a “smart machine” to detect colorectal cancer in its earlier stages is particularly important since colorectal cancer is easier to treat in its early stages and poses a greater danger in its later stages since that’s when cancerous cells can enter directly into a person’s bloodstream.
Sandra Guy is a Chicago-based freelance writer.