Incidence Rate among
African Americans
When NFL Hall of Famer Gene Upshaw died of pancreatic
cancer in 2008, it was the first time that many Americans had heard of the
disease. Like many patients with this deadly cancer, the 63‐year‐old Upshaw
died a short period after his diagnosis, shocking many football fans. The news
of his death also put a spotlight on a disease that, although rare, but deadly,
disproportionately affects African Americans.
Pancreatic cancer is diagnosed in African Americans more
often than in other racial/ethnic groups in the United States. And African Americans are more likely than
other groups to die from the disease. The reasons for these disparities are not
clear. Some researchers have noted, however, that certain risk factors are more
common among African Americans than among other groups. Known risk factors for pancreatic
cancer include tobacco use, long‐standing diabetes, obesity, inflammation of
the pancreas, a family history of pancreatic cancer, and certain hereditary
conditions.
According to a report by the Sol Goldman Pancreatic
Cancer Center, the incidence rate of pancreatic cancer among Blacks is 50% to
90% higher than other racial groups. It also concludes that Blacks are less
likely to receive surgery.
Smoking Effect on
Increased Risk
Cigarette smoking is considered a significant risk of
cancer of the pancreas. In fact some studies show that smoking causes about 25%
of all cases of pancreatic cancer. Smoking is more common among African
Americans versus other races. Although Blacks do quit smoking at the same rate
as Whites, a higher ratio of Blacks still continue to smoke. These facts would
tend to be a legitimate reason why Blacks do experience a higher degree of risk
of pancreatic cancer.
Obesity, Pancreatitis
and Type 2 Diabetes Risk Factors
Obesity is a high risk factor for pancreatic cancer. That
is likely because obesity is also a risk factor of diabetes, which in-turn is a
significant pancreatic cancer risk factor. According to the Department of Human
Services Office of Minority Health, 31% of Black men and 39% of Black women
over the age of 18 are obese or significantly overweight. Those numbers compare
to 26% of White men and 23% of White women.
Type 2 Diabetes and Pancreatitis is also more common
among African Americans than Whites. Over 80% of people that have Type 2
Diabetes are overweight. According to the Sol Goldman Pancreatic Center, Type 2
Diabetes doubles the risk of cancer of the pancreas. These facts would also
serve to support reasons why Blacks experience a higher occurrence of
pancreatic cancer.
Possible Income
Disparity
According to the US Census Bureau, African Americans
account for about 25% of Americans at the poverty level. Poverty and low income
could be associated with increased risk. Individuals who earn lower incomes
tend to smoke more which doubles the risk of pancreatic cancer. Those at
poverty levels are also less likely to receive proper nutrition or quality
healthcare.
It is interesting however that even though there is a
greater number of Hispanics and Native Americans at the poverty level versus
Whites, the incidence rates of pancreatic cancer among Hispanics and Native
Americans are significantly less versus the White population.
Latest Research
To better understand the causes and risk factors for
pancreatic cancer, researchers led by Jiemin Ma, Ph.D., now affiliated with
Brigham and Women's Hospital in Boston examined long-term disease trends in
pancreatic cancer death rates in the United States between 1970 and 2009. They
found in white men, pancreatic cancer death rates decreased by 0.7% per year
from 1970 to 1995, then reversed, increasing by 0.4% per year through 2009 (the
latest year for which data was available). Among white women, rates increased
slightly from 1970 to 1984, stabilized until the late 1990-s, then increased by
0.5% per year through 2009. In contrast, death rates among African Americans
increased between 1970 and the late 1980-s (women) or early 1990-s (men), after
which they began to decrease. However, death rates continued to be substantially
higher in blacks than in whites in both men and women.
The authors say the difference in mortality trends
between blacks and whites are not fully explained by differences in patterns of
smoking, widely recognized as the main contributor to decreases in pancreatic
cancer death rates. Smoking prevalence has decreased in both blacks and whites
since 1965. The authors surmise that other factors may have modified the
impacts of smoking on pancreatic cancer, and say further studies on the
mechanisms by which smoking causes pancreatic cancer are warranted.
While obesity has been linked with a 20% increased death
risk from pancreatic cancer, the lack of an increase in pancreas cancer
mortality rates in blacks, among whom obesity is more prevalent, would make
obesity alone an unlikely culprit. In addition, improvements in diagnostic
techniques may have contributed to increasing incidence and mortality rates
among whites by identifying pancreatic cancers that previously went
un-diagnosed. But a lack of reliable long-term data makes it difficult to
evaluate the potential influence of other suspected risk factors, like meat and
vegetable intake. The authors say the decreasing mortality trend in African
Americans over the past 10 to 15 years is particularly interesting, as the
factors that are likely contributing to recent increases in pancreatic cancer
deaths in whites (e.g.: obesity, diabetes, and improved diagnosis) have also
increased in African Americans.
"This study underscores the need for urgent action
on several fronts," said Ahmedin Jemal, DVM PhD, senior author of the
paper. "We need to invest more into pancreatic cancer research to
understand why this disease is rising or falling in different races. In the
meantime, we have to address modifiable risk factors such as obesity and
smoking to reduce the future burden of pancreatic cancer in all
populations."
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