An NCI-designated Comprehensive Cancer Center
By Josh Jenisch | April 11, 2018
In the foreground of the photograph, a single cigarette butt sticks out of the sand at an angle. Behind it, rusting and forgotten, sits an ancient metal swing set.
April - Minority Month - Serrano Mayra Serrano, M.P.H., C.H.E.S.
This powerful image was taken by a student participating in a City of Hope-led study called “Photovoice,” involving community members in Duarte, California (where City of Hope is located) using cameras to document elements of the environment  impacting their health.
“The idea of the study was to give people who feel disenfranchised a voice in shaping their community,” said Mayra Serrano, M.P.H., C.H.E.S., the project's coordinator and community outreach specialist with City of Hope.
“With that one picture of the playground, this student was able to tell us more about his relationship with his own environment than we would have learned from hours of interviews.”
That is important, she says, because environment — be it social or physical — plays a critical role in the health of individuals and their communities. According to the National Institutes of Health, upwards of two-thirds of all cancers are caused by environmental factors.
And, according to Serrano, underserved populations are particularly at risk.
The Modern Environment
The environment is full of all sorts of unpleasant things that can make you sick — bacteria, viruses, chemicals and even radiation. But exposure is higher for poor communities.
“Those with limited financial resources are subjected to increased environmental risks,” said Kimlin Tam Ashing, Ph.D., professor and director of the Center of Community Alliance for Research & Education (CCARE) at City of Hope. “They have less access to nourishing food, adequate insurance, health care and information about health in general.
"Overall, they are in greater distress.”
Treating the sick without doing anything to address the environmental issues that led to that sickness isn’t a long-term solution, said Ashing.
“In order to improve health, we can no longer ignore the environmental determinants,” she said. “If we don’t address the environment, all our efforts at treatment are, for the most part, futile. We need to face up to the facts and say there are huge societal ills at play here. We need sound policy on housing and education, access to health foods and health care. Unless we address those issues as a society, we’re going to see these health disparities grow.”
“Poverty,” as former director of the National Cancer Institute Samuel Broder said, “is a carcinogen.”
The Food Environment
April - Minority Month - Ashing White BG Kimlin Tam Ashing, Ph.D.
Though we often associate cancer risk with exposure to dangerous things in the environment — asbestos, benzene and the like — disease is just as likely to arise from a lack of something — for example, nourishing food.
“We’ve long known that height is positively and negatively responsive to nutrition and metabolism is very responsive to exercise,” said Ashing, citing examples of seemingly simple things with profound implications for improving human health and well-being.
“Maybe other aspects of human health are just as responsive as height,” she added. “Can we improve health outcomes just by improving the environment?”
Food deserts — defined as urban areas without access to healthy food within one mile, or rural areas without access to healthy food within 10 miles — are environments Ashing wants to improve.
Google “health food store West Hollywood,” and you'll find dozens of results. Try the same search centered in the Bell Gardens neighborhood of East Los Angeles and you’ll find zero.
“One of the keys to better health is eating more fruits and vegetables,” said Ashing. “But how are you going to do that in a food desert? What are you going to do when your primary source of food is a liquor store?”
“It’s not just about eating healthy and exercising,” said Serrano. “It’s more complex than that. Some of the women we work with have two or more jobs. They get home at 11 o’clock at night and don’t have time to cook a healthy meal — and even if they did have time, there isn’t a grocery store anywhere nearby. You’ve got to target the whole person and everything they’re dealing with.”
The Chemical Environment
Exposure to certain chemicals in the physical environment can also increase cancer risk, according to Shiuan Chen, Ph.D., professor and chair of the Department of Cancer Biology at City of Hope.
“There are many findings indicating exposure to different environmental chemicals increases the risk of cancer,” said Chen, “but primarily in animal models. It is difficult to demonstrate a direct cancer-causing effect in humans because we cannot, of course, test directly in humans.”
April - Minority Month - Chen White BG 3 Shiuan Chen, Ph.D.
Chen is currently studying two chemicals, PBDEs (found in flame retardants) and BPA (found in plastics), and their effect on cancer risk.
He hypothesizes that during menopausal transition, a woman’s body is very sensitive to chemicals like PBDEs and BPA, which act like the female hormones estrogen and progesterone in the body. His research is designed to find out whether these chemicals increase the risk of breast cancer.
This is especially important research for financially insecure populations, who tend to encounter BPA on a more regular basis.
According a Boston University study, “People with lower incomes have higher body burdens of BPA," and income is one of the strongest predictors of concentrations of the chemical in the body. The researchers suggest this might be due to poorer populations’ reliance on low-cost food, often sold in packaging containing BPA.
Chen is hoping — should the hypothesis hold true — his study could spark real social change.
“We want to produce strong scientific evidence to convince governmental regulatory agencies to stop the use of such environmental chemicals,” he said. “We want to increase awareness among the general population and encourage them to voice their concerns to the government.”
Information into Action
Chen’s last point is particularly potent for a researcher like Ashing and a community health educator like Serrano, who believe that providing communities with information about health and wellness can lead — eventually — to community advocacy and improved health.
“Everybody, rich or poor, wants information,” said Ashing. “They want knowledge. They want to be empowered to make educated decisions based on the information and resources available to them.”
Armed with information about everything from healthy eating habits to the importance of regular cancer screenings, these communities can become a force to be reckoned with.
“An informed community becomes an empowered community,” said Ashing. “And empowered communities start to advocate on their own behalf. They start to speak up to government and appeal for policy changes.”
Serrano points to the photograph of the cigarette and the swing set as a prime example. After seeing the image, and others like it, city council members in Duarte were spurred to action.
On February 25, Serrano attended a ribbon-cutting ceremony at a new park and playground located in the same space where the decaying swing set once stood.
“It’s a testament to the power of community,” she said. “Even kids can affect their own environment.”

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