Dr. Clayton Yates studies why prostate and breast cancer hit people of African ancestry harder than anyone else. He is the John R. Lewis Endowed Professor of Pathology, Oncology and Urology at the Johns Hopkins School of Medicine and Director for Translational Health Disparities and Global Health Equity Research.
His lab identified quadruple negative breast cancer, a subtype more common in women of African ancestry. Cell-MENTOR named him one of the 100 most inspiring Black scientists in America.
What inspired your research on African ancestry?
As a kid, I was close to my grandfather. When I was 13 years old, he took me on a trip here to Maryland. He came home and died.
I wanted to know why, and I found out from my family that he had prostate cancer. As a young person, I have been on a quest as to why this disease took my grandfather away from me. He was my buddy in sports. It’s been my driving force since then.
Why are Black men more likely to die from prostate cancer?
It’s not one factor. But one thing we think is common is that Black men are presenting in the clinic with high levels of inflammation.
Before you get cancer, even in a normal person, we’re seeing high levels of stress-related cytokines and hormones that, if a person were to get cancer, make it more aggressive.
How much of that comes down to access to care versus genes?
The fact that they’re there is not access to care. That’s biology, because it’s happening without any treatment.
We just published a paper showing that Black men who are detected early, at early stage cancer, have the same outcomes as other races. However, if that Black patient is diagnosed with late-stage disease, there’s a huge gap, and Black men overwhelmingly do not do as well.
What did your research in Nigeria teach you about Black men in the U.S.?
When I started looking at the biology, I immediately thought, if there is something associated with our genes, it has to be associated with our ancestry, and I should be able to trace that through the diaspora to West Africa.
We’ve been able to trace through the diaspora genes that seem to be associated with hereditary prostate cancer in African ancestry people only. There are variants of genes predominantly expressed in Nigerian men. When we looked at African American men and men who had high West African ancestry, that gene was expressed. As people lose that admixture, we see that gene go away. And some of those are cancer genes.
Why are so many Black men afraid to get checked?
Unfortunately, the prostate is in a sensitive area for men. It’s part of a vital function that men see as related to our identity as men. Possibly losing that identity is a bit of the hesitancy men face.
But if you catch it early, you don’t have to lose any of those functions. We have surgery that spares the nerves required for erectile function. It’s cancer, it’s real, but if we catch it early, that person can go on and resume a normal life.
Can food or exercise lower your risk?
Exercise in general. We now know that cardiovascular-based exercises help decrease your risk for prostate cancer and most other cancers as well.
We know eating five fruits and vegetables every day decreases a man’s risk for prostate cancer. You want that balanced diet. Less meat, more vegetables, especially green leafy vegetables.
When should Black men start getting screened?
The national guidelines for men are 50 years old. We recommend 45 for Black men. Those numbers are being revisited right now. We’ve stopped prostate cancer screening uniformly, and we’re seeing the rates go back up, particularly in Black men. It’s almost alarming, because we’re not doing the early screening we used to do.
How close are we to treatments based on ancestry and tumor biology?
I felt we had enough genetic evidence and enough clinical drugs that match the genetics that we’re not utilizing properly in a precision medicine approach. We have a trial about to open in Nigeria, a targeted approach based on the biology we found in those individuals.
A colleague of mine, Oliver Sartor at Tulane, did a clinical trial with Black men using a drug called sipuleucel-T, known as Provenge. Because of the inflammation Black men present with, Black men responded twice as well as others. That’s now been replicated at Duke University.
Why should Black patients join clinical trials?
We’re not going to get better unless we participate.
I understand the argument from an individual saying, “A drug was developed and got all the way to clinic, and now you just want to test it on me.” But since we’re understanding what genetics contribute, we can design that trial especially for you, based on your biology and your cultural and community settings. In that case, you should not have a reason not to be involved.
What can Black men do now to protect themselves?
My presentation in the community is called “Man Up for Prostate Cancer.” Men, we have to take care of our bodies, especially when you start getting to 40, 50 years old. See your doctor.
Because of this inflammation, we have evidence that low-dose aspirin mitigates not necessarily the incidence but the aggressiveness of the disease. I personally take it every day.
People of African ancestry, because of the melanin in our skin, lack vitamin D. If we can get those vitamin D levels up to physiological levels, we can slow that aggressiveness. Those are things you can do today.
Where can people follow your research?
If you Google me, Clayton Yates at Johns Hopkins University, there’s my webpage. We’re working on something more patient-facing in the next few weeks, with take-homes Black men can use, especially around the holidays, to have discussions with their family.
