Interethnic differences in pancreatic cancer incidence and risk factors: The Multiethnic Cohort

Abstract

While disparity in pancreatic cancer incidence between blacks and whites has been observed, few studies have examined disparity in other ethnic minorities. We evaluated variations in pancreatic cancer incidence and assessed the extent to which known risk factors account for differences in pancreatic cancer risk among African Americans, Native Hawaiians, Japanese Americans, Latino Americans, and European Americans in the Multiethnic Cohort Study. Risk factor data were obtained from the baseline questionnaire. Cox regression was used to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for pancreatic cancer associated with risk factors and ethnicity. During an average 16.9‐year follow‐up, 1,532 incident pancreatic cancer cases were identified among 184,559 at‐risk participants. Family history of pancreatic cancer (RR 1.97, 95% CI 1.50‐2.58), diabetes (RR 1.32, 95% CI 1.14‐1.54), body mass index ≥30 kg/m 2 (RR 1.25, 95% CI 1.08‐1.46), current smoking (<20 pack‐years RR 1.43, 95% CI 1.19‐1.73; ≥20 pack‐years RR 1.76, 95% CI 1.46‐2.12), and red meat intake (RR 1.17, 95% CI 1.00‐1.36) were associated with pancreatic cancer. After adjustment for these risk factors, Native Hawaiians (RR 1.60, 95% CI 1.30‐1.98), Japanese Americans (RR 1.33, 95% CI 1.15‐1.54), and African Americans (RR 1.20, 95% CI 1.01‐1.42), but not Latino Americans (RR 0.90, 95% CI 0.76‐1.07), had a higher risk of pancreatic cancer compared to European Americans. Interethnic differences in pancreatic cancer risk are not fully explained by differences in the distribution of known risk factors. The greater risks in Native Hawaiians and Japanese Americans are new findings and elucidating the causes of these high rates may improve our understanding and prevention of pancreatic cancer.

Diabetes-Related Complications and Pancreatic Cancer Incidence in the Multiethnic Cohort

“…This suggests that they may be at higher risk of developing pancreatic cancer. The incidence of pancreatic cancer is indeed higher for African Americans ( 31 , 32 ) and Native Hawaiians ( 33 , 34 ). Although we did find that Latinos were more likely to have 5 or more complications, evidence suggests that they do not have a higher incidence of pancreatic cancer compared with other racial ethnic groups ( 12 ).…”

Current epidemiology of pancreatic cancer: Challenges and opportunities

“…Subgroups of Asian Americans exhibit significant heterogeneity in PC incidence, with the ASIRs ranging from the highest of 8.1 in Japanese and 7.5 in Koreans to the lowest of 4.4 in South Asians ( 22 ). A multiethnic cohort study with an average 16.9-year follow-up showed a higher incidence of PC among African Americans (ASIR, 52.7, P<0.01), Native Americans (ASIR, 73.4, P<0.001), and Japanese Americans (ASIR, 56.8, P<0.0001) but no difference for Latino Americans (ASIR, 42, P=0.87) compared to European Americans (ASIR, 41.3) ( 23 ). Only 20% of racial disparities in PC incidence could be attributed to the interethnic differences in the distribution and effects of predominant environmental risk factors, including smoking, adiposity, and red meat intake.…”

Genetic characterization of pancreatic cancer patients and prediction of carrier status of germline pathogenic variants in cancer-predisposing genes

“…Despite the importance of reviewing a sufficient number of investigations to improve the precision and detail of such guidelines, there has been only two large-scale case-control association studies, conducted by the same research group, using a multigene panel that examined over 1000 patients with pancreatic cancer [ 7 , 14 ]. Additionally, most investigations that examined several hundred patients almost only targeted non-Hispanic European subjects [ 5 , 7 , 11 , 12 ], despite interethnic differences in susceptibility to pancreatic cancer [15] . We have previously identified differences in genetic characteristics of Japanese breast and prostate cancer patients compared to European patients [ 16 , 17 ].…”