African Americans at higher risk for pancreatic cancer at younger age

HONOLULU — Study data suggest that urban African Americans are more likely to be diagnosed with advanced pancreatic adenocarcinoma at a younger age and are less likely to receive treatment, according to a presenter at ACG 2015.

“African Americans have a disproportionately higher incidence and mortality from pancreatic cancer as compared to other ethnic groups,” Saurabh Chawla, MD, from Emory University School of Medicine in Atlanta, Georgia, said during his presentation. “This increased risk has been variously attributed to cigarette smoking, diabetes, obesity, and lower socioeconomic status, which is known to be an independent risk factor for pancreatic cancer. The increased mortality has been attributed to an advanced stage of presentation … and also, even after controlling for socioeconomic status, they’re less likely to receive care. What is less known is that there is an under-representation of African Americans in large national registries and databases, and if you look at subgroup analysis of these larger studies, or at small, single center, regional studies, there is a trend of African Americans presenting at a younger age.

Saurabh Chawla

“With this background and our own clinical observation, we came to the hypothesis that urban African-American patients with pancreatic cancer present at a younger age with more advanced disease than reported in large regional or national studies.”

In a retrospective, single institution, database study, Chawla and colleagues identified 119 African Americans presenting with pancreatic cancer at an inner-city safety hospital using institutional database records from 2008 to 2013. They compared age at diagnosis, gender, race, comorbidities, tobacco use, alcohol use, insurance status, tumor stage, treatment and surgery to cases reported in the SEER and national cancer databases. They also compared differences between early-onset pancreatic cancer (aged 60 years or younger) and older patients.

They found that the median age of diagnosis of 60 years among the African-American cohort (64% aged younger than 65 years)  was significantly lower than the median age of diagnosis of 71 years reported in the SEER database (P < .001). Furthermore, 69% of the African American patients presented at stage III or IV compared with the 61% national average (P = .03), 60% received no treatment and only 9% underwent surgery.

Multivariate analysis showed diabetes (HR = 4.05; 95% CI, 1.11-14.77) and history of smoking (HR = 3.68; 95% CI, 1.11-12.2) were significantly associated with pancreatic cancer in patients aged 60 years or younger.

 “We feel that this study can stimulate further research and that the epidemiology of pancreatic cancer in African Americans needs to be established in larger studies,” Chawla said. “If truly urban African Americans present at a younger age, this could be due to certain environmental factors, but even differences in tumor biology and genetics in younger patients … may offer targets to guide early diagnosis and treatment in this important disease. Finally, given that 60% of our patients did not get treatment even after controlling for socioeconomic status, this could be due to certain other plethora of factors and these disparities and treatment need to be further investigated.” – by Adam Leitenberger 

Reference:

Chawla S, et al. Abstract 9. Presented at: ACG; Oct. 19-21, 2015; Honolulu, HI.