Scientists from the University of Minnesota are teaming up with the Mille Lacs Band of Ojibwe (MLBO) in Onamia, Minnesota, to investigate aspects of lung cancer and nicotine metabolism from commercial tobacco that may be unique to the American Indian populations in Minnesota. The University researchers are part of the Minnesota Precision Medicine Collaborative (MPMC), which has funding through the Provost’s Grand Challenges Research Initiative to use precision medicine approaches in order to tackle health disparities.
Precision medicine has been central to the progress made in cancer treatment in recent years, and advances in medicine and technology have caused cancer mortality rates in the United States to decline for many. However, American Indians in Minnesota are not seeing the decline in cancer mortality rates that has occurred among the general population of the United States, nor even the lower death rate ratio of American Indians in other regions of the country.
The MPMC researchers decided to zero in on lung cancer, which is one of the most prevalent malignancies for American Indians in Minnesota, according to Minnesota Cancer Facts & Figures 2015, a summary report by the American Cancer Society, Minnesota Cancer Alliance and the Minnesota Department of Health. A 2016 report by Jean Forster in the School of Public Health and Kristine Rhodes with the American Indian Cancer Foundation revealed that commercial tobacco use remains high among urban American Indians in Minnesota, where 59% of American Indian adults in Hennepin and Ramsey counties report that they are cigarette smokers—a far cry from the estimated 16% of smokers among the state’s overall population. The researchers thought precision medicine could improve smoking cessation rates, and they approached the MLBO about a possible partnership.
One of the pilot studies will focus on the rate of nicotine metabolism in current MLBO smokers. Pharmacologic smoking cessation treatment has been tailored to nicotine metabolism in a few clinical trials among mostly white smokers. In one large trial, prescribing varenicline (ie, Chantix) to individuals with normal-to-fast nicotine metabolism proved more effective than prescribing a transdermal nicotine patch. Among slow metabolizers, the efficacy of the two methods did not differ but side effect severity was lower for the patch.
Dana Carroll and Ellen Meier, post-doctoral scientists in the Masonic Cancer Center’s Tobacco Research Program led by renowned researcher of nicotine addiction and treatment Dorothy Hatsukami, are conducting the nicotine metabolism study. They note that success with cessation isn’t the only factor affected by rate of metabolism. In fact, faster metabolism of nicotine has been shown to predict heavier smoking, greater exposure to carcinogens and toxicants from tobacco smoke, and a higher risk for lung cancer.
Meanwhile, the disparities in lung cancer mortality rates may result from poor access to screening. In the second pilot study, pulmonologist and assistant professor of medicine Abbie Begnaud is working closely with MLBO medical staff to test a new approach to lung cancer treatment and early detection. Begnaud—who directs the Lung Cancer Screening Program at the University of Minnesota—says that the most important advance in the treatment of lung cancer has been discovery of genetic mutations that drive lung cancer progression, along with therapies targeted to those mutations. In a related retrospective study, she is looking at existing, de-identified data on American Indians treated for lung cancer at five Minnesota health systems, to see if lung cancers which carried a special mutation were treated with precision therapies—or even if they were tested for the mutation at all.
The pilot studies will be conducted at clinics operated by MLBO, and they have the enthusiastic support of the tribe’s health commissioner, Rebecca St. Germaine. “This is a welcome initiative that creates a partnership with American Indian tribal health initiatives to broaden our scope of clinical practices and change the future on disabling chronic conditions,” says St. Germaine.
Pamala Jacobson, one of the principal investigators of the MPMC, says it is necessary for researchers take the time to establish authentic, honorable working relationships within communities affected by health disparities. “For precision medicine approaches to be effective, we have to know how to apply this exciting new science to all populations, not just healthcare systems in metropolitan or those serving high income patients,” says Jacobson. “Conducting the needed research and implementing precision medicine to benefit the health of American Indians and other minority populations is a priority.”
MPMC investigators and the MLBO have been planning their work together for nearly a year to ensure that the research is not only respectful of Ojibwe beliefs and practices, but will be of value to the tribe.
The MPMC and MLBO Lung Cancer Research Team outside of the Ne-Ia-Shing Clinic in Onamia, MN. Pictured (l. to r.) are: MLBO Medical Director Donald Gunderson, MD; assistant professor Abbie Begnaud, MD; MLBO Health and Human Services Commissioner Rebecca St. Germaine; professor Dorothy Hatsukami, PhD; professor Pam Jacobson, PharmD; fellow Ellen Meier, PhD; fellow Dana Carroll, PhD.