AcCELerate: A Conversation with Dr. Marcia Cruz-Correa
, by CRCHD Staff
In April 2024, NCI launched the Cancer Equity Leaders (CEL), a diverse team of premier cancer research leaders. In this new blog series—“AcCELerate: Conversations with Cancer Equity Leaders”—CEL members provide insights on their careers and their areas of expertise, as well as their perspective on how to advance cancer health equity. In the first installment of the series, we heard from CEL member Marcia Cruz-Correa, M.D., Ph.D., a professor of medicine and biochemistry at the University of Puerto Rico (UPR) Medical Sciences Campus. Dr. Cruz-Correa shared thoughts about her career path and her work to address health disparities among Hispanic populations, including spearheading a program to encourage Puerto Rico residents to receive regular colorectal cancer screenings.
What does being a part of the CEL mean to you, and what do you hope to accomplish as a CEL member?
I am honored to be part of the CEL to work collectively with many other leaders and advance the agenda of improving access and of understanding the reasons why there are still cancer disparities. Our goal is to be able to create a network of scientists, academicians, community, industry, government, and many other stakeholders that will help create solutions that we can implement and then decrease cancer disparities.
What efforts are taking place at your center addressing cancer health equity and inclusion?
At the UPR Comprehensive Cancer Center, we are focused on the multiple aspects that affect care for our community across all aspects of the cancer continuum. Specifically, we have partnered with community-based organizations to help us reach out to community health professionals, health care systems, and other governmental/academic partners to provide access to educational programs, cancer screening, and clinical trials. This effort requires a genuine determination and participation of community team members to determine the needs of the community and develop programs that are culturally aligned. There is much more to do, but the vision for cancer health equity and inclusion is a clear priority for our institution and partners.
How did you become a cancer disparities researcher? How did your experience as a Continuing Umbrella of Research Experiences (CURE) grantee and Partnerships to Advance Cancer Health Equity (PACHE) PI support your career?
As a Hispanic woman in science, I have always focused on diseases that disproportionally affect patients from diverse populations, especially Hispanics. It all started during medical school. I was building a patient registry from the ground up and obtaining blood samples and clinical data to understand the burden of disease in patients with inflammatory bowel disease. I saw that the natural history, response to treatment, age at presentation, and complications among the Hispanic patients we cared for were different from those of non-Hispanic populations. That was the spark that guided my quest for answers, and I decided that I needed to learn how to ask the right questions and conduct the right studies. I needed formal training in cancer research. With that in mind, I looked for postgraduate training and was accepted into a combined program for clinical investigation with the School of Medicine and School of Public Health at Johns Hopkins University.
As a gastroenterologist formally trained in clinical research and genetics, I applied for a K07 that allowed me to examine the association of cancer epigenetics with colorectal cancer across different populations, and that became the inspiration for the next decade of my life as a clinical investigator. That grant opened doors to additional scientific questions integrating molecular markers of colon cancer progression, subsequently funded by a K22 from NCI. These first two NCI grants provided me with the resources to start my laboratory and allowed me to join national networks of investigators who were examining the role of different agents as chemoprevention/interception in colon cancer prevention.
I had returned to Puerto Rico to continue my career as part of UPR. I always kept a strong clinical endeavor, and I realized that the environment and access to care were key factors in early cancer among my Hispanic patients. This fueled our desire to work with the community to help educate about hereditary cancer, cancer prevention, and colorectal cancer screening.
We created the Puerto Rico Colorectal Cancer Coalition to bring together stakeholders interested in colorectal cancer prevention and early detection in 2010. For the next decade, we developed campaigns to increase awareness and worked with insurance companies, primary care doctors, and the community to screen for colorectal cancer. These efforts aligned with epidemiological data on the incidence and mortality of colorectal cancer and supported a change in the guidelines for colorectal cancer screening. In 2015, Puerto Rico became the first U.S. jurisdiction to start screening before age 50.
The PACHE program was instrumental in my integration into Puerto Rico. I started as an investigator funded by one of the pilot projects with a partner scientist at the MD Anderson Cancer Center. That funded pilot grant was the foundation of a multicenter program in biomarker detection and early detection of colorectal cancer. Subsequently, I became a PI for the program, helping develop collaborations, providing research funding, and investing in the next cadre of investigators.
For more than 20 years, NCI and Sanya Springfield, Ph.D., and her team have been supportive beyond expectations to my career and those of so many other diverse scientists. They have enabled the development of a strong critical mass of diverse cancer researchers in Puerto Rico addressing key challenges across the cancer spectrum and paving the way to better outcomes and health policies to reduce the burden of cancer and improve our lives.
What strategies have helped to advance cancer health equity among underserved communities in Puerto Rico?
We have worked with numerous stakeholders to guide research-driven health policies, including policies for HPV vaccination, new anal cancer screening, and screening for colorectal cancer starting at age 40. In fact, Puerto Rico is in the top five U.S. jurisdictions with the highest HPV vaccination rates. We also have catalyzed coalitions of private-public partnerships to help promote research-driven cancer policies across all communities.
In 2020, I was asked to lead the UPR Comprehensive Cancer Center to align the efforts of UPR, the UPR Cancer Center, the Department of Health, and the Puerto Rico central government. For the next 4 years, we worked with government agencies, academics, foundations, and other stakeholders to develop critical infrastructure, including securing state and federal funding and recruiting more than 400 physicians, health care providers, and scientists to join the Cancer Center.
What are the key areas of research needed to better understand and address cancer disparities?
Access to care services. That means not only health insurance coverage but also access to services within health care systems. Thus, research prioritizing health care delivery systems examining diverse groups, including Hispanics, is warranted.
Health education for community members and health care providers. Behavioral and social scientists who can develop culturally sensitive programs for integration with health and education systems can guide efforts to increase health literacy, which will improve compliance with evidence-based screening and treatment strategies.
Participation of Hispanics in clinical trials. This requires a multidisciplinary approach that includes infrastructure development and training of clinical trialists. This approach could be deployed across community settings to bring novel therapies and diagnostic and screening tests to the community, where more than 80% of cancer care occurs. There is ample opportunity to expand the integration of the academic centers within community health care networks. This takes collaboration, partnerships, and a genuine desire to bring access and inclusivity of our diverse populations in the development of new drugs and methods. That is health equity for all!
What advice would you give to someone interested in pursuing a career in cancer disparities research?
This is an amazing time to join the team of warriors and dreamers who see opportunities to change and continue to open doors for everyone, regardless of where they live or where they came from. Health equity is our north, and there are many areas of opportunity to help us reach this goal. It is important to get formally trained in cancer research and integrate with basic, translational, clinical, and population scientists. Cancer disparities are not confined to one area of cancer research. It requires a collaborative effort of relentless cancer researchers across all scientific disciplines to examine the origins of cancer disparities and find innovative solutions to move us closer to cancer health equity.
We all can contribute. There is not a one-size-fits-all approach, and the field will continue to evolve. Find your mission, find your path, and trust a vision of equity. Empower yourselves and thus empower others to live better lives, and by doing that, we will have robust communities that will thrive and create a better world for us all.