In honor of Hispanic Heritage Month, this week’s episode of The Cancer Letter Podcast features three oncology leaders whose research focuses on identifying and solving health disparities specifically in the Latinx community.
This episode is available on Spotify and Apple Podcasts.
Ruben A. Mesa, Amelie Ramirez, and Luis Carvajal Carmona spoke about the concrete impact of federal policy stances on cancer outcomes in Latinx patients.
Mesa, who is president of the Advocate Health Cancer National Service Line, president of the Atrium Health Levine Cancer, and executive director of the Atrium Health Wake Forest Baptist Comprehensive Cancer Center, said that his mother recently celebrated her 15th anniversary as a breast cancer survivor.
“Just fantastic to be able to celebrate with her,” Mesa said. “And I reflected on why was it that I was able to celebrate with her as a survivor and not be here sad that I had lost my mother to breast cancer many years ago?”
Mesa identified two key drivers: progress from advances in cancer surgery, radiation, and medical therapies, and the fact that his mother’s cancer was caught early.
“Cancer was caught early, [which is] such a crucial piece,” Mesa said. “And at the point in her arc, she was already at that point when she had cancer, she was a U.S. citizen. She had insurance. She was employed. But if she had been lacking those things, maybe her cancer would not have been caught early. She could have had a late-stage presentation that she may not have had the other aspects in terms of health that she might’ve had otherwise.”
These challenges are not new. But changes in federal policy after President Donald Trump’s inauguration are exacerbating the problem.
“Immigration status had always been a bit of a concern, but it’s a much greater concern when there is a fear of a very aggressive stance in terms of trying to find individuals that are undocumented,” Mesa said.
Mesa is also the senior vice president of Advocate Health, vice dean for cancer programs and the Charles L. Spurr MD Professor of Medicine at Wake Forest University School of Medicine.
Ramirez is the director of the Institute for Health Promotion Research and chair of the Department of Population Health Sciences at UT Health San Antonio. She is also associate director of cancer outreach and engagement at Mays Cancer Center.
Carvajal Carmona is associate vice chancellor and professor in the Department of Biochemistry and Molecular Medicine at University of California, Davis.
Other stories mentioned in this podcast include:
- The Directors: Steven Artandi and Eric Winer on how looming policy changes “reverberate” through oncology “Even when funding gets restored and if the H-1B visa threat doesn’t materialize, it creates an environment where especially young people become uncertain.”
- ASCO and Google Cloud set forth a vision for using AI to modernize health care and advance oncology
- KRAS pioneer and Stephenson Prize winner Frank McCormick aims to prevent all KRAS cancers with a pill
This episode was transcribed using AI transcription services. It has been reviewed by our editorial staff, but the transcript may be imperfect.
The following is a transcript of this week’s In the Headlines, a weekly series on The Cancer Letter podcast:
Jacquelyn Cobb: Hi, everyone. This week, we have a special episode of The Cancer Letter Podcast in honor of Hispanic Heritage Month. We have three leaders in oncology on the podcast today whose research focuses on identifying and solving health disparities specifically in the Latinx community.
I’ll turn over the moderator mic to Ruben Mesa, who is president of the Advocate Health Cancer National Service Line and president and executive director of the Atrium Health Wake Forest Baptist Comprehensive Cancer Center. But first, I’ll very, very quickly run through last week’s headlines.
Our cover story was the latest episode of The Directors, which is a special segment of The Cancer Letter Podcast. In that episode, Steven Artandi of Stanford Cancer Center and Eric Winer of Yale Cancer Center had a meaty and detailed conversation about how looming policy changes quote, unquote, “reverberate” through oncology. They talked about H1B visas; they got really into the nitty-gritty. It’s an excellent conversation.
Also, last week, ASCO and Google Cloud wrote a guest editorial outlining their shared vision of using AI in oncology, and I wrote a story about Frank McCormick, KRAS pioneer and winner of the inaugural Stevenson Prize for Cancer Research.
With that, I will gladly pass the mic to Dr. Mesa.
Ruben Mesa: Well, hello everyone and welcome. I’m joined by two wonderful colleagues today as we are celebrating a Hispanic Heritage month. And coming to The Cancer Letter a year after, we had a discussion last year, and it’s been… What a year it’s been.
I’m looking forward to us unpacking a little bit of the issues of cancer in Latinos. How have things evolved since last year with the challenges that we face battling cancer overall, but additional challenges as well as strategies dealing with those challenges that have been evolving?
But I’m joined today by two wonderful colleagues, Dr. Amelie Ramirez, and Luis Carvajal-Carmona. I probably cannot do adequate justice to their titles and evolving roles. So, maybe Amelie, why don’t we start with you?
Amelie Ramirez: Great. Good morning, and thank you so much. I’m Amelie Ramirez, professor and chair of Population Health Sciences at UT Health San Antonio, and the associate director for outreach and education for the Mays Cancer Center.
Ruben Mesa: Wonderful. Luis?
Luis Carvajal-Carmona: Good morning everyone. I’m Luis Carvajal-Carmona. I’m a professor here at the University of California Davis School of Medicine. I also act as an associate vice chancellor here.
Ruben Mesa: Wonderful. Well, all of us, as cancer center leaders and leaders in this field, we know that we start a bit with the issue of the problem. So before we get into the challenges of over this year and strategies, much to talk about the core issue.
So, first, Amelie, I know with the many hats that you’ve worn, you certainly have been a driver helping to define what are the issues that are specific for Latinos as it relates to cancer. We’ll give a shout-out, of course, to the wonderful meeting that you’ll have coming up next year that focuses on this very topic.
Amelie Ramirez: Great. Thank you so much. It’s really been a mission of mine to really raise the flag on the importance of looking at the Latino population. We represent almost 20% of the US population. And cancer there, for a while, was the leading cause of death among Latinos.
Now it’s again, neck and neck with cardiovascular disease, but we have such little information on what is attributing to that. We know that one of the major issues, obviously, is access to care, but there’s other cancers that are beginning to emerge in our population that we all need to focus on, such as liver cancer. We were some of the first here in South Texas to show that we had higher rates of liver cancer in Latinos compared to Texas and the rest of the nation.
But we’re also seeing other GI issues such as stomach cancer that are on the increase. Our population is also affected by younger age. We’re diagnosing younger age populations and Latinos with the different types of cancer. And breast cancer is the leading cause of death for our Hispanic women. These are facts that are not well understood. And I think we as researchers need to bring to the forefront to continue bringing solutions to our community which are also dependent on economic status and education. So it’s really a holistic approach that we need to take.
Ruben Mesa: Wonderful. I was on a call last week with my mother who… She’s a Latina, of course. Both my parents are from Cuba, and she was celebrating 15 years as a breast cancer survivor.
Amelie Ramirez: Wow. Congratulations. Yeah.
Ruben Mesa: Just fantastic to be able to celebrate with her. And I reflected why was it that I was able to celebrate with her as a survivor and not be here sad that I had lost my mother to breast cancer many years ago.
And as I thought about that, I think there were really two key drivers. The first was all of the efforts in cancer research that had preceded her being diagnosed, advances in how we detect cancer in the surgical procedures, in adjuvant radiation therapy, and the medical therapy, including hormonal therapy that helped her both overcome her cancer and not relapse.
Second, that her cancer was caught early, such a crucial piece. And at the point in her arc, she was already at that point when she had cancer, she was a US citizen. She had insurance. She was employed. But if she had been lacking those things, maybe her cancer would not have been caught early. She could have had a late-stage presentation that she may not have had the other aspects in terms of health that she might’ve had otherwise.
Now, Luis, I know one of the areas that you study is really about both cancer prevention and health promotion in migrant Latino populations. And I’m mindful again that my mother got to benefit from her status as a citizen, but we know that this clearly is not the case for all. So, what are some of those things that you have learned with your work? And is that even harder in this current era?
Luis Carvajal-Carmona: Yeah. Thank you, Ruben, for highlighting that. It has been harder because of the intersectionality between being a Latino and being a migrant. And many of the migrants in this part of California are also undocumented migrants. So, they are under more pressure now to seek cancer prevention and health care, in general.
And I will say that the example of your mother, very happy to hear about your mother, Ruben, about her survivor of breast cancer. It’s a good example of how heterogeneous are the Latinos in the US. So, we are not a monolith. There are many Latinos like us who have access to health care, who have been educated and have been lucky to have a lot of privileges in the society.
But I will say that our efforts to lower the cancer burden in Latinos, should focus on the more marginalized communities. And I would say migrant populations, particularly migrant rural farm worker populations, are among the most marginalized.
So, we have done a lot of surveys here in California, the Central Valley of California, where we have every possible driver of disparities. And we see groups that are particularly vulnerable, solo migrant men, those men who come from Mexico here to work in the fields. Latina homemakers who are also migrants, they have among the lowest screening rates for cancers. We increase a bit, the screening rates, they access to health care and the health promotion because not only about access to health care. There are multiple drivers that are also close to our culture.
We could have big advances. In terms of cancer prevention, we have done an intervention here on colon cancer education. And we have seen that colon cancer screening rates among these vulnerable communities are less than 40%. So, there is a lot of work that needs to be done in order for us to address those disparities.
Amelie Ramirez: And Ruben, if I can, to build on just a comment that you made earlier, in terms of survivorship, what we’re seeing in our Latino population is that we do not have good survival rates. And right now, there’s about 20 million cancer survivors nationwide, and about a fourth of them are Latinos, and we need to do a better job.
But part of it goes back to exactly what Luis was just saying, that the early detection has not been there. They haven’t been coming in early enough for the screening. So, all of those things are connected. And recently, we had a large task force of 12 Hispanic researchers from across the country to ask, “Why did cancer become a leading cause of death a couple of years ago?” And access to care was one of the major issues that the group identified.
Ruben Mesa: Indeed, it’s one of these things that when they ask what keeps you up at night, this is clearly one of them. The hats I wear now, I both lead our NCI Comprehensive Cancer Center for Wake Forest, but I’m also president of our cancer service line, both here in North Carolina and more broadly in Illinois, Wisconsin, Georgia, and wherever Advocate Health goes.
And as we look at our data, it had been seen several years ago that our Latino men and the rates of colorectal cancer screening were clearly lower than other groups because as we’ve tried to incorporate social determinants of health in other aspects into our populations, we all know as cancer researchers that prevention screening is so central to really trying to make an impact. Until we have dramatic changes in how we treat cancer, catching cancer earlier, preventing it is essential. And we had built a variety of different interventions to try to really reach out to this community.
And again, there’s several factors. One, men and how they utilize healthcare may be different. Two, there’s health literacy issues. There’s practicality issues, again, being able to… You’re an hourly worker, and being able to obtain preventative services during business hours is a barrier or concerns about insurance.
And even now—immigration status had always been a bit of a concern, but it’s a much greater concern when there is a fear of a very aggressive stance in terms of trying to find individuals that are undocumented.
So, I have a lot of concerns. And I’m particularly concerned about the changes in terms of Medicaid or the Affordable Care Act or other things are going to further limit that because we know that, again, if you are fortunate to have a screening, what comes next is a key part as well.
Who pays for the subsequent procedure? Let’s say, you have a stool-based test. Who pays for the colonoscopy? If you need a surgery, who pays for the surgery? All of these key things.
So, we represent three different parts of the country in some ways. Texas, a red state, although Bexar County, certainly a very supportive county for their citizens where you’re at, Amelie. I’m in North Carolina, which is very much of a purple state in many ways. And, Luis, perhaps things a bit more open in California.
But as it relates to the changes with Medicaid and other changes, concerns that you guys have, as it relates to some of these challenges for patients getting access.
Amelie Ramirez: It’s huge, Ruben, and it becomes more difficult. Those of us who are really into prevention research, we’ve had our hands tied for the longest time. If we try to promote more screening, what do we do if a patient gets diagnosed and they don’t have health insurance?
And so we’re always left with that burden. And our safety net organizations right now, I tell everybody, they’re like really a quilt that’s been well-used, and the stitching is beginning to be frayed. And so if there’s a lack of support for our safety net organizations and then with a decrease in coverage healthcare coverage, we’re going to have a major problem on our hands. Less people are going to be able to be screened given the treatment that they need.
Luis Carvajal-Carmona: I will add that even in California where we have Medi-Cal which is our Medicaid program that is open to all Californian regardless of immigration status. There are concerns here. There are multiple drivers of this, if the premiums go up, that is going to determine many people to seek enrolling these programs.
So it’s not only about money. It’s about other aspects that are going to influence if people seek preventative health cares. But going back to Ruben, something that has proven very effective for us to improve and do this, and Amelie has done it amazingly well in Texas, is to work community health workers and promotoras and to go and provide a screening where the people are at the times that works for them.
Here during the pandemic, we did that with mobile vans for free COVID-19 testing. And we used to go to visit the farm worker communities outside working hours in migrant centers in places like that where we knew they were going to be there. So I think as cancer centers leaders, we also need to think about making our centers more of a matrix in terms of community matrix, in terms of don’t wait for the patients to come to the physical being of the center. Go and provide the service where they are. That is an effective way to improve the situation a bit.
Amelie Ramirez: Yeah. And I think we need to increase our patient navigation services as well. As Luis said, it’s one thing is to identify, but then even the mystery of how to go the next step. And so this cross work between our healthcare system and our community outreach works needs to flow seamlessly.
We’ve been working in an area with persistent poverty with men to get them to come in for colon cancer screening. And the patient navigators have really made a big difference. But there’s also a cultural factor there, particularly with the Latino males, that they really avoid the colonoscopy. And so with these new medical advances that we’re getting, perhaps, we need to think of other tests to use to see if we can get some of that early detection going on at a lower cost and still just as effective.
Luis Carvajal-Carmona: And I would add to that, Amelie and Ruben, that the culture is very important. So, we work here a lot with promotoras, and we go and talk to the community often, and there is a lot of misconception about, for instance, colon cancer prevention is only colonoscopy. People don’t know that there are tests. And also, in most Latin American countries, endoscopies are done without sedation. So, it can be very traumatic. So, that’s an extra deterrent that we didn’t know much about it until we went and talked to the people.
Ruben Mesa: Wonderful. Now, there’s a couple areas that I’m hopeful for. I’m wondering if you guys have been able to leverage these at all. We’re with our center in our system trying to leverage opening opportunities as it relates to approaches for rural healthcare as well as kind of the emphasis on chronic diseases, realizing, again, there are aspects of the metabolic syndrome, diabetes, others that are important for health overall, of course, but certainly can be drivers in cancer.
Amelie, maybe starting with yourself, I know that, again, you’ve been very passionate for your institute for health promotion research, which is really such a wonderful way to look at this because, again, trying to separate out prevention of cancer from prevention of cardiovascular disease, they’re all tied together. So any ways that your team is hoping to leverage some of these different areas of focus that might be beneficial broadly?
Amelie Ramirez: Thank you, Ruben, for that question. Actually, with our program, Salud America, which is grown to be a large social media network of over 500,000 individuals following us in what we do, part of our job has been to increase literacy, increase literacy on the different issues that are impacting our population.
And as you just said, it’s now not just cancer, but it’s diabetes, it’s Alzheimer’s, it’s obesity, all of these metabolic issues that are really flaring the flame that it’s going to really have a major impact on our Latino community if we don’t do better outreach.
But the strategy that we’ve been incorporating is really identifying positive role models from the community because, oftentimes, paid advertising doesn’t work. But if you get somebody from the community who gives you a testimony about why they went in for screening or what it meant to them makes a big difference.
One of our cancer survivors said, she said, “I used to ask God why did he send cancer to me, but now I know. Now, I can make a difference through research and contributing my knowledge to help others.” So, there’s these different strategies that we try to use, but we try to also educate on the different risk factors within our community. So, it’s very important that, again, we take more of this comprehensive approach to education.
Ruben Mesa: Wonderful. Luis, I know that there are very significant rural pockets that you’ve studied and there in California, particularly amongst the farming community. Any lessons that you guys have leveraged or kind of new approaches that you’re trying to employ?
Luis Carvajal-Carmona: As I said earlier, I think the key for us to really advance equity is to be willing to listen to them, to build trust and to meet them where they are. The model that we are working here with community health worker has been very effective. We have a promotora school, we call them the embajadores school. So, in our group, we have a training program where we teach them about health promotion and cancer specifically.
There is a program here in California called CalAIM that is now going to recognize the time of the promotoras in community health centers. And the school is for that. And they are embajadores and ambassadors. People listen to them because they trust them. They speak the language that they speak, not only Spanish, but also being able to communicate that in that culturally sensitive way.
So, I think the lesson here is to actually meet the communities where they are, listen to them, and have a true, meaningful and bidirectional communication where your research and implementing efforts are informed by the people out there in the community.
Ruben Mesa: Wonderful. Now, Amelie, you’ve been such a key leader in terms of having clinical trials, really try to be reflective of our communities. And I think as we look at this all now, clearly, I think that that representation of the community has many levels.
It clearly includes a heritage. It includes culture, includes gender. It includes age across the lifespan. It includes rural versus urban versus suburban. These are all very different. How are those efforts going? And again, are you seeing the challenges? I remember the catchment area from the Mays Cancer Center very well as a Latino majority population. Are you seeing different challenges in terms of clinical trial participation now than you did, let’s say, a year or two ago?
Amelie Ramirez: We are making small advances. I think one of the things that we have been focusing on as part of our outreach and education is encouraging a change in intentions to participate if an individual is offered a trial because we’re starting from ground zero where they really don’t understand a trial.
I’ve always encouraged our researchers to talk about it more as studies so that the trial doesn’t have that negative, like I’m going to be placed in front of a jury or more politically related that this is really a study.
We want to learn more about how we can help you clarifying the ideas of what a placebo is, helping them understand what randomization means. So, we’re trying to do kind of pre-education and ask them, “Should you be offered a trial? Would you be willing to participate? And we are definitely seeing intentions to say, “Yes, I would, now that I have this knowledge.”
But then again, I go to our researchers and ask them, “What are you doing with regards to your eligibility criteria? Are you ensuring that your eligibility criteria is also inclusive of our population? And how can we help you with that? Are you making sure that your messages are available in English and Spanish and are going to different places to ensure that we recruit those individuals?”
So, those are some of the things that we’re seeing. And we are beginning to see an uptick in individuals saying, “Yes, I’m willing to participate.” And again, through support that we received from Genentech, we were able to disseminate this on a national basis. Now, we have other centers coming to us and telling us, We’re underrecruiting with Latinos. Can we work with your Salud America program to help us accrue patients?” So, definitely this, breaking it down into steps and educating the community, has been critical.
Ruben Mesa: So, maybe each of you, and I’ll start off, what is one key thing that you think is important for this next year as it relates to advancing the science of cancer research for Latinos? I’ll say from my end, I think clearly a strong emphasis on our trainees, trying to have our trainees remain passionate about the mission against cancer and realize that that mission is there, it’s key, and that thinking about their mission broadly, both in terms of federal sources of funding, foundations, other creative collaborations really are key and really to look at the opportunities really holistically. But I’m keeping that trainee piece very much on the radar. Luis, how about yourself?
Luis Carvajal-Carmona: I agree with the trainees. We need to support mentees more than ever this year. But also, I think the challenge for us is to inform the rest of the community that cancer, certain Latinos is beneficial for everyone in the country. We have learned a lot about cancer in general because we have been studying a specific Latino population.
The HPV vaccine was developed by a trial in Costa Rica. We know about arsenic and cancer because of some communities in Chile.There have been amazing discoveries on breast cancer in women from Mexico and Peru. And those discoveries not only benefit Latinos. They benefit every family, every patient in this country. So, I think it is not only about addressing disparities is very important. It’s about advanced cancer science in general. And if we don’t include Latino population in these efforts, we are going to be missing out of learning about cancer.
Ruben Mesa: Very important message. And Amelie, why don’t you have both the final word as well as remind folks about the meeting?
Amelie Ramirez: Yes. Thank you so much, Ruben. And exactly what both of you have said, we need to move the needle with regards to research. And the importance of looking at our population is the heterogeneity of our communities, and that’s what’s missing. Learning more about our ancestry and the fact that we represent less than 5% in any of our clinical trials, yet we’re 20% of the U.S. population.
And as you mentioned, we represent different regions of the United States, Ruben. This is what I’m trying to do with our conference on advancing cancer research in Latinos and all populations. And so we’re really excited. And it’s also to bring researchers together to show not only our young researchers that are coming into the field, the post-docs, and so forth, but to see them here and see Latino researchers doing this novel work has been very inspiring to so many.
So, even though I call this kind of our boutique conference, it’s really making a difference. Everybody that comes and says, “I’ve never felt such elation and need to want to continue doing the work that I’m doing.” So the conference is scheduled for February 18th through the 21st in 2026. I hope to see you all there. And both Dr. Mesa and Dr. Carvajal-Carmona, both of you will be presenting. So thank you so much for agreeing to be part of the agenda. Look forward to seeing you then.
Luis Carvajal-Carmona: Well, thank you, Amelie. And thank you, Ruben and The Cancer Letter for inviting us to do this. I really appreciate that. The Cancer Letter is doing this in Latino Heritage Month.
Ruben Mesa: Yeah.
Luis Carvajal-Carmona: So, thank you. I’m happy to do it every year.
Amelie Ramirez: Thank you to The Cancer Letter. It’s read nationwide, and so it’s really important. It’s these steps that really help us move the needle.
Ruben Mesa: Really grateful to Paul and everyone on the team. It’s a town square for the cancer research and care community that is very, very unique and always has played an important role, but I think now more than ever.
Jacquelyn Cobb: Thank you for joining us on The Cancer Letter podcast, where we explore the stories shaping the future of oncology. For more in-depth reporting and analysis, visit us at cancerletter.com With over 200 site license subscriptions, you may already have access through your workplace. If you found this episode valuable, don’t forget to subscribe, rate, and share. Together, we’ll keep the conversation going.
Ruben Mesa: Until next time, stay informed, stay engaged, and thank you for listening.
