Our study confirmed the higher incidence of pancreatic adenocarcinoma noted among African Americans living in California.1 The focus of our study was not on risk factors, and it would be beyond the scope of the article to judge which factors were established or speculative.
Our analysis, based on the California Cancer Registry dataset, found that African Americans, non-Hispanic whites, and Hispanics had similar proportions of subjects who reported having medical insurance.1 Although we are aware of the global economic disparities between the demographic groups, our dataset did not demonstrate this disparity and was reported as such.
In our analysis, we found that African Americans age younger than 65 years had the highest proportion of tumors occurring in the body or tail of the pancreas (41.5% vs. 32.6% in non-Hispanic whites).1 We mentioned that this may be one possible contributory explanation to our finding that African Americans were least likely to undergo surgery. Although the tail of the pancreas is technically easier to resect, it is well established that tumors involving the tail of the pancreas are less likely to be resectable and to have a worse prognosis than right-sided lesions (the uncinate, head, or neck of the pancreas). A more recent article by the quoted3 Hopkins group reported that among 616 patients who underwent potentially curative resections, 563 cases involved right-sided lesions whereas only 49 of the resectable lesions were found in the body or tail of the pancreas.4 Furthermore, patients with right-sided lesions demonstrated improved 1-year and median survival rates compared with those patients whose tumors occurred in the body or tail of the pancreas. They also stated that tumors occurring in the left side of the pancreas were more often unresectable at the time of presentation and therefore were not included in their analysis. Our finding that African-Americans had a slightly higher proportion of tumors occurring in the body and tail of the pancreas compared with the other racial/ethnic groups has not to our knowledge been reported previously. However, this data point should not influence how a surgeon would approach any individual patient.
Despite its dismal prognosis, the research and funding for pancreatic carcinoma is relatively small compared with that for other malignancies such as those of the breast and colon. Moreover, awareness and investigation of racial/ethnic disparities in pancreatic carcinoma patients is barely on the proverbial radar screen. Therefore, we agree with Dr. Hayanga that the focus should be on the facts (i.e., pancreatic adenocarcinoma indeed occurs more commonly in African Americans) and concur with the plea for much-needed investigation and intervention.