Sanford Health is not griping about the health disparities that plague Native American communities; it's doing something about them. With clinics serving the tribes of South Dakota and North Dakota, Sanford Health takes a three-pronged approach to its mission: prevention, treatment and research.
Currently, Dr. Subhash Chauhan is working on research funded by a $1.6-million National Institutes of Health grant to investigate why American Indian women in the Northern Plains have a higher incidence of cervical cancer than do Caucasian women.
Chauhan explains, "The cervix is the opening of the uterus. Unfortunately, what happens is that the cervix gets infected with HPV [human papillomavirus], which is responsible for cervical cancer. Preliminary data shows HPV incidence is quite high [48 percent] for Native American women in the Northern Plains—two to three times what it is in the Caucasian population."
HPV-positive American Indian women are two times more likely to have abnormal Pap tests [the screening test for cervical cancer] than HPV-positive Caucasian women, suggesting, says Chauhan, that underlying factors exist that increase HPV pathology in Native American women. These women's mortality rate from cervical cancer is nine times greater than the mortality rate for Caucasian women. Part of the difference in mortality may be attributed to access to health care and when the cervical cancer is diagnosed, but other factors likely play a part, says Chauhan.
Chauhan and his research team will first look at whether smoke exposure is one such factor. Smoking is a recognized risk factor for cervical cancer, says Chauhan, and four times as many Native American women smoke as do Caucasian women. Further, the majority of HPV-positive American Indian women smoke. Laboratory results have shown that the smoke carcinogen BaP enhances the expression of HPV proteins associated with cervical cancer. The research will involve inducing a smoking response in lab animals to find out what smoking is doing to the protein responsible for cervical cancer.
Assuming there is a connection between smoking and the proteins that lead to cervical cancer, Chauhan will test whether a natural anti-cancer compound called curcumin can suppress HPV infection in American Indian women. This part of the study will recruit 60 Native American and 60 Caucasian women from Sanford Health's clinical practice and inject the compound into the cervix to see whether it inhibits HPV. If it does, curcumin could be used as a preventive and a treatment for cervical cancer.
As part of the project, Chauhan said he was planning to train two or three Native American masters level students in research techniques and methodology.
Dr. Amy Elliott, director of Sanford Health's Disparities Research Center, says the research at the institution is developed in full collaboration with the tribes whose members will participate. The first question Sanford researchers working on American Indian health disparities asks, she says, is: "Is this a project people would want?" The projects must be approved by the tribes that would be involved even before the research grant application is written. Some tribes' councils pass resolutions to approve the research, while others have a research review board tasked with evaluating projects. Two South Dakota tribes are participating in Chauhan's cervical cancer study. "We are so honored to have good working relationships with the tribes," Elliott says.
The objective of this study and others at Sanford Health is not just academic. "What's exciting is conducting scientifically sound studies to help inform treatment," says Elliott. Research projects also raise awareness, she says. For example, knowing the possible effects of smoking on cervical cancer could be a reason to stop smoking. Knowing that there is a test for HPV could lead women to ask for the test. Knowing that you have HPV and that you can pass it on to your partner could could change behavior. Finally, knowing that you have HPV tells you that you need to be proactive about getting yearly Pap tests, since one reason for the high mortality rate for cervical cancer among Native American women could be late diagnosis.
Sanford Health Vice President of Research for the Sioux Falls Region David Pearce concurs about the intent of the institution's research. "Our goal is to have 'wet bench' research translate into prevention and treatment for the people we serve. Our translational work takes research from the bench to the bedside."
He says the institution has research centers focused on cancer, children, cardiovascular issues and health outcomes and prevention, as well as the largest research center in the nation on health disparities.
Pearce explains, "Every population has a certain predisposition to certain diseases; genes make us all different. Sanford Health is looking at underserved populations, such as Native Americans. Some treatments that are effective in Caucasian population are ineffective in Native American populations. An example is the conventional treatment for Type II diabetes."
Sanford Health, based in the Dakotas, is the largest, rural, not-for-profit health care system in the nation with locations in 126 communities in seven states. The system includes 35 hospitals, 140 clinic locations, 1,200 physicians in 70 medical specialties and 25,000 employees. It is the largest employer in North and South Dakota and the teaching hospital for the University of South Dakota. Businessman and philanthropist Denny Sanford has supported Sanford Health with nearly $700 million in gifts.