In this episode of the Empowering Providers to Empower Patients (EPEP) podcast, host Dr. Nicole Rochester interviews Dr. Leanne Woods-Burnham about the hidden blind spots shaping cancer outcomes today. From misclassified cell lines to overlooked risk factors in primary care, this insightful conversation reveals where provider awareness falls short, and how those gaps translate into missed opportunities for early detection, equitable screening, and truly personalized care.
Key Topics in this Podcast
- Hidden blind spots in provider awareness that limit early detection and screening
- How genetic ancestry, tumor heterogeneity, and protein expression influence precision medicine
- Why PSA screening guidance fails to reach high-risk groups, and how to fix it
- The importance of individualized screening conversations in primary care
- Community-based initiatives like Blitz the Barriers that improve outcomes for highest-risk populations
Transcript
Dr. Nicole Rochester:
There’s awareness of what you know you don’t know, and then there’s what you don’t even realize that you’re missing. Dr. Burnham, when you published about genetic ancestry analysis revealing misclassified cell lines, it exposed a blind spot in cancer research. What are the critical blind spots in current healthcare provider awareness that are limiting patient options right now?
Dr. Leanne Woods-Burnham:
So, I feel like an area of blindness is, right now, for some primary care physicians to just to have the realization that they are able to tailor their discussion regarding the pros and cons of screening beyond what is indicated at their particular institution or in their EMR, even if they don’t know a lot about prostate cancer and the current guideline recommendations on screening.
A lot of times, and I just know from personal experience going to the doctor with loved ones in my family, you know, sometimes I’ve had a conversation with one PCP who said, well, you know, according to what EMR is telling me, you don’t need this test. But I had to move so far beyond that and be like, well, you know, given his race, given his family history, and all of these things, can we fluctuate slightly outside of what you’re seeing on your screen, and tailor this to this particular patient?
And so, I’m always surprised at how many primary care physicians are not necessarily even aware that we might need to be looking at different ages for different groups, even though U.S. Preventive Services Task Force does recognize that there’s certain populations that are at higher risk, but that’s, like, way down in the weeds of the reading. So not everyone is aware of that, which is somewhat surprising, but the data shows us, what we know is that earlier PSA testing, so we’re talking about in their 40s for Black men, really drives better outcomes in the future.
And so, organizations such as Prostate Cancer Foundation, or American Cancer Society, they recognize this, and they call for this, but that doesn’t always make it into the clinic, and so I think that individual conversation in the clinic can really, it’s sort of a blind spot where we have a lot of room for improvement.
But also, when we’re talking about, you mentioned, when we were talking about biological heterogeneity or patient preferences, when we’re looking at a tumor, we’re talking about the pathology of it. There are differences that we see with different proteins that are expressed, which are gonna alter what those treatments look like. So, when I’m talking about looking at something such as HER2, you know, down the line, targeting that is in clinical trials right now, but down the line when it comes to standard of care, there might be genes or proteins such as HER2 that are expressed more in certain populations, and so we should be using a precision medicine approach, be more encouraged to offer certain treatments to that type of a patient than another, and do the testing to find out if that is warranted.
But there’s also a hot topic right now in the cancer world is also looking at some of these comorbidities and metabolic dysregulation, so we look at the influence of obesity, or the influence of diabetes, and how does that affect the cancer itself, but also how does that affect cancer treatments that we use, and differences in treatment response. And so, these are sort of blind spots that are sort of emerging that can better shape the clinical approach.
Dr. Nicole Rochester:
Wonderful, thank you. If you had a mandate to implement 3 concrete strategies to reduce disparities in prostate cancer outcomes over the next 5 years, what would they be?
Dr. Leanne Woods-Burnham:
Okay, so I think some real actionable items that we could do, 3 things over the next 5 years. First one, is I’m a strong advocate for the PSA screening ForHim Act, that is on Capitol Hill right now, right? This is a bipartisan movement to be able to lessen out-of-pocket costs for men who are going to get PSA testing in the clinic. As women, when we go for our annual mammogram, we don’t have to worry about what the copay for that is, just a preventive annual mammogram. But for men, that’s not the case. For men who are at higher risk for prostate cancer might need to be screened earlier. So supporting that act, I think, will go a long way in the next few years.
Also, I think providing resources and support to programs that are providing community education and outreach can go a long way. I’m really excited to see what Zero Prostate Cancer is doing currently. They have an initiative called Blitz the Barriers where they are looking to improve outcomes for men who are the highest risk populations, and they’re targeting certain cities where they know outcomes are worse. So they’re starting with Atlanta and Baltimore right now, but that will expand to other cities, but I think organizations and movements such as those that are looking at community outreach and education programs that are already successful and figuring out ways to support them further is gonna go a long way.
And then the third thing I would recommend, and it’s kind of, you know, tricky currently with how funding is going, and… but I always think if we can support funding for people who are doing disparities research, then that’s gonna go a long way to reduce these disparate outcomes that we see. And so, I’m a faculty member now, but a few years ago, I was a postdoctoral fellow, and so I really feel for the trainees out there right now who are trying to navigate and find their way, and are really passionate about addressing disparities work, but the funding opportunities are so limited to get right now. So I think it…ways that we can increase funding opportunities for people passionate about this would be something that we should strive for.