Are Racial Disparities in Pancreatic Cancer Explained by Smoking and Overweight/Obesity?

Between 2001 and 2005, Blacks from the United States experienced a 32% higher pancreatic cancer death rate than Whites. Smoking, diabetes, and family history might explain some of this disparity, but prospective analyses are warranted. From 1984 to 2004, there were 6,243 pancreatic cancer deaths among Blacks (n = 48,525) and Whites (n = 1,011,864) in the Cancer Prevention Study II cohort. Multivariate Cox proportional hazards models yielded hazards ratios (HR) for known and suspected risk factors. Population attributable risks were computed and their effect on age-standardized mortality rates were evaluated. Blacks in this cohort had a 42% increased risk of pancreatic cancer mortality compared with Whites (HR, 1.42; 95% confidence intervals (CI), 1.28-1.58). Current smoking increased risk by >60% in both races; although Blacks smoked less intensely, risks were similar to Whites (HRBlack, 1.67; 95% CI, 1.28-2.18; HRWhite, 1.82; 95% CI, 1.7-1.95). Obesity was significantly associated with pancreatic cancer mortality in Black men (HR, 1.66; 95% CI, 1.05-2.63), White men (HR, 1.42; 95% CI, 1.25-1.60), and White women (HR, 1.37; 95% CI, 1.22-1.54); results were null in Black women. The population attributable risk due to smoking, family history, diabetes, cholecystectomy, and overweight/obesity was 24.3% in Whites and 21.8% in Blacks. Smoking and overweight/obesity play a substantial a role in pancreatic cancer. Variation in the effect of these factors underscores the need to evaluate disease on the race-sex level. The inability to attribute excess disease in Blacks to currently known risk factors, even when combined with suspected risks, points to yet undetermined factors that play a role in the disease process. (Cancer Epidemiol Biomarkers Prev 2009;18(9):2397–405)

[1]  V. Beral,et al.  Factors associated with incident and fatal pancreatic cancer in a cohort of middle‐aged women , 2009, International journal of cancer.

[2]  P. A. van den Brandt,et al.  Alcohol Intake and Pancreatic Cancer Risk: A Pooled Analysis of Fourteen Cohort Studies , 2009, Cancer Epidemiology Biomarkers & Prevention.

[3]  A. Basu,et al.  New-onset diabetes: a potential clue to the early diagnosis of pancreatic cancer. , 2009, The Lancet. Oncology.

[4]  H. Kennedy,et al.  Pancreatic cancer: a review of the evidence on causation. , 2008, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[5]  D. Silverman,et al.  Adiposity, physical activity, and pancreatic cancer in the National Institutes of Health-AARP Diet and Health Cohort. , 2007, American journal of epidemiology.

[6]  N. Nelson.  Pancreatic cancer research matures. , 2007, Journal of the National Cancer Institute.

[7]  B. Miller,et al.  Measures of racial/ethnic health disparities in cancer mortality rates and the influence of socioeconomic status. , 2007, Journal of the National Medical Association.

[8]  J. Palmer,et al.  A Prospective Study of Body Size and Breast Cancer in Black Women , 2007, Cancer Epidemiology Biomarkers & Prevention.

[9]  S. Larsson,et al.  Body mass index and pancreatic cancer risk: A meta‐analysis of prospective studies , 2007, International journal of cancer.

[10]  M. Röösli,et al.  Cellular telephone use and time trends in brain tumour mortality in Switzerland from 1969 to 2002 , 2007, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[11]  J. Gurwitz,et al.  Racial differences in tumor stage and survival for colorectal cancer in an insured population , 2007, Cancer.

[12]  U. Nöthlings,et al.  Body mass index and physical activity as risk factors for pancreatic cancer: the Multiethnic Cohort Study , 2007, Cancer Causes & Control.

[13]  E. Vittinghoff,et al.  New-onset diabetes and pancreatic cancer. , 2006, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[14]  P. Pinsky.  Racial and ethnic differences in lung cancer incidence: how much is explained by differences in smoking patterns? (United States) , 2006, Cancer Causes & Control.

[15]  E. Holly,et al.  Diabetes Mellitus and Pancreatic Cancer in a Population-Based Case-Control Study in the San Francisco Bay Area, California , 2006, Cancer Epidemiology Biomarkers & Prevention.

[16]  S. Larsson,et al.  Fruit and Vegetable Consumption in Relation to Pancreatic Cancer Risk: A Prospective Study , 2006, Cancer Epidemiology Biomarkers & Prevention.

[17]  E. Feuer,et al.  SEER Cancer Statistics Review, 1975-2003 , 2006 .

[18]  D. Albanes,et al.  Insulin, glucose, insulin resistance, and pancreatic cancer in male smokers. , 2005, JAMA.

[19]  E. Holly,et al.  Vegetable and Fruit Intake and Pancreatic Cancer in a Population-Based Case-Control Study in the San Francisco Bay Area , 2005, Cancer Epidemiology Biomarkers & Prevention.

[20]  Mariza de Andrade,et al.  Probability of pancreatic cancer following diabetes: a population-based study. , 2005, Gastroenterology.

[21]  D. Krewski,et al.  Dietary patterns and risk of pancreatic cancer , 2005, International journal of cancer.

[22]  W. Willett,et al.  Dietary patterns and pancreatic cancer risk in men and women. , 2005, Journal of the National Cancer Institute.

[23]  M. Thun,et al.  Obesity, Recreational Physical Activity, and Risk of Pancreatic Cancer In a Large U.S. Cohort , 2005, Cancer Epidemiology Biomarkers & Prevention.

[24]  G. Friedman,et al.  Obesity and multiple myeloma , 1994, Cancer Causes & Control.

[25]  M. Thun,et al.  Alcohol consumption increases the risk of fatal breast cancer (United States) , 2001, Cancer Causes & Control.

[26]  Steven S. Coughlin,et al.  Predictors of pancreatic cancer mortality among a large cohort of United States adults , 2000, Cancer Causes & Control.

[27]  L. Vatten,et al.  A prospective study of lifestyle factors and the risk of pancreatic cancer in Nord-Trøndelag, Norway , 2000, Cancer Causes & Control.

[28]  M. Thun,et al.  Diabetes mellitus and pancreaticcancer mortality in a prospectivecohort of United States adults , 1998, Cancer Causes & Control.

[29]  Cancer Epidemiol Biomarkers Prev , 2004 .

[30]  Office on Smoking.  The Health Consequences of Smoking: A Report of the Surgeon General , 2004 .

[31]  Michael J Thun,et al.  Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. , 2003, The New England journal of medicine.

[32]  K. Lillemoe,et al.  Why Do Black Americans Have a Higher Risk of Pancreatic Cancer than White Americans? , 2003, Epidemiology.

[33]  F. Sarkar,et al.  Clinicopathologic Analysis of Pancreatic Adenocarcinoma in African Americans and Caucasians , 2003, Pancreas.

[34]  G. Colditz,et al.  Gallstones, cholecystectomy, and the risk for developing pancreatic cancer , 2002, British Journal of Cancer.

[35]  W. Foulkes,et al.  Risk of pancreatic cancer among individuals with a family history of cancer of the pancreas , 2002, International journal of cancer.

[36]  D. Sidransky,et al.  Cigarette smoking is strongly associated with mutation of the K‐ras gene in patients with primary adenocarcinoma of the lung , 2001, Cancer.

[37]  G A Colditz,et al.  Physical activity, obesity, height, and the risk of pancreatic cancer. , 2001, JAMA.

[38]  M. Thun,et al.  Estrogen replacement therapy and ovarian cancer mortality in a large prospective study of US women. , 2001, JAMA.

[39]  J. Hauw,et al.  Trends in mortality from sporadic Creutzfeldt-Jakob disease in France 1992–7 , 2000, Journal of neurology, neurosurgery, and psychiatry.

[40]  A. Dyer,et al.  Abnormal glucose metabolism and pancreatic cancer mortality. , 2000, JAMA.

[41]  P. Villeneuve,et al.  Alcohol, tobacco and coffee consumption and the risk of pancreatic cancer: results from the Canadian Enhanced Surveillance System case‐control project , 2000 .

[42]  P. Villeneuve,et al.  Alcohol, tobacco and coffee consumption and the risk of pancreatic cancer: results from the Canadian Enhanced Surveillance System case-control project. Canadian Cancer Registries Epidemiology Research Group. , 2000, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[43]  K. Lillemoe,et al.  Diabetes mellitus, other medical conditions and familial history of cancer as risk factors for pancreatic cancer , 1999, British Journal of Cancer.

[44]  J. Stoker,et al.  The Department of Health and Human Services. , 1999, Home healthcare nurse.

[45]  T. Sellers,et al.  Smoking, alcohol, coffee, and tea intake and incidence of cancer of the exocrine pancreas: the Iowa Women's Health Study. , 1997, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[46]  K. Lillemoe,et al.  Alcohol and pancreatic cancer in blacks and whites in the United States. , 1995, Cancer research.

[47]  E. Calle,et al.  Utility of the National Death Index for ascertainment of mortality among cancer prevention study II participants. , 1993, American journal of epidemiology.

[48]  Alan D. Lopez,et al.  Mortality from tobacco in developed countries: indirect estimation from national vital statistics , 1992, The Lancet.

[49]  Gerhard Jentzsch,et al.  Working group on , 1991 .

[50]  L. Garfinkel,et al.  Smoking habits and tar levels in a new American Cancer Society prospective study of 1.2 million men and women. , 1986, Journal of the National Cancer Institute.

[51]  D P Byar,et al.  Estimating the population attributable risk for multiple risk factors using case-control data. , 1985, American journal of epidemiology.

[52]  L. Garfinkel.  Selection, follow-up, and analysis in the American Cancer Society prospective studies. , 1985, National Cancer Institute monograph.