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Author(s): Tepper, Clifford G; Dang, Julie HT; Stewart, Susan L; Fang, Dao M; Wong, Kimberly A; Liu, Stephenie Y; Davis, Ryan R; Dao, Doan Y; Gregg, Jeffrey P; Torok, Natalie J; Chen, Moon S | Abstract: BACKGROUND:An exploratory study was performed to determine the prevalence of the patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs78409 [G] allele among the Hmong as a risk factor for nonalcoholic fatty liver disease (NAFLD). NAFLD/nonalcoholic steatohepatitis is the world's most common chronic liver disease and is expected to replace viral hepatitis as the leading cause of cirrhosis and potential precursor to hepatocellular carcinoma (HCC). Of all populations in California, the Hmong experience the highest risk of death from HCC and the highest prevalence of metabolic syndrome risk factors among Asians that predispose them to NAFLD. Here a genetic explanation was sought for the high rates of chronic liver disease among the Hmong. The literature pointed to the PNPLA3 rs738409 [G] allele as a potential genetic culprit. METHODS:Cell-free DNA was isolated from 26 serum samples previously collected in community settings. Quantitative polymerase chain reaction-based single-nucleotide polymorphism (SNP) genotyping was performed with a validated TaqMan SNP genotyping assay, and results were analyzed with TaqMan Genotyper software. RESULTS:The PNPLA3 rs738409 [CgG] variant occurred at a frequency of 0.46 (12 of 26; 95% confidence interval, 0.27-0.67). This carrier rate would rank the Hmong as the third highest population in the 1000 Genomes Project. CONCLUSIONS:Although this small sample size limits the generalizability, the high frequency rates of this allele along with the presence of metabolic syndrome risk factors warrant further studies into the etiology of NAFLD among the Hmong. Cancer 2018;124:1583-9. © 2018 American Cancer Society.

Personalized medicine cannot be achieved without the public's willingness to contribute biospecimens for cancer research and their support for the research being conducted. In many cases, the historical and cultural mistrust by racial/ethnic minorities in biomedical research stem from the adverse legacy of uninformed consent in communities of color; from Tuskegee to the Havasupai Indians, these events have amplified the disconnect between researchers and these minority communities. Engaging these communities in biospecimen contribution for cancer research requires: time, trust and talent. For sustained and respectful relationships, collecting blood biospecimens must be viewed as mutually beneficial and not as a one-sided effort. These collaborations should build community capacity to not only understand the value of biospecimens for cancer research but also advocate for their need. Researchers should commit to investing the time necessary to developing community relationships and earning community trust. Simultaneously, educational outreach efforts need to be ethnically specific, linguistically diverse, culturally appropriate and cognitively empowering. Building upon the past decade of the NCI funded Asian American Network for Cancer Awareness, Research and Training (AANCART)’s foundation of trust and service with the Asian American community, researchers were able to leverage relationships to not only introduce the idea of biospecimen contribution to the community, but to also exceed our expectations in collecting blood biospecimens from Asian Americans. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):ED01-03.

Background: Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9 per 100,000, Hmong Americans experience liver cancer at a rate that is 6 to 7 times more than that of non-Hispanic Whites. Serologic testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer-related deaths through earlier identification of those at risk. Methods: Academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation. Results: Intervention group participants were more likely to report receiving serologic testing for HBV (24% vs. 10%, P = 0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, P = 0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment [OR 3.5; 95% confidence interval (CI) 1.3–9.2], improvement in knowledge score (OR 1.3 per point; 95% CI 1.02–1.7), female gender (OR 5.3; 95% CI 1.7–16.6), and having seen a doctor in the past year at baseline (OR 4.8; 95% CI 1.3–17.6). The most often cited reason for testing was a doctor's recommendation. Conclusions: LHWs were effective in bringing about HBV screening. Doctor visits and adherence to doctors' recommendations were pivotal. Participation of health care providers is essential to increase HBV testing. Impact: LHWs can significantly increase HBV screening rates for Hmong but their doctors' recommendation is highly influential and should be pursued. Cancer Epidemiol Biomarkers Prev; 22(5); 782–91. ©2013 AACR.