Pancreatic Cancer Related Health Disparities: A Commentary

Abstract

We summarize the risk factors that may significantly contribute to racial disparities in pancreatic cancer, which is now the third leading cause of cancer deaths and projected to be second around 2030 in 12 years. For decades, the incidence rate of pancreatic cancer among Blacks has been 30% to 70% higher than other racial groups in the United States and the 5-year survival rate is approximately 5%. Diabetes and obesity have been identified as potentially predisposing factors to pancreatic cancer and both are more common among Blacks. Smoking continues to be one of the most important risk factors for pancreatic cancer and smoking rates are higher among Blacks compared to other racial groups. The overall risk of pancreatic cancer due to changes in DNA is thought to be the same for most racial groups; however, DNA methylation levels have been observed to be significantly different between Blacks and Whites. This finding may underlie the racial disparities in pancreatic cancer. Identification and prevention of these factors may be effective strategies to reduce the high incidence and mortality rates for pancreatic cancer among Blacks.

Cancer health disparities in racial/ethnic minorities in the United States

“…AA/Bs have both a higher incidence [269][270][271][272][273] and mortality rate 270,271,[273][274][275] compared with NHWs as well as other populations, which has been documented for both younger and older adults (<50 years vs. >50 years) across all USA states other than Hawaii. 174,271,272 Nearly all racial/ethnic groups showed a steady increase in incidence over a 27-year period from 1988 to 2015, with AI/ANs (who had the lowest incidence of all race/ethnicity groups) showing the greatest increase over time and AA/Bs showing stable incidence rates.…”

“…276 Potential aetiological factors Behavioural and lifestyle factors that are related to pancreatic cancer risk and prognosis, including smoking, diabetes, obesity and alcohol consumption, have been suggested to play a role in the observed disparities in incidence and mortality, especially among AA/Bs. 89,270 In particular, sudden-onset diabetes has been reported to increase the risk of pancreatic cancer among AA/Bs and Latinos. 277 The study of genetic factors that might contribute to racial/ ethnic disparities in pancreatic cancer has been limited.…”

“…Healthcare and treatment Differences in diagnosis and treatment have been shown to contribute to some of the observed disparities in survival by race/ethnicity, especially for AA/Bs. 89,270,281,282 Factors such as older age, minority race/ethnicity, lower SES, being uninsured or on Medicaid, higher comorbidity index and treatment at a nonacademic centre or a low-volume hospital have been inversely correlated with receiving standard therapy including surgery, 281,[283][284][285][286][287][288] and are also associated with patient refusal of treatment. 275,289 A study conducted within the Kaiser Southern California patient population (an integrated system), reported no racial/ethnic differences with regard to pancreatic cancer treatment and outcomes.…”

Role of extracellular vesicles in tumour microenvironment

“…Circ-PDE8A was found to be a highly-expressed circRNA in pancreatic ductal adenocarcinoma (PDAC) [67][68][69][70]. Circ-PDE8A easily binds to miR-338, and moderates the pathological function of PDAC via the miR-338/MACC1/MET pathway [70].…”

Racial and ethnic disparities in a state‐wide registry of patients with pancreatic cancer and an exploratory investigation of cancer cachexia as a contributor to observed inequities

“…Higher PC burden among Blacks has been attributed to risk factors such as tobacco exposure, obesity, and diabetes in some studies but not others . Furthermore, nonmodifiable factors such as genomics, epigenetics, and the microbiome have also been identified as potential contributors to PC disparities in Blacks . From a socioeconomic standpoint, Blacks are less likely than other racial/ethnic groups to be insured, married, referred to PC specialists, or diagnosed/treated at high‐volume hospitals .…”