Nearly 30 years ago, while completing an assignment for his master’s degree in public health, Brian Rivers discovered he had a family history of prostate cancer.
“I was shocked by this information, but also intrigued,” Rivers said in an interview with Robert A. Winn, director of the VCU Massey Comprehensive Cancer Center, the guest editor of The Cancer Letter during Black History Month.
This discovery by Rivers led to another: he had been previously unaware of the severity of prostate cancer and the disproportionate impact of this cancer on Black men in the United States.
“As I immersed in cancer research, I discovered more questions than I found answers. During that time, there were very few research studies studying the etiology of prostate cancer, particularly among Black men,” Rivers said. “The more I searched, the more I discovered there were very few research studies that spoke to me regarding my risk for prostate cancer and how to prevent it.”
Rivers would go on to complete his doctoral dissertation on the topic, and has spent his career focused on prostate cancer in Black men. He is now director of the Cancer Health Equity Institute at Morehouse School of Medicine, one of four historically Black medical schools in the country.
“Now, fast forward 25 years, I guess the unanswered research questions were quite significant, as I have spent most of my professional career researching gaps across the prostate cancer continuum.”
Rivers’s goal is to help MSM’s Cancer Health Equity Institute to reach NCI designation.
Now, fast forward 25 years, I guess the unanswered research questions were quite significant, as I have spent most of my professional career researching gaps across the prostate cancer continuum.
“Why? Because it is important for the public to understand that we have been rigorously evaluated regarding the quality of research we are conducting, and that we’re translating that research toward being able to eliminate the burden of cancer, particularly among rural and medically underserved populations in Georgia.”
To maximize the impact of MSM’s Cancer Health Equity Institute, Rivers prioritizes rigorous science and collaboration.
“Step one is realizing the charge before us is to do good science. Step two is do it collaboratively, learning from each other and expanding the impact. At Morehouse School of Medicine, we’re celebrating our 50th anniversary this year. We’re a small but mighty institution.”
Rivers understands the importance of Black History Month, even though “in Atlanta, it’s seemingly every month.”
“We understand the importance of the concept of history,” Rivers said. “It gives an individual, a group, a population both identity and purpose. Understanding your contributions to American history is important and empowering. It’s equally important for others to understand and celebrate Black history.
“It gives America, in part, its identity. It reinforces the dynamic culture of America and allows for the interconnectedness of all communities to overcome any challenge, such as the cancer burden among medically underserved and rural communities.”
President Trump issued an executive order Jan. 20 condemning “radical and wasteful government DEI programs and preferencing,” eliminating the federal government’s diversity equity and inclusion offices, sending employees who administer these programs packing, and making plans for their prompt firing (The Cancer Letter, Jan. 24, 2025).
The conversation follows:
Robert A. Winn: Dr. Rivers, I look to you as one of the country’s leading scholars surrounding health equity in cancer research, specifically among the Black population. What I want to know is what got you into research? And how did this lead you to your work to eliminate disparities in cancer research, treatment, care, and survivorship?
Brian Rivers: If we go back nearly 30 years ago, I’m in grad school, working on my master’s in public health with a concentration in social and behavioral sciences. In my cancer prevention class, as a component of our final grade, we had to do a complete genogram, a visual display of a person’s family, relationship, and medical history. It was during that time that I learned that I had a family history of prostate cancer.
I was shocked by this information, but also intrigued, as I had just graduated from Vanderbilt University with a degree in biology. I’m a fundamental biologist. I love biology, always had a knack for studying living organisms and how they function. My new mission was now to understand not only cancer, but prostate cancer specifically.
Prior to completing the genogram, I was not aware of the severity of prostate cancer, and how it is adversely impacting Black men in this country. As I immersed in cancer research, I discovered more questions than I found answers.
During that time, there were very few research studies studying the etiology of prostate cancer, particularly among Black men. The more I searched, the more I discovered there were very few research studies that spoke to me regarding my risk for prostate cancer and how to prevent it. I would go on to complete my master’s thesis and doctoral dissertation on the topic of prostate cancer and Black men, with an acute focus on primary and secondary prevention.
Now, fast forward 25 years, I guess the unanswered research questions were quite significant, as I have spent most of my professional career researching gaps across the prostate cancer continuum.
In examining my program of research, most of my extramurally funded studies examined models of decision-making, informed and shared, across the cancer continuum. These approaches uniquely examined the barriers and facilitators to decision-making relative to prostate cancer screening, diagnosis, treatment, and survivorship.
Although many research questions remain relative to prostate cancer, such as why Black men suffer disproportionately, I have hope that we are beginning to unravel the complexities. Is it biology? Social factors? Access to care issues? Or just one’s own volition, one’s own behavior?
Through my research, I have discovered that in general, most high-risk populations do not understand the epidemiology of prostate cancer and why this disparity is occurring. In response, I have expanded my research efforts to examine the barriers and facilitators to research participation among medically underserved populations and those in rural areas and develop interventions informed by the findings.
To ensure generalizability of the research findings, participants should not only reflect those in our catchment areas, but also those disproportionately impacted by the disease you are studying.
Through extramural funding, primarily from NIH, our research team began to test different research models of effectively engaging Black men and their caregivers. We tested models in community settings, such as barbershops, faith-based organizations, and community-based and safety-net hospitals.
Our work with prostate cancer survivors and their spouses informed our upstream efforts relative to the decision-making process for prostate cancer screening and treatment. We have built apps and other digital tools to convey the complexities of prostate cancer and also utilized patient navigators to guide men to screening or surgical and/or radiation oncologists to discuss treatment options.
Then as we are now, we were excited to expand the science to include men at increased risk for prostate cancer. As the data indicates, most minority and medically underserved populations are not treated at the major cancer centers, for a variety of reasons including insurance status, geographical proximity, or community norms around referrals.
Being able to raise their voices and reflect them in the scientific literature was extremely rewarding for me, as I saw my voice now represented!
It’s science; right? It’s just science, understanding the differences between different groups and trying to bring knowledge that can then come up with future interventions.
BR: Exactly. Over the past two decades, we have made incredible strides to understanding the unique interplay of the drivers of adverse outcomes and they are multilevel in scope.
During my tenure on the National Advisory Council on Minority Health and Health Disparities of the NIH National Institute of Minority Health and Health Disparities, I witnessed how the findings from the health disparities research agenda begin to inform an action plan or strategy to advance health equity—giving people what they need, when they need it, in the amount they need it. That’s how I learned so much about NIH, the purpose and legality of research, research prioritization and funding patterns, and the impact…
…The impact that the science actually has on the people within the United States that they don’t even know about.
BR: Right, and the commission of NIH to be that premier biomedical enterprise for all Americans, not just those who can afford it, but all Americans, ensuring that the scientific discoveries that are made at the laboratory bench are translated and are beneficial to all people in this country, from those in rural areas to the medically underserved. Ensuring the discoveries through research lead to increased quality of care, whether primary, secondary, or tertiary, for all.
And the discoveries that are made at the NIH and the National Cancer Institute have made a difference for all communities. The American Association for Cancer Research report that was put out showed that every racial group has benefited, to some extent, from the science, and that it is reaching the communities.
BR: What a report! Many thanks to Dr. Margaret Foti and the AACR for their visionary leadership. It’s extremely important work to continue to evaluate our progress as it relates to addressing health disparities and advancing health for ALL Americans.
Whether it’s through the lens of a racial and ethnic group or through geography (urban/rural), we must evaluate the progress and where the gaps in science remain. The progress report is our bi-annual report card and ensures we are using the funds received from NIH and other sponsors appropriately.
You and I both know and have seen the data of the cost benefit associated with addressing health disparities, particularly in cancer care. We have heard countless cancer survivors talk about not being able to afford getting a diagnosis of cancer or dealing with what we call financial toxicity.
And we are just so indebted to many of those leaders who really blazed that trail, who had the insight and the fortitude to pass the National Cancer Act that catalyzed and transformed America to be the premier leader in cancer research and care. Through the Act, cancer centers were established, and we now have over 70 in this county…which is incredible!
It will be important to ensure these cancer centers are meeting the needs of the medically underserved and those in rural areas. Hopefully, more will be coming online that will employ a different research approach or use novel digital tools and resources to enhance care delivery and prevention.
Tell me about how you came to Morehouse School of Medicine? How did you make the transition from academics to this leadership role?
BR: While I was on council at NIH, I met MSM’s president and CEO, Dr. Valerie Montgomery Rice. Dr. Montgomery Rice’s vision is to establish a cancer center, the first one on a campus of a HBCU. Morehouse School of Medicine has received numerous awards based on its social mission and our high touch to communities and high-risk populations who are not commonly represented in research.
I grew up in Atlanta, but I didn’t know the health data on the region. Georgia is contributing 40% to the prostate cancer disparity nationally. So, that’s when I knew: We have work to do in Georgia.
I accepted a position of director of the Cancer Health Equity Institute or our Cancer Center here at Morehouse School of Medicine. I was charged with beginning to translate the science to the community. We have built our program around that strategy—translational research, but not negating the discoveries at the bench, the clinical research, and of course, population science.
As the leader at one of the four historically Black medical schools in the country, what have you been doing to maximize the impact HBCUs have on cancer?
BR: Step one is realizing the charge before us is to do good science. Step two is do it collaboratively, learning from each other and expanding the impact. At Morehouse School of Medicine, we’re celebrating our 50th anniversary this year. We’re a small but mighty institution.
Understanding your contributions to American history is important and empowering. It’s equally important for others to understand and celebrate Black history.
MSM was established by our founding president and dean, Dr. Louis Sullivan, who later went on to serve as U.S. Secretary of Health and Human Services, with a mission to expand primary care in the state of Georgia, particularly among rural and medically underserved populations.
Five decades later, we are excited about growth and the future looks very bright! We are building on the shoulders of giants, more lives are being saved and the quality of life is being enhanced for all.
The American Cancer Society put forth two great program grants, initially piloted with the four historically Black medical schools, that really helped us further expand our cancer research infrastructure.
As a result, we launched our inaugural cancer pilot grant program, the Institutional Development Grant program, which funds pilot grants internally for up to about $40,000 for a year and the opportunity to renew them. This mechanism provides the faculty the opportunity to develop that preliminary data that’s needed for these R-level grants. We are extremely appreciative to the American Cancer Society for that investment.
The second program grant was the Cancer Health Equity Research Centers initiative, designed to better understand the role and impact of social determinants of health across the cancer continuum.
Through these initiatives, we have been able to recruit spectacular scholars, young scholars who are eager to figure out how to advance cancer discoveries and translate what we know to make sure that all Americans are benefitting from these discoveries, especially those who are disproportionately impacted by certain sicknesses and diseases as indicated in the AACR Cancer Disparities Progress Report, which you presented to Congress, Dr. Winn.
What I love about the progress report, is that name: Progress. I really appreciate that you are contributing to not only identifying and figuring out what’s happening in the disparity field but considering how we move beyond it. What does progress look like? I thank you and your leadership in this space. When you think about reducing the cancer burden, what’s your vision for Morehouse School of Medicine? What, ultimately, would success look like?
BR: My vision is to collaboratively work with a dynamic team of scholars to establish an NCI-designated Cancer Center at MSM. Why? Because it is important for the public to understand that we have been rigorously evaluated regarding the quality of research we are conducting, and that we’re translating that research toward being able to eliminate the burden of cancer, particularly among rural and medically underserved populations in Georgia.
We wish for all individuals the opportunity to achieve their optimal health, so that you can live and see your grandkids and great-grandkids grow and do great things. That’s ultimately the vision.
Recognizing that it’s Black History Month and we reside in a catchment area with a large yet diverse population of Black Americans, we are energized by the unique opportunity to address their needs. It’s a challenge indeed, but we are equipped and ready for it!
As outlined in the AACR Cancer Disparities Progress Report, Black Americans have the highest cancer-related mortality in the country and the same is true for Georgia. Why? Well, we hope to provide those answers through science and research and perhaps these findings could inform national and international level approaches toward eliminating disproportionate disease burdens.
Over the past two decades, we have shifted the scientific paradigm from characterizing disparities to action. Now that we have advanced the scientific community’s understanding, we can target our approaches and develop intervention strategies to ensure that care delivery models are equitable for all individuals in this country. I, as a researcher, am responsible to the groups before me.
…And the community that you serve.
BR: Absolutely! As we celebrate Black History this month—in Atlanta, it’s seemingly every month, but we understand the importance of the concept of history. It gives an individual, a group, a population both identity and purpose.
Understanding your contributions to American history is important and empowering. It’s equally important for others to understand and celebrate Black history.
It gives America, in part, its identity. It reinforces the dynamic culture of America and allows for the interconnectedness of all communities to overcome any challenge, such as the cancer burden among medically underserved and rural communities.
Your background is in that implementation and dissemination science, but can you tell me about the role genetics and genomics play in your work at Morehouse School of Medicine?
BR: Absolutely. Genomics research is central to our research paradigm at MSM, particularly in understanding its association with an individual’s behavior and their environment.
Dissemination and implementation science seeks to understand how to best apply scientific advances in the real world, by incorporating the evidenced-based knowledge base into clinics and communities. That’s how we’re going to advance health equity for all.
Being able to leverage scientific findings from genomic research studies, with participants who have been historically underrepresented, and translate those findings into meaningful interventions based on our zip codes—or, as you coined the phrase, our ZNA.
Understanding and being able to interrogate DNA in the context of ZNA among medically underserved populations and rural communities, realizing that it’s the unique interplay of biology, behavior, and environment, is where more scientific understanding is needed.
We must continue to research how these factors are associated. But at the same time, continue to translate discoveries into meaningful interventions for all Americans.
We talk a lot about Harold Freeman, the father of patient navigation, and what he envisioned. Now, we see the fruits of that labor with so many iterations of the Patient Navigation Model he established: clinical trial navigators, nurse navigators, genomic navigators, and community navigators.
He was ingenious in designing the core competencies for the patient navigation model. I am a huge fan of this model and use it frequently in multilevel approaches to implementation and dissemination research. Embedded in the model are competencies to foster trust and trustworthiness.
As you look at your career and our industry, what keeps you awake at night?
BR: Knowing that I’m in the South. When you travel outside the city limits of Atlanta, you will find Georgia is mostly rural. And there is such a huge healthcare need, Rob, in our rural areas. Out of the 159 counties in Georgia, most of them are rural. What keeps me up is, how do we develop a robust program of cancer research inclusive of our rural communities.
Being in the Black Belt region and only a couple of counties from where the most atrocious study in the history of the world took place, the U.S. Syphilis study that took place at Tuskegee. We’re still dealing with the multi-generational effects of that, and as a result, we focus a lot on bioethics in our approaches to engage our communities.
Another issue that keeps me awake is realizing that the health systems in rural areas are constantly changing. They’re closing their doors, Rob, for a variety of reasons, but if you overlay that with data from the progress reports that you’ve been a part of, that you’ve led for the AACR, both the parent progress report and the disparities, Black Americans in the Southeast Region of the United States are faring the worst.
That’s what keeps me up at night. That’s why we need a cancer center on the campus of MSM, because we have that unique connectivity to these individuals in our catchment area and communities throughout the state of Georgia.
As an institution, that’s what we were charged to do: To increase the representation of primary care in the rural counties and address the burden of chronic diseases. We now have two regional campuses in Georgia to ensure our scientific approaches are inclusive of people in those rural areas.
One of the things that I really have come to admire about MSM is your focus on treating people where they are and having to think bigger and bolder and re-imagine, how do we make sure that our rural communities are also benefiting from the science progress that we are making? I thank you for your work, Brian, and for taking the time to share your story today.
BR: I appreciate you. Thank you for your leadership.
