||1R01CA209798-01A1 Interpret this number
||University Of Southern California
||Investigating the Cause of Racial/Ethnic Disparity in Pancreatic Cancer Incidence
Pancreatic cancer (PC) is one of the deadliest cancers with a 5-year survival rate of 7%. Notable racial/ethnic
differences in PC incidence have been observed, with U.S. blacks having 30% higher rates compared to whites.
The rates of PC in Native Hawaiians and Japanese Americans have been rising in past two decades and have
surpassed those of whites, but no study has been conducted to identify the cause(s) of this rising incidence. In
the large prospective Multiethnic Cohort Study (MEC; N>200,000) we observed highly significant differences in
PC incidence across racial/ethnic populations, with African Americans having 39% higher rates compared to
whites. Native Hawaiians are observed to have the highest rates in the cohort that are 74% higher than whites
while rates in Japanese Americans are 32% higher and rates in Latinos are similar to whites. We expect that
inter-ethnic differences in risk factor prevalence are likely to explain the observed ethnic differences in PC
incidence. However, to date, few studies have included African Americans and no studies have included
Japanese Americans, Native Hawaiians, or Latinos; thus, the factors underlying PC disparities remain undefined.
The goal of this study is to identify factors that explain racial/ethnic disparities in PC incidence, particularly the
excess risks observed in African Americans, Japanese Americans, and Native Hawaiians. We hypothesize that
in addition to known risk factors, host genetic factors and unknown non-genetic factors contribute to the observed
racial/ethnic differences in PC incidence. To test our hypothesis, we will leverage the well-characterized lifestyle
and genetic data of the MEC, a long-standing ethnically diverse prospective cohort of >200,000 African
American, Latino, Native Hawaiian, Japanese and white participants established in the early 1990's in California
and Hawaii. The MEC is uniquely positioned to address racial/ethnic disparities in PC incidence, with >2,100
incident cases of PC diagnosed over >20-years of follow-up and with detailed lifestyle and exposure data
collected in a consistent fashion amongst all populations to permit valid ethnic comparisons. Our specific aims
are: 1) To quantify racial/ethnic-specific associations of known and potential/suspected risk factors with PC
incidence in African Americans, Japanese Americans, Latinos, Native Hawaiians, and whites; 2) To determine
whether the risk factors confirmed or discovered in Aim 1 contribute to the observed ethnic differences in PC
incidence; 3) To characterize the association of known common genetic variants with PC risk in African
Americans, Japanese Americans, Latinos, and Native Hawaiians and build a quantitative risk model to compare
the distribution of genetic risks across populations associated with these marker alleles. By leveraging the
existing resources/infrastructure, this study will efficiently and cost-effectively examine multiple factors that may
contribute to racial/ethnic disparities in PC. Because of the lack of effective treatment and low survivorship,
identifying modifiable risk factors is critical in reducing PC burden; this is even more crucial for minority
populations who are at greater risk and are likely to have limited access to care.
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