Creating the environment for a successful community partnership.

This paper describes the development of the American Indian Oncology Program (AIOP) and presents the accomplishments of a participatory research approach that involved an integrated network for cancer care and research. AIOP used a participatory process to develop infrastructure, identify research questions, develop methodologies, write supplemental grants, and evaluate accomplishments based on community defined measures of success. Partnerships between University and Indian Health Service, private, and state institutions led to improved collaboration. Health services delivery improved by increasing provider involvement at multiple institutions via a Tumor Board. Community awareness improved through workshops addressing community-specific cancer concerns. Collectively, these resulted in an environment receptive to the development of research activities. The AIOP team, through a participatory process, developed infrastructure at each institution that facilitated interaction, community-based education, and improved patient care; identified new partners; raised community-level knowledge and awareness about cancer; encouraged a research-friendly environment and building research capacity; and increased the cultural competency of researchers wishing to work in American Indian communities and created a cadre of future American Indian cancer researchers. As evidenced by successful pilot project development and formation of ongoing research and funding applications, the authors created a research-receptive environment and promoted potentially sustainable research capacity in the community. Much of their success is the result of utilizing a participatory model for capacity building that included not only communities but institutions. Cancer 2006. Published 2006 by the American Cancer Society.

Transcriptosome and serum cytokine profiling of an atypical case of myelodysplastic syndrome with progression to acute myelogenous leukemia.

A Native American-Indian female presenting with anemia and thrombocytosis was diagnosed with myelodysplastic syndrome (MDS, refractory anemia). Over the course of 5 years she developed cytopenias and periods of leukocytosis with normal bone marrow (BM) blast counts, features of an unclassifiable MDS/MPS syndrome. The patient ultimately progressed to acute myelogenous leukemia (AML, FAB M2) and had a normal karyotype throughout her course. The episodes of leukocytosis were associated with infectious complications. Transformation to AML was characterized by a BM blast percentage of 49%. Peripheral blood and BM samples were obtained for serum protein analysis and gene expression profiling (GEP) to elucidate her disease process. An ELISA assay of the serum analyzed approximately 80 cytokines, which demonstrated that hepatocyte growth factor/scatter factor and insulin-like growth factor binding protein 1 were markedly elevated compared to normal. GEP demonstrated a unique "tumor molecular profile," which included overexpression of oncogenes (HOXA9, N-MYC, KOC1), proliferative genes (PAWR, DLG5, AKR1C3), invasion/metastatic genes (FN1, N-CAM-1, ITGB5), pro-angiogenesis genes (c-Kit), and down regulation of tumor suppressor genes (SUI1, BARD1) and anti-apoptotic genes (PGLYRP, SERPINB2, MPO). Hence, a biomics approach has provided insight into elucidating disease mechanisms, molecular prognostic factors, and discovery of novel targets for therapeutic intervention.

Correlates of mammogram density in southwestern Native-American women.

Little is known about the breast cancer risk factors or mammogram characteristics among Native-American women. Southwestern Native-American women have a low risk of breast cancer and a high risk of diabetes. Our purpose was to determine the prevalence of known clinical risk factors for breast cancer and their association with mammogram density in a sample of Southwestern Native-American women undergoing breast cancer screening. A retrospective review was performed of screening mammogram examinations in 455 women. Density was classified by American College of Radiology Breast Imaging Reporting and Data System (BIRADS) density patterns 1 to 4 (fat to dense). Clinical data including patient age, weight, body mass index, parity, lactation, age at first birth, menopause status, hormone replacement therapy, diabetes status, and family history of breast cancer were obtained. Multivariate analyses were performed. Among the entire group, 152 women (33.4%) had diabetes. Patient age (P = 0.0012), weight (P < 0.0001), menopause status (P = 0.0134), estrogen use (P = 0.0311), age at first birth (P = 0.0035), and diabetes (P = 0.0015) were associated with mammogram density. Diabetes was associated with mammogram density in premenopausal women (P = 0.0032) but not in postmenopausal women (P = 0.3178) in stratified analyses. Diabetes, hormone replacement therapy, age, weight, menopause status, parity, and age at first birth were significantly associated with mammogram density. The association of mammogram density with diabetes varied by menopause status and was significant only for premenopausal women.