Race a factor in pancreatic cancer surgery

It's known that African Americans have an elevated risk of pancreatic cancer, but new study findings show they may also be less likely to receive surgery for the disease.

Researchers found that among more than 2,700 Californians diagnosed with pancreatic cancer between 1988 and 1998, black patients were at slightly higher risk of being diagnosed with advanced cancer. They were also less likely than white, Hispanic or Asian patients to receive surgery, even when the cancer was in an earlier stage.

Dr. Kenneth J. Chang and his colleagues at the University of California, Irvine, report the findings in the journal Cancer.

Overall, African Americans had the highest incidence of pancreatic cancer of any racial group, a finding in line with past research, they note. It's thought that this racial disparity may be related to higher rates of certain pancreatic cancer risk factors among African Americans - including smoking, diabetes and obesity.

Pancreatic cancer is among the most deadly of cancers because it typically progresses quickly and is usually caught only at a later stage, often after the cancer has spread to other organs.

Although the risk of being diagnosed at an advanced stage is high in general, black patients in the current study were at somewhat greater risk than other racial groups. Moreover, they were the least likely to have surgery, even when the cancer was caught at an earlier stage, according to Chang's team.

Among patients with early-stage pancreatic cancer, 80 percent of black patients did not receive surgery, compared with 77 percent of Asian patients, 68 percent of whites and about 62 percent of Hispanics.

There are a few potential explanations for the discrepancy, according to Chang and his colleagues. One factor could be tumor location; tumors in a part of the pancreas known as the "head" are considered more amenable to surgical removal. In this study, both black patients and Asian patients - those with the second-lowest rate of surgery - had fewer tumors in the head of the pancreas.

Another factor could be the aggressiveness of the cancer, according to the researchers. A previous study found that African Americans had far higher rates of a particular genetic mutation that may make some pancreatic tumors especially aggressive.

One factor that did not seem to play a role was health insurance. Rates of medical coverage, Chang's team found, were comparable among the different racial groups.

More studies are needed, the researchers conclude, to "delineate the barriers" black patients may face in receiving surgery for pancreatic cancer.

SOURCE: Cancer, January 15, 2005.