Breast cancer researcher aims to uncover how ‘zip code is tied to genomic code’
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The Miami Dolphins and AutoNation awarded a $1 million grant to Neha Goel, MD, MPH, FACS, to examine the critical health disparities that drive mortality among patients with breast cancer.
The funding will support a 4-year Breast Cancer Research Foundation project and continue to support the Miami Breast Cancer Disparities Study.
Goel, associate professor of surgery in the division of surgical oncology at Sylvester Comprehensive Cancer Center of the University of Miami Miller School of Medicine, initiated the study to better understand how where people live can impact breast cancer outcomes.
“I started the prospective, longitudinal Miami Breast Cancer Disparities Study in 2019 to understand the genomic and nongenomic underpinnings of breast cancer disparities,” Goel told Healio. “The ongoing study enrolls newly diagnosed women seen both at our NCI-designated cancer center as well as our sister safety-net hospital, which is critical because we enroll women of diverse racial, ethnic and socioeconomic backgrounds. There is this juxtaposition of advanced and disadvantaged neighborhoods that allows us to build this unique genomic-epidemiologic infrastructure to inform and answer many important ongoing research questions.”
Goel spoke further with Healio about the Miami Breast Cancer Disparities Study, her goals for the grant, as well as her advice for other women in the field.
Healio: What led this to become the focus of your research?
Goel: I have always been passionate about improving health equity for all patients.
It never seemed fair that two people with the same race/ethnicity, insurance, tumor and treatment characteristics had different survival outcomes based on the neighborhood in which they live. Trying to understand the root cause of this, and developing interventions to overcome this disparity to achieve health equity for all breast cancer patients has been a major goal of mine.
When I first came to the University of Miami as an assistant professor of surgery out of fellowship training in 2018, I analyzed survival outcomes for about 6,000 breast cancer patients treated at the University of Miami and our sister safety-net hospital, Jackson Memorial Hospital. We found that independent of known factors associated with disparities in breast cancer survival — such as individual-level factors like race and ethnicity, access to insurance, tumor factors like breast cancer subtypes and stage at diagnosis, and even after receipt of NCCN guideline-concordant treatment — women residing in disadvantaged neighborhoods had shorter breast cancer-specific survival and overall survival outcomes.
To me, this was quite alarming and pointed to unaccounted factors that could be genomic factors and/or other social environmental factors associated with where women live. As a result, I started the Miami Breast Cancer Disparity Study.
Healio: What is the Miami Breast Cancer Disparity Study?
Goel: The study takes a comprehensive translational, epidemiologic and genomic approach to understand how where one lives impacts tumor biology.
Building off that, we recently published a paper in Annals of Surgery that showed that among 300,000 national patients treated and reported in the National Cancer Database, lower neighborhood level income was independently associated with more aggressive biology — defined using Oncotype DX scores, which is a clinically relevant genomic biomarker — even after accounting for individual-level factors, such as race and ethnicity, insurance, education and tumor characteristics.
Novel discoveries in our prospective, cohort data from the Miami Breast Cancer Disparities Study have shown that women living in disadvantaged neighborhoods have more aggressive tumor biology. Understanding how and why where one lives impacts tumor biology led me to apply for the Breast Cancer Research Foundation grant.
Healio: What are your plans for the 4-year grant?
Goel: Our grant, titled “Built Environment to Tumor Microenvironment: Disparities and Aggressive Breast Cancer by Neighborhoods Disadvantage,” builds off our discovery that compared with women residing in advantaged neighborhoods, women living in disadvantaged neighborhoods — defined as higher rates of poverty, unemployment and lower education — are more likely to have aggressive breast cancers, independent of known risk-factors associated with aggressive tumor biology.
The goal of our research with the Breast Cancer Research Foundation grant is to understand how and specifically what factors associated with where one lives “get under the skin” to impact the tumor microenvironment and, ultimately, survival. We have lab studies that will focus on looking at the tumor microenvironment and specific drivers that might be correlated with disadvantaged neighborhoods. On the patient level, we have surveys that patients can answer with respect to the neighborhood adversity that they face.
Healio: What advice can you offer other women in the field who may be interested in leading their own research efforts?
Goel: This advice is applicable for all early and upcoming researchers: One must be passionate about his/her field of research.
It’s important to have a topic that you are genuinely interested in. My research keeps me up at night trying to find solutions to improve outcomes for my patients. Having excellent mentors and an institution that supports junior faculty is also critical to jumpstarting research efforts.
Healio: What are some of the challenges that you have encountered along your career path and how have you overcome them?
Goel: Like most researchers, when building my lab, Zip Code to Genomic Code, it was critical to find a team of researchers and collaborators who were hardworking and dedicated to the lab’s short- and long-term goals. Writing grants to secure future funding is also an ongoing, parallel process along with our daily clinical and research activities.
In general, whenever I face a challenge, I always keep the big picture in mind. As a clinician, my duty is to provide the best care for my patients, and what truly inspires my research is finding novel discoveries and interventions that I can bring back from the lab to help my patients in clinic.
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For more information:
Neha Goel, MD, MPH, FACS, can be reached at neha.goel@med.miami.edu.
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