Innovating the Field of Cancer Research as a First-Gen Scientist Against Socio-Economic Adversities.

There is clear evidence that higher educational attainment leads to better outcomes. My parents valued the importance of an education. However, economic and social resources were limited stemming from my parents’ immigrant and socio-economic status. Postsecondary matriculation was a concern for us. I was raised in Central California, which is one of the most ethnically diverse and productive agricultural regions in the world. Hispanics/Latinos are the largest minority group. My parents are Mexican immigrants. They have limited English proficiency and an educational attainment that is less than that of a high school diploma. Therefore, their access to quality jobs were inadequate - they were employed as farm- and dairy workers.

The work my parents engaged in was physically demanding. Despite my parents working full-time and multiple jobs, they were paid at minimum wage with no advancement opportunities. There was also no job security and we relocated several times. I would often assist my parents with job searching and filling out their unemployment forms; serving as a liaison between them and their employers. Taken together, these factors made achieving any academic success difficult. Conversely, these experiences taught me how to be resourceful at a young age.

I was raised on dairy farms throughout my childhood; sheltered from cities like San Francisco and Los Angeles by orchards, farms, and mountains. I attended primary and secondary school in rural California. There was segregation and discrimination among Hispanic/Latinos within these communities. As I matured, I became aware amid students with parents that had a college education that they were at an advantage. These students had adequate access to resources, including sports, clubs, tutoring, transportation, and college preparation. I on the other hand, had conformed to my plight and I accepted my low-income background with the disadvantages that came with it. Nonetheless, my background provided me with a benefit, including the gratification of experiencing the commodities that I didn’t have before.

Throughout high school, I was unprepared to assemble a competitive application that comprised of essays, test scores, and recommendation forms for college. I was encouraged by my parents to apply for college, but their esteem for higher education was short of the aid that they could provide. I was unaware of college academics, financial aid, campus resources, and housing. I also didn’t study for the SATs/ACTs. Collectively, these factors affected the number of applications I could successfully submit. I only submitted one application. Still and all, it was during this time that I was helping my parents learn basic English because I wanted them to attain better employment. I can recollect how my mother guilelessly received her certificate when she completed the first level of English as a Second Language (ESL). She was proud of herself, and I was proud of her. She re-enrolled in ESL I multiple times prior to ESL II because she wanted to understand the fundamentals of speaking, writing, and reading English completely. It was my parents’ commitment to learn basic English that I was exposed to the concept of grit, such as to be perseverant and passionate about a long-term goal, despite how difficult and impossible it may appear to be.

Coming from a low-income household produced several challenges. This was evident when I attended the California State University Stanislaus (CSUS) and became aware that affording an education was arduous. I couldn’t fund my college tuition, in addition to the expenses that were associated with school, including books, parking, and food. The availability of jobs in Central California were dismal after the Great Recession, and the competition for employment was high; getting hired without a college degree with minimal work experience was a challenge. Notwithstanding the lack of jobs, I was fortunate to have been employed as a certified nursing assistant (CNA) to fund my education. I was 18 years old and was assigned the role of providing symptomatic and supportive care to patients. This was a big responsibility at a young age.

Looking back, I came upon the opportunity to work as a CNA on account that I volunteered at a nearby hospital throughout high school. The nurses became aware that I struggled to fund my education and as a whole, they assisted me with finding employment within the hospital as a CNA. Thereafter, it was through the hospital that I was exposed to the clinical aspects of Cancer Biology that solidified my decision to embark on a Bachelor's of Science in the Biological Sciences (with a concentration in Molecular Biology and a minor in Chemistry) as a vehicle to a career in cancer research. As a CNA, I learned about cancer therapy, imaging, and surgery from both the clinicians and nurses. I was trained to be empathetic, meticulous, and collected. I also observed the gradual impact of therapy on patients’ cancers, families, and well-being. However, patient outcomes varied and I made some interesting observations among these patients. Taken together, these observations built the foundation of my goals for and beyond graduate school.

The first observation I made was that a subset of patients displayed cancer progression on therapy. These patients had the worse outcomes compared to others. Thus, I began to develop an interest in therapy refractory cancers (TRCs), which acquire resistance to therapy. This affixed my interest to uncover the different mechanistic pathways that induced therapeutic resistance as to develop novel therapeutic strategies that targeted TRCs. However, I recognized that I required specialized training in Cancer Biology to achieve this goal.

The second observation I made as a CNA was that cancer disparities existed among Hispanics/Latinos – a NIH-designated disparity population. I observed among Hispanics/Latinos that were diagnosed with cancer were experiencing greater distress that stemmed from socioeconomic and healthcare factors. I also recognized Hispanic/Latino patients were underusing cancer therapy because of a language barrier and I was the only Hispanic/Latino direct healthcare worker fluent in Spanish in the department I worked in. Therefore, I provided Spanish interpretation to Hispanic/Latino patients, all the while improving patient-physician communication and patient compliance. This observation made me aware that diversity was necessitated in the STEM workforce.

My experience with cancer disparities motivated me to help students/trainees who have surmounted challenges to attain an education, and that come from similar backgrounds like my own. Thereafter, I began to become more engaged in tackling this alarming problem in the U.S. STEM workforce by becoming a role model among underrepresented high school and undergraduate students through the California Department of Education Regional Occupational Program and the Central Valley Math and Science Alliance, respectively. These programs provided technical education to students to pursue and complete advanced training in STEM at postsecondary institutions.

Collectively, my commitment to helping underrepresented students and improving/delivering excellent patient care at the hospital resulted in several awards, including a scholarship by the hospital that funded my undergraduate education, which I struggled to fund. Thus, I encourage students to volunteer, which can provide a plethora of opportunities, including networking, a possibility of being hired, financial aid, mentorship, and career-related training. Through volunteering, I was provided the foundation, training, and confidence to apply to graduate school to pursue my goal of a career in cancer research. Volunteering also provided me a platform to contribute to healthcare - it was a gratifying and rewarding experience.

After I graduated from the CSUS, I embarked on graduate school to receive specialized training in cancer research. Importantly, I wanted to be involved in the transition of my own basic science discoveries from the lab to humans, patients, practice, and ultimately, to the community. My undergraduate studies did not include clinical research and cancer biology. Therefore, I applied and was accepted at the University of Miami Miller School of Medicine (UMMSOM) in Miami, Florida, to pursue a Master of Science in Clinical and Translational Investigation (MSCTI).

In retrospect, I learned from my mistakes as a high school student when I applied to college. It was during this time that: 1) I studied for the GRE at least one year in advance; 2) I prepared and had my essays read by faculty for feedback; 3) I made a list of all the universities that offered training in MSCTI with their deadlines/application requirements; 4) I noted down the resources that were offered at each institution (financial aid, transportation, housing assistance, etc.); 5) I contacted alumni for feedback about the program; and 6) I applied for application and exam fee waivers. With these key elements, I could comfortably apply to graduate school.

I took advantage of the opportunity to attend the UMMSOM to move out of Central California. This was my first time living away from home and out of state - I was relocating ~3,000 miles away. I was afraid of being away from by parents. More so, I was afraid of being independent. Conversely, when I moved to Miami, Florida, I was exposed to the many opportunities that were nonexistent in rural California, including a diversity in resources and people. The environment and culture in Miami provided me with the distractions (e.g. beaches, food, music,) to prevent me from becoming homesick. Additionally, the UMMSOM provided off-campus housing assistance through an online platform that assisted students to search out roommates. This was a helpful service, especially in searching for places to rent and whom to live with. I highly recommend students to ask their institutions if they offer this service. In Miami, I lived with a Ph.D. student in Epidemiology, whereas the other roommate was a recent graduate from and who worked at the UMMSOM. My roommates exposed me to a strong work ethic, but importantly, to the process of a Ph.D. program, including funding, coursework, comprehensive and qualifying exams, and dissertation work.

During my MSCTI training, I was exposed to cancer research, including research at the bench, in the clinic, and community. My peers were MDs and PhDs, and I was the only student in the program without a professional degree. However, they were highly supportive, especially during my presentations as I lacked the experience they had. Nonetheless, my training within the program was diverse and included: grant writing, clinical trials, research ethics, epidemiology, biostatistics, health disparities, team science, and bioinformatics. Furthermore, My MSCTI thesis work was supervised by clinician-scientists. We focused on developing novel strategies that targeted gemcitabine-resistant pancreatic cancer, which has a 5-year survival rate of ~13%. Ultimately, our findings were acknowledged. We received distinction from the American Pancreatic Association (APA), in addition to our findings being selected for presentation at several venues, including the American Association for Cancer Research (AACR) and the Society of Academic Surgeons.

Contrastingly, I also co-directed a retrospective cohort study that studied 300 patients with gastrointestinal stromal tumors (GISTs) at the UMMSOM. My role was to collect and analyze data from all GIST patients’ medical records, including information about their tumor and response to therapy. Ultimately, we found: 1) that patients were inadequately treated for other cancers at other institutions; and 2) patients that had their GISTs profiled at diagnosis had better outcomes. Consequently, the outcomes of this study supported the standard at the UMMSOM that all GIST patients undergo tumor profiling at diagnosis to provide treatments that are suitable to their GISTs. As a result, our findings were featured in the Harvard Medical School Catalyst Program’s newsletter and assisted me to receive membership into the American Society of Clinical Oncology (ASCO). During this period, Harvard Medical School and the National Institutes of Health (NIH) were prompted to provide me with additional training on translational medicine to help me reach my goal of becoming a successful translational cancer researcher. These courses both institutions provided included: clinical pharmacology, clinical research, strategies in grant writing, implementation research, mixed methods research, imaging in clinical and translational research, and ‘omics’ research.

The aforementioned achievements would not have occurred if I have not been flexible and welcoming with the opportunities that were presented to me. Therefore, I recommend students to responsibly welcome as many opportunities to work on several projects. Oftentimes, the most pedagogic opportunities are those unrelated to one’s interests. For example, I initially worked on GIST because the availability to research breast cancer were at a minimum. I could’ve waited for an opening to be made available to research breast cancer, but this was not guaranteed; working on GIST provided me the foundation to seek out subsequent on pancreatic cancer and enroll in courses at other institutions.

I chose to pursue a Ph.D. in Cancer Biology to be provided the fundamentals of Cancer Biology. To edify, I elected to complete my Ph.D. at the Wayne State University School of Medicine (WSUSOM) in Detroit, Michigan, on account of 1) their affiliation to a National Cancer Institute (NCI)-designated comprehensive cancer center – Karmanos Cancer Institute; 2) the comprehensive training program in Cancer Biology; and 3) their commitment to promoting diversity in STEM. I also firmly believed the program would provide me with the dexterity to reach my long-term goals, which include:1) to direct a research program; 2) to research the mechanistic pathways of therapeutic resistance and develop therapies targeting TRCs; and 3) to improve diversity and inclusion in the STEM workforce. I do not regret my decision in moving to Detroit from Miami to pursue my Ph.D. at the WSUSOM.

Currently, I am a third-year, first-generation Ph.D. candidate in Cancer Biology. In a few months, I will be a fourth-year candidate. This academic achievement would not have been possible if it wasn’t for the support and encouragement I’ve received from the institution, graduate school, and the Cancer Biology Graduate Program. Upon matriculating into the program, I was awarded the Dean’s Diversity Fellowship to provide me with the economic support to fund my education. Furthermore, the institution organized monthly meetings and workshops called a Learning Community, where other underrepresented students gathered from different programs to receive graduate school and career guidance.

Prior to selecting my mentor, I rotated in three labs where I studied lung, prostate, and ovarian cancer. From these rotations, I gained a lot of technical acumen, including exposure to various assays to assess the therapeutic response of cancer cells. Aside from these rotations, I took courses that centered on cancer, including the fundamentals of cancer biology, molecular development of cancer, pharmacology, functional genomics, cancer therapeutics, clinical oncology, cancer metabolism, cancer disparities, rigor and reproducibility, study design, strategies in grant writing, and drug development. My favorite courses would comprise of journal club and seminar, which provide students the opportunity to learn novel methods and receive feedback from their peers/faculty to improve their science. Currently, my research focuses on breast cancer, particularly in developing therapeutic strategies that target triple-negative breast cancer (TNBC) - the most aggressive form of breast cancer.

As a Ph.D. candidate, I’ve also had the opportunity to learn from medical oncologists. I regularly attend seminars and retreats that are hosted by the various research programs at the Karmanos Cancer Institute, including Grand Rounds and the Molecular Therapeutics, Molecular Imaging, Tumor Biology/Microenvironment, and Population Studies/Disparities programs. It was not uncommon for faculty and the directors of these programs to arrange students to have lunch and meet with invited speakers - Nobel Laureates were invited. I had the honor of meeting Nobel Prize Winner, Dr. David Baltimore, who discovered reverse transcriptase.

Importantly, I was provided a mentoring committee as a Ph.D. student on account of the educational inequities I’ve encountered on my pursuit to higher education as a first-generation minority student. My mentoring committee, which would sequentially become my dissertation committee, would regularly meet with me to provide me the resources that I required to be successful. This included discussions about my academic and research progress with career guidance. Each of the committee members have an open-door-policy. Their offices are located in the same building where I work. Therefore, my capacity to read, write, communicate, and think has significantly improved - I’ve successfully passed my courses and the exams that are required for candidacy.

Under my mentor’s training, I’ve been a recipient of several awards, in addition to authoring original research papers that highlight strategies on inhibiting the growth of TNBC cells. Thus, my findings on TNBC have been acknowledged and presented at several venues. The former includes being awarded the NIH T32 Ruth L. Kirschstein fellowship, first-place poster presentation, and two travel awards to present at the 2020 and 2021 Society of Advancing Chicanos/Hispanics and Native Americans in the Sciences (SACNAS) Conference. In addition, I was appointed by my peers to the student representative of the Cancer Biology Graduate Program during the 2020 COVID-19 pandemic; serving as a peer mentor to enrolled students, meeting with faculty candidates, assisting with student recruitment, and co-organizing our program’s annual symposia for students to showcase their research. Hereafter, I was invited to provide two talks to students enrolled in the FocuSSTEM Nextgen Program, which is a program organized by WSUSOM and the Karmanos Cancer Institute that fosters exceptional educational experiences to students in under-resourced schools in Michigan. I have served as a judge for the program’s Virtual STEM Challenge that engages high school students with Cancer Biology faculty to compete in teams to solve a real-life cancer case.

Taken together, my work ethic, coupled with my commitment to my research in breast cancer and promoting diversity in STEM during the 2020 COVID-19 pandemic, has resulted in the 2021 National Diversity Council’s National Latino Leader Award and the Wayne State University Profiles in Warrior Strong Award. The latter was presented by the WSUSOM Board of Governors. However, despite all these accomplishments, my biggest accomplishment would consist of surmounting the challenges, as aforementioned, to attain an education. It was difficult, but not impossible. Attaining an education provided me the opportunity to remove myself from the plight I had in rural California. Therefore, I hope by sharing my narrative that students who aspire to have careers in STEM, and that come from similar backgrounds like my own, can recognize my errors, and thereby avoid them. Likewise, to forge success, either academically or professionally, grit is required as a sustenance for intelligence, which is comprised of a strong work ethic, perseverance, resourcefulness, passion, courage, and conscientiousness. These key elements have provided me with the dexterity to embark on a path to tackle the second deadliest disease worldwide – cancer.

- Julio M. Pimentel