Traditional And New Lifestyle Interventions for Breast Cancer Prevention (TANICA)

Project Leads: 
Tanisha Aflague, PhD., RDN
Monica Esquivel, PhD., RDN, CSSD

Project Summary:

Breast cancer in both Guam and Hawai‘i is the second highest contributor to cancer mortality. Obesity disproportionately affects women of various ethnic and socioeconomic backgrounds, where rates of obesity among Native Hawaiian and CHamoru women are greater than non-Hispanic White and Filipino counterparts, respectively. Obese women diagnosed with breast cancer have an increased relative risk for recurrence (40 to 50%) and mortality (53 to 60%). Research on cancer survivorship has been independently linked to better survival after breast cancer with a healthy body weight, physical activity, a high fiber diet, and a lower intake of saturated fat. Collectively, physical activity and a healthy diet pattern contribute to a healthy body weight. Evidence suggests that lifestyle interventions that lead to weight loss can reduce breast cancer recurrence, yet no comprehensive lifestyle intervention exists for Guam and Hawai‘i.

Specific Aims:

Aim 1
Establish and convene a Community Advisory Council (CAC) to identify policy, system, and environmental (PSE) priority areas for reducing obesity among female Native Hawaiian, CHamoru, and Filipino breast cancer survivors in Guam and Hawai‘i.

Aim 2
Examine the feasibility and acceptability of the TANICA pilot intervention for reducing obesity among female Native Hawaiian, CHamoru and Filipino breast cancer survivors in Guam and Hawai‘i.

Colorectal Cancer Among CHamoru and Filipinos in Guam and Hawai‘i: Recommendations for Screening Interventions and Programs

Project Leads: 
Tressa Diaz, PhD
Kevin Cassel,PhD

Project Summary:

Colorectal cancer (CRC) is the second and third leading cause of cancer death in Hawai‘i and Guam respectively with the highest rates among males and Pacific Peoples (PP) (e.g. CHamoru, Filipinos). Colorectal cancer incidence in Hawai‘i is higher than the U.S. with the highest age-adjusted rates among Filipinos. In Guam, CHamoru have the highest age-adjusted mortality rates from CRC compared to other Asian and Pacific Islander groups. Screening and early detection to address CRC disparities in these populations are critical.

This pre-pilot study will conduct in-depth research to examine knowledge and beliefs associated with CRC and screening, recommendations for community and culturally relevant prevention interventions, and the need for age-specific education interventions.

Specific Aims:

Aim 1
Determine the cognitive and cultural perspectives on colorectal cancer and screening among CHamoru and Filipinos living in Guam and Hawai‘i.

Aim 2
Assess acceptability of and recommendations for colorectal cancer screening education intervention methods among CHamoru and Filipinos.

New Insights Into Gastrointestinal (GI) Pathobiology for Native Hawaiians/Pacific Islanders

Project Leads: 
Deng Youping, PhD
Peiwen Fei, MD, PhD
Tedros Bezabeh, PhD

Project Summary:

Colorectal cancer (CRC) health disparities exist in Native Hawaiians (NH) / Pacific Islanders (PI), particularly in the mortality rates. But this is currently understudied. We have studied race specific biological variations, which may offer valuable insights into CRC evolution and targets of intervention. Using RNA-seq, we found a set of biological variations unique to Native Hawaiians compared to the Whites of TCGA. Understanding CRC biological variations unique to NH/PI will be crucial to targeting and understanding the observed CRC health disparities

Specific Aims:

Aim 1
To discover new biological variations and validate those found in our preliminary studies unique to Native Hawaiians/Pacific Islanders with CRC

Cross-Sectional Analysis of Areca Alkaloids in Buccal Cells and Hair from Areca Nut Chewers as Candidate Biomarkers for Short and Long Term Areca Nut Exposure

Project Leads: 
Adrian Franke, PhD
Ana Joy Mendez, PhD, RN

Project Summary:

Areca nut (AN) chewing is an addictive and cancer-causing behavior practiced by hundreds of millions of people worldwide including in Guam. In this innovative study, we will compare levels of AN-specific compounds measured from the inner cheek cells and scalp hair from AN chewers in Guam to self-reported AN short- and long-term chewing habits. This unique approach will permit, for the first time, the objective approximation of when and how much AN was consumed. This, in turn, will greatly assist in AN cessation efforts, the most effective way to reduce AN-induced cancers.

Specific Aims:

Aim 1
Determine the relationship between areca alkaloid levels in BCs and scalp hair from chewers in Guam and their self-reported AN exposure (expressed as AANL) of the previous week (short term) and previous month and six months prior (long-term).

Aim 2
Determine whether the above correlations differ between class 1 and class 2 chewers. in Guam and Hawai‘i.

Adolescent Tobacco and Betel Nut Use Prevention in Guam

Project Leads: 
Francis Dalisay, PhD.
Pallav Pokhrel, PhD.

Project Summary:

High rates of tobacco and areca nut use in Guam and the rest of the U.S.-Affiliated Pacific Islands are of concern, especially in the context of the cancer disparities faced by the USAPI populations. Most tobacco/areca nut users initiate use during adolescence and our data suggests that adolescent tobacco product and betel nut use in Guam are alarmingly high compared to the U.S. nationally. This Project proposes to develop an adolescent tobacco and areca nut use prevention program for Guam youths. If successful, the program may be disseminated to the rest of the USAPI. The program may thus help curb the initiation of tobacco and areca nut use among USAPI adolescents and, by doing so, may reduce the high rates of cancer-related morbidity and mortality faced by the USAPI populations.

Specific Aims:

Aim 1
Primary: Test the efficacy of the school-based curriculum in a randomized controlled trial. Secondary: Test the effects of the social media-based campaign.

Aim 2
Develop a school-based curriculum and a social media based social marketing campaign for tobacco product (i.e., cigarette, e-cigarette, smokeless tobacco) and areca nut use prevention among middle school students in Guam.

Cyanotoxin and Liver Cancer Development in Two High-Risk Populations

Project Leads: 
Laura Biggs, PhD
Brenda Hernandez, PhD, MPH

Project Summary:

Breast cancer inIndividuals from Hawaii and Guam have the highest rates of liver cancer in the U.S. Our proposed research will investigate the contribution of Cyanobacteria, the toxins they generate, and established risk factors to chronic liver disease (CLD). CLD is a major risk factor for the development of liver cancer. Cyanobacteria are naturally occurring bacteria that can be found in food and water sources. Their distribution on Guam is not well characterized. Preliminary data show that cyanotoxins can interact with established risk factors to influence liver cancer development. Established risk factors include hepatitis B and C, excessive alcohol consumption, and, more recently, metabolic syndrome (MetS)— including obesity, hyperlipidemia, insulin resistance, and non-alcoholic fatty liver disease (NAFLD).

Specific Aims:

Aim 1
To evaluate the association of oral Cyanobacteria and periodontal pathogens with liver fibrosis and steatosis and the modifying effects of viral hepatitis, alcohol, and MetS.

Aim 2
To evaluate the association of salivary and serum Cyanotoxins with liver fibrosis and steatosis and the modifying effects of viral hepatitis, alcohol, and MetS