A population-based analysis of race and gender differences in pancreas cancer survival

A15

Pancreatic cancer is the fourth leading cause of cancer related mortality in the United States. From 2000-2004, the incidence rate of pancreas cancer among African Americans (15.0 per 100,000) exceeded the rate seen in White Non-Hispanics (11.4 per 100,000). Relative 5-year survival rates vary by both race and gender, with recent data suggesting African American women now have the best survival (5.8%), and African American men have the worst survival (3.2%) for those diagnosed from 1996-2003, according to data from the Surveillance, Epidemiology and End Results (SEER) database. Recent studies have failed to examine the effects of race and gender concurrently on pancreas cancer survival.
 African American and White Non-Hispanic individuals diagnosed with primary adenocarcinoma of the pancreas from 1973-2004 were identified through 17 registries making up the SEER database. These data were stratified by race, gender, stage and age at diagnosis. Differences in categorical variables were identified through chi-squared tests and differences in continuous variables were identified through t-tests. Preliminary findings from univariate analyses are described below. We will present Cox proportional hazards models to determine if demographic, tumor and treatment variables that predict survival vary by race and gender.
 Our study population included 48,738 White Non-Hispanic (88.2%) and 6,542 African American (11.8%) individuals with adenocarcinoma of the pancreas. The mean age at diagnosis for African American (AA) men was 63.7 (SD=11.0), which was significantly younger than White Non-Hispanic (WNH) men (mean age=66.8 SD=11.2). AA women were also significantly younger at diagnosis with a mean age of 67.0 (SD=10.9) compared to WNH women (mean age=69.8, SD=10.9). Overall, more AA men (66.8%) and women (61.6.0%) were diagnosed at distant stages of disease, compared to their WNH counterparts (64.0% and 60.3%, respectively), these differences were statistically significant (both p=0.01). White Non-Hispanic men and women were significantly more likely to be diagnosed at autopsy or by death certificate only, compared to AAs (both p<0.0001). Excluding individuals identified by autopsy or death certificate, WNH men and women were more likely to undergo cancer directed surgery than AA men and women (p=0.04 and p=0.0006, respectively). Surgery was contraindicated due to other co-morbid conditions more often in AA men compared to WNH men, however, no differences were identified in women. Similarly, AA men were less likely to receive radiation than WNH men (p=0.0009), a difference that was not seen in women (p=0.37). African American men had significantly lower mean months of survival than WNH men (6.2 and 7.1, respectively), whereas mean survival for women was equal (7.3 months for both races).
 Pancreatic cancer is a rapidly fatal disease with its mortality nearly identical to its incidence. It is noted for many cancers that survival is worse for African Americans, but closer analysis of pancreas cancer cases reveal that this disparity is driven by AA men, not women. Advancements in screening and early diagnosis are needed before a significant reduction in mortality from pancreas cancer will be realized.