MDNewsline recently interviewed international cancer researcher Dr. Talia Wegman to discuss the importance of molecular and genetic testing and cancer in Latinx patients. Dr Talia is a past National Cancer Institute (NCI) Division of Cancer Epidemiology & Genetics postdoctoral fellow and has been recognized in the U.S. and Mexico for her research in molecular genetics and oncology.
MDNewsline: Dr. Talia, can you tell us how cancer affectes Latinx patients differently?
Dr. Talia: Cancer is one of the leading causes of death among Hispanics. Compared to non-Hispanic Whites, Hispanics are more likely to be diagnosed with advanced stages of disease and experience poor quality of life following a cancer diagnosis. Cancer outcomes are influenced by a combination of social, cultural, behavioral and biological factors.
Brain cancer, hereditary cancers, and breast cancer are all more common among Latinos than the general population and present at younger ages. Latinos with brain tumors tend to be 10-15 years younger. With breast cancer, Latinos the tendency to be diagnosed at a younger age is likely due to genetic factors.
MDNewsline: We know that familial support is important and can be impactful for care. Can you describe any unique cultural factors and roles that family can play?
Dr. Talia: I find that many of the Mexican patients I treat don’t want to talk about their own risk of having cancer. Generally, they think if you talk about their risk of getting cancer you are bringing them bad luck. Despite being very close to our families, we don’t like to talk about family diseases. Though a grandmother may have died from cancer, there can sometimes be underlying shame and uncomfortable feelings discussing this openly. For instance, out of respect for privacy, my patients wouldn’t ask their cousins if they have or had cancer?
MDNewsline: What can oncologists do to improve outcomes for Latinx cancer patients?
Dr. Talia: The main message for those treating cancer in Latinx families and really any patients is to get the family history. Sometimes it’s hard because they are in multiple locations but it’s important for them to trace their networks. A physician should always ask them about molecular testing though a barrier may be that many family members live outside of the country. Molecular testing is more widely available nowadays. Even though there are only a few Latinx geneticists, with telemedicine it’s getting easier to reach these populations. Even if a family is remote we can now do molecular testing from the home.
MDNewsline: What triggers the need for patients to do genetic testing?
It’s very common for breast cancer patients to be diagnosed around 40-45 years and prostate cancer patients right before 50, but for young people with cancer who are Mexican or Ashkenazi Jewish, we have seen a founder mutation . Ashkenazi Jews have 3 different mutations generally as it relates to breast cancer.
If a physician has a patient with cancer that’s very young or if it’s very rare, they should send them to a geneticist or genetic counselor as it’s important to understand the genetic mutations. If the tumor is rare in presentation, such as uncommon histology, bilateral presentation, or younger age, they should definitely send the patient to a geneticist or genetic counselor.
MDNewsline: How has cancer care changed amidst COVID-19?
Dr. Talia: We know cancer patients are among the highest risk populations for COVID so oncologists are trying to delay treatment as much as possible. More often than not they are looking to provide more oral therapy and send cancer patients home as they don’t want patients being at the hospital while they can contract COVID-19. Changing treatments appointments is the best option to avoid hospital care. People who are not in treatment are sitting at home. Many patients who just ended chemotherapy are not getting the follow up treatment they need because they are most at risk.
People aren’t getting tested as often. There is concern that those who may have masses may not come to the hospital to get them checked out. People are delaying going to the doctor and for good reason. Latinos with cancer often get diagnosed late. For breast cancer, usually we are not diagnosed until stage 3 or 4. My fear is that COVID-19 will further delay diagnosis for many patients.
MDNewsline: As a Spanish-speaking clinician, how important is it for healthcare systems to have language interpreters?
Dr. Talia: While at NCI we had interpreters. While practicing in the U.S. I found it was very hard to speak with doctors. When you have a disease that threatens your health and there are a number of emotional components involved, it’s hard to speak in a language that’s not your own. The U.S. health system is difficult to find health insurance and it was hard to identify what policies and plans were better for my own family. Sometimes I went to the doctor with my kids and it was difficult to understand how much and when I needed to pay out of pocket expenses. I experienced this as a physician so you can imagine that it is definitely a need to make this system easier to navigate for patients.
MDNewsline: How does we increase Latinx clinical trial participation?
My area of research is cancer genetics focused on Latin America. We have made great progress in terms of the availability of genetic research data. In clinical trials, there’s still a low representation of Latinx patients. This prevents us from assuring that side effects are the same. If we want to ensure that these treatments are truly impactful, we need to have more Latinx and African patients enrolled in clinical research.
Language and writing in Spanish can be advantageous. Getting people to understand that the trials are safe is key. The cultural belief that you’ll be experimented on. Also it’s important to let them know that it’s a great opportunity to get the best treatments out there. Medications that are available and those that are not yet available can be accessible at lower costs or for free depending on the clinical research study.
Dr. Talia Wegman studied medicine at Universidad Nacional Autonoma de México (UNAM), and received her PhD at the University of Guadalajara in Human Genetics. She is board certified in clinical genetics works with families who are at high risk for cancer, focusing on the relationship between cancer and genetics.
Follow Dr. Talia on twitter today at @taliawegman