Colorectal cancer (CRC) is the 3rd most common malignancy in the US and the third leading cause of cancer death. Compared to European Americans (EAs), African Americans (AAs) have a substantially higher CRC mortality rate that is a function of both a higher incidence rate and lower survival rate. Racial disparities in survival persist even after controlling for stage at diagnosis. The reasons for this are not known, but possible explanations include racial differences in aggressiveness of the tumors, socioeconomic variables, and or treatment-related factors. The training and research plan proposed in this K07 career development award will enable me to transition to the next phase of my academic career as an independent investigator in molecular and genetic cancer epidemiology. The training plan consists of several complementary activities including: (1) didactic training (formal coursework/workshops), (2) wet-laboratory experience, (3) attendance at national conferences and seminars (4) mentored clinical research and training in the responsible conduct of research. The primary goal of the research plan is to investigate the role of race, pathologic and molecular prognostic indicators and CRC survival. The research plan is carried out in two studies.
In Aim one, a clinic-based study, we will perform a cross-sectional analysis to provide a comprehensive and accurate summary of the pathologic, molecular, and pathomolecular features of primary and metastatic tumors in AAs and EAs with CRC. Specifically, we will estimate the proportion of poor pathologic (e.g. histologic type, colonic location, grade) and molecular (e.g. KRAS, BRAF, p53, CIMP, MSI) prognostic indicators in AAs compared to EAs.
In Aim 2, building on Aim 1, we will perform a survival analysis in a cohort of CRC patients to examine the joint influence of race and pathologic and molecular prognostic indicators on survival. Specifically, we will test the hypotheses that after adjustment for confounding variables, (a) younger (<50 years old) AAs compared to EAs will have a higher proportion of poor pathomolecular prognostic indicators and worse survival and (b) older (e 50 years old) AAs compared to EAs will have similar proportions of poor pathomolecular prognostic indicators and similar survival. The combination of the candidate's commitment to understanding the etiology of the racial disparity in colorectal neoplasia, the excellence and expertise of her mentoring team and the strong institutional commitment of the Medical University of South Carolina (a designated National Cancer Center) to reduce the racial disparities in cancer will help the applicant become an independent researcher. The research findings from the present proposal will culminate in a submission of an R01 in year 4 of the award. Ultimately, my goal is draw on the techniques in molecular and genetic epidemiology to reduce the disparities in incidence and survival between AAs and EAs in South Carolina and beyond.

Public Health Relevance

Relevancy Statement Colorectal cancer is the source of significant morbidity and mortality especially among African Americans. Studies, like the one proposed, seek to understand the etiology of the racial disparities in colorectal cancer and hence provide insights into the mechanisms of the disease process. We envision the present proposal as part of the larger question of exploring, understanding, and improving outcomes among AA diagnosed with colorectal cancer.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Academic/Teacher Award (ATA) (K07)
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Study Section
Subcommittee G - Education (NCI)
Program Officer
Perkins, Susan N
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Medical University of South Carolina
Internal Medicine/Medicine
Schools of Medicine
United States
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Luque, John S; Wallace, Kristin; Blankenship, Bridgette F et al. (2018) Formative Research on Knowledge and Preferences for Stool-based Tests compared to Colonoscopy: What Patients and Providers Think. J Community Health :
Wallace, Kristin; DeToma, Allan; Lewin, David N et al. (2017) Racial Differences in Stage IV Colorectal Cancer Survival in Younger and Older Patients. Clin Colorectal Cancer 16:178-186
Rachidi, Saleh; Wallace, Kristin; Wrangle, John M et al. (2016) Neutrophil-to-lymphocyte ratio and overall survival in all sites of head and neck squamous cell carcinoma. Head Neck 38 Suppl 1:E1068-74
Wallace, Kristin; Brandt, Heather M; Bearden, James D et al. (2016) Race and Prevalence of Large Bowel Polyps Among the Low-Income and Uninsured in South Carolina. Dig Dis Sci 61:265-72
Wallace, Kristin; Burke, Carol A; Ahnen, Dennis J et al. (2015) The association of age and race and the risk of large bowel polyps. Cancer Epidemiol Biomarkers Prev 24:448-53
Rachidi, Saleh; Wallace, Kristin; Day, Terry A et al. (2014) Lower circulating platelet counts and antiplatelet therapy independently predict better outcomes in patients with head and neck squamous cell carcinoma. J Hematol Oncol 7:65
Schildkraut, Joellen M; Alberg, Anthony J; Bandera, Elisa V et al. (2014) A multi-center population-based case-control study of ovarian cancer in African-American women: the African American Cancer Epidemiology Study (AACES). BMC Cancer 14:688
Wallace, Kristin; Hill, Elizabeth G; Lewin, David N et al. (2013) Racial disparities in advanced-stage colorectal cancer survival. Cancer Causes Control 24:463-71
Brock, Andrew S; Wallace, Kristin; Romagnuolo, Joseph et al. (2013) Patients' short-term knowledge of personal polyp history inadequate despite systematic notification of results after polypectomy. South Med J 106:285-9
Wallace, Kristin; Sterba, Katherine R; Gore, Elena et al. (2013) Prognostic factors in relation to racial disparity in advanced colorectal cancer survival. Clin Colorectal Cancer 12:287-93

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