Sarah Jackson Appointed Earl Stadtman Investigator in IIB
, by Elise Tookmanian, Ph.D.
In July 2023, Sarah S. Jackson, Ph.D., M.P.H., (she/her), was appointed as an Earl Stadtman tenure-track investigator in the Infections and Immunoepidemiology Branch (IIB). Dr. Jackson is an expert in the study of sex differences in cancer and cancer risk, screening, and outcomes in transgender and gender-diverse (TGD) adults. Pursuant to her research objectives, she is leading the field in the development and testing of self-reported questionnaire-based measures of sexual orientation and gender identity (SOGI) data. Additionally, she was selected for the competitive NIH Distinguished Scholars Program, a cohort of investigators who have a commitment to promoting diversity and inclusion in the biomedical research workforce.
Sex Differences in Cancer
Men are two to three times more likely than women to develop most non-sex-specific cancers. This phenomenon has largely been attributed to differences in lifestyle/behavioral risk factors, e.g., men are more likely to smoke. Dr. Jackson has developed a research program to further explore the contributions of intrinsic biological factors in cancer risk. She has established collaborations within IIB to explore sex-driven variations in immunity and immune-related malignancies, namely, the Transplant Cancer Match Study and HIV/AIDS Cancer Match Study, with Eric A. Engels, M.D., M.P.H., senior investigator and IIB Branch Director, and studies of Epstein-Barr virus with Zhiwei Liu, Ph.D., IIB investigator.
In collaboration with Jill Koshiol, Ph.D., IIB senior investigator, Dr. Jackson will analyze direct measurements of sex hormones to further understand the etiology of gallbladder cancer—more common in women—and look for potential treatment targets for this highly-fatal malignancy.
Cancer Among Transgender and Gender Diverse (TGD) Individuals
In the US, an estimated 1.4 million adults identify as transgender or gender diverse (TGD): those whose gender identity differs from their sex assigned at birth. However, gender identity information is not collected in the U.S. census or most population-based cohorts. Compared with their cisgender counterparts, TGD individuals may be at higher risk of developing and dying from certain cancers due to higher prevalence of risk factors, such as HIV infection or smoking, as well as increased social stigma and marginalization. The lack of data makes it very difficult to study cancer and other diseases in this population. To address this issue, Dr. Jackson is developing a study to evaluate measures of SOGI. “LGBTQ+ individuals are present in all our data, but currently, they are not counted,” said Dr. Jackson. “The collection of SOGI data in all health studies is vital to monitor the health of the LGBTQ+ community."
Dr. Jackson is leveraging data from the UK Clinical Practice Research Data Link (CRPD) to study this topic. In previous studies, Dr. Jackson found that TGD individuals have a 34–75 percent increased risk of death compared to their cisgender counterparts, driven primarily by external causes of death, such as suicide, homicide, and accidental poisoning. Additionally, her research team found an elevated prevalence of several cancer risk factors, including smoking, alcohol use, obesity, high cholesterol, diabetes, and HIV in the TGD population. Using the National Cancer Database, Dr. Jackson found that TGD cancer patients were more likely to be diagnosed at later stages, less likely to receive treatment, and have worse survival for many cancer types compared to cisgender patients. Her research will continue to investigate these questions by developing new resources and collaborations, including a partnership with the Population Research in Identities and Disparities for Equality (PRIDE) Study, a US-based study consisting of more than 5,000 TGD individuals. She is launching a pilot study to evaluate the feasibility and acceptability of self-sampling for HPV testing among transgender men and transgender women in England.
Dr. Jackson earned her Ph.D. in epidemiology at the University of Maryland, Baltimore, where she did her doctoral research on risk prediction models for healthcare-associated infections. Prior to joining DCEG, she worked in vaccine clinical trials at The EMMES Corporation and with the AIDS Clinical Trials Group at Social & Scientific Systems. Dr. Jackson joined IIB in 2018 as a postdoctoral fellow. In 2021, she was inducted into the NIH Independent Research Scholar Program and promoted to research fellow. She has received numerous awards for her work, including the NCI Director’s Intramural Innovation Award, the William G. Coleman Minority Health and Health Disparities Research Award, and the NCI Director’s Award of Merit for leading diversity initiatives in the division.