Racial disparities in treatment for pancreatic cancer and impact on survival: a population-based analysis

  • Vinamrata Singal
  • Ashwani K. SingalEmail author
  • Yong-Fang Kuo
Original Paper



Pancreatic adenocarcinoma is the fourth leading cause of cancer-related deaths in both men and women. Mortality from pancreatic cancer is higher amongst blacks compared to other races. We performed this analysis with the aim of examining racial disparity for receipt pancreatic cancer treatment and its association with survival.


Using the surveillance, epidemiology, and end results (SEER) database from 1988 to 2008, cases with locoregional pancreatic cancer were analysed. Kaplan–Meier survival curves were assessed to assess the survival amongst various races. Cox proportional hazard model was built to assess the impact of receipt of treatment on the racial disparity in survival.


Of 16,282 cases with locoregional pancreatic cancer, 1,806 (11%) occurred in blacks. Median survival was 8–9 months with poorest survival in blacks. Blacks and Hispanics received radiation treatment less often compared to other races. On Cox regression logistic regression analysis, blacks had 20% poorer survival compared to whites. Treatment for pancreatic cancer explained only one-fourth of this poorer survival.


Blacks have worst survival from locoregional pancreatic cancer. Receiving treatment for pancreatic cancer only explains 25% of the poorer survival amongst blacks, suggesting role of other factors. Studies are suggested to (a) identify barriers in receipt of treatment for pancreatic cancer amongst blacks and (b) to assess role of genetic and other factors to examine racial differences in survival.


Pancreatic cancer SEER Racial disparities Survival 


Conflict of interest

We declare that we have no conflict of interests.


  1. Arnold LD, Patel AV, Yan Y, Jacobs EJ, Thun MJ, Calle EE et al (2009) Are racial disparities in pancreatic cancer explained by smoking and overweight/obesity? Cancer Epidemiol Biomarkers Prev 18(9):2397–2405PubMedCrossRefGoogle Scholar
  2. Caetano R, Baruah J, Ramisetty-Mikler S, Ebama MS (2010) Sociodemographic predictors of pattern and volume of alcohol consumption across hispanics, blacks, and whites: 10-year trend (1992–2002). Alcohol Clin Exp Res 34(10):1782–1792PubMedCrossRefGoogle Scholar
  3. Doubeni CA, Field TS, Buist DS, Korner EJ, Bigelow C, Lamerato L et al (2007) Racial differences in tumor stage and survival for colorectal cancer in an insured population. Cancer 109(3):612–620PubMedCrossRefGoogle Scholar
  4. Fesinmeyer MD, Austin MA, Li CI, De Roos AJ, Bowen DJ (2005) Differences in survival by histologic type of pancreatic cancer. Cancer Epidemiol Biomarkers Prev 14(7):1766–1773PubMedCrossRefGoogle Scholar
  5. Genkinger JM, Speigelman D, Anderson KE, Bergkivst L, Brandt PA, English DR, Freudenheim JL, Fuchs CS, Giles GG, Giovannucci E, Hankinson SE, Horn-Ross PL, Leitzmann M, Mannisto S, Marshall JR, McCullough ML, Miller AB, Reding DJ, Robien K, Rohan TE, Schatzkin A, Stevens VL, Stolzenberg-Solomon R, Vergage BAJ, Wolk A, Ziegler R, Smith-Warner SA (2009) Alcohol intake and pancreatic cancer risk: a pooled analysis of fourteen cohort studies. Cancer Epidemiol Biomarkers Prev 18(3):765–776PubMedCrossRefGoogle Scholar
  6. Hidalgo M (2010) Pancreatic cancer. N Engl J Med 362(17):1605–1617PubMedCrossRefGoogle Scholar
  7. Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics. CA Cancer J Clin 60(5):277–300PubMedCrossRefGoogle Scholar
  8. Jiao L, Silverman DT, Schairer C, Thiebaut AC, Hollenbeck AR, Leitzmann MF, Schatzkin A, Stolzenberg-Solomon RZ (2009) Alcohol use and risk of pancreatic cancer: the NIH-AARP diet and health study. Am J Epidemiol 169(9):1043–1051PubMedCrossRefGoogle Scholar
  9. Li D, Xie K, Wolff R, Abbruzzese JL (2004) Pancreatic cancer. Lancet 363(9414):1049–1057PubMedCrossRefGoogle Scholar
  10. Lim JE, Chien MW, Earle CC (2003) Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg 237(1):74–85PubMedCrossRefGoogle Scholar
  11. Lowenfels AB, Maisonneuve P (1999) Pancreatico-biliary malignancy: prevalence and risk factors. Ann Oncol 10(Suppl 4):1–3PubMedCrossRefGoogle Scholar
  12. Lucas FL, Stukel TA, Morris AM, Siewers AE, Birkmeyer JD (2006) Race and surgical mortality in the United States. Ann Surg 243(2):281–286PubMedCrossRefGoogle Scholar
  13. Murphy MM, Simons JP, Hill JS, McDade TP, Chau Ng S, Whalen GF et al (2009) Pancreatic resection: a key component to reducing racial disparities in pancreatic adenocarcinoma. Cancer 115(17):3979–3990PubMedCrossRefGoogle Scholar
  14. Reddy NK, Bhutani MS (2009) Racial disparities in pancreatic cancer and radon exposure: a correlation study. Pancreas 38(4):391–395PubMedCrossRefGoogle Scholar
  15. Riall TS, Townsend CM Jr, Kuo YF, Freeman JL, Goodwin JS (2010) Dissecting racial disparities in the treatment of patients with loco regional pancreatic cancer: a 2-step process. Cancer 116(4):930–939PubMedCrossRefGoogle Scholar
  16. Ries LAG, M. D., Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, Maritto A, Miller BA, Feuer EJ, Altekruse SF, Lewis DR, Clegg L, Eisner MP, Richman M, Edwards SK (2008) SEER Cancer statistics review, 1975–2005. From
  17. Schwartz KL, Crossley-May H, Vigneau FD, Brown K, Banerjee M (2003) Race socioeconomic status and stage at diagnosis for five common malignancies. Cancer Causes Control 14(8):761–766PubMedCrossRefGoogle Scholar
  18. Shavers VL, Harlan LC, Jackson M, Robinson J (2009) Racial/ethnic patterns of care for pancreatic cancer. J Palliat Med 12(7):623–630PubMedCrossRefGoogle Scholar
  19. Silverman DT, Brown LM, Hoover RN, Schiffman M, Lillemoe KD, Schoenverg JB, Swanson GM, Hayes RB, Greenberg RS, Benichou J, Schwartz AG, Liff JM, Pottern LM (1995) Alcohol and pancreatic cancer in blacks and whites in the United States. Cancer Res 55:4899–4905PubMedGoogle Scholar
  20. Silverman DT, Hoover RN, Brown LM, Swanson GM, Schiffman M, Greenberg RS et al (2003) Why do Black Americans have a higher risk of pancreatic cancer than White Americans? Epidemiology 14(1):45–54PubMedCrossRefGoogle Scholar
  21. Tseng JF, Tamm EP, Lee JE, Pisters PW, Evans DB (2006) Venous resection in pancreatic cancer surgery. Best Pract Res Clin Gastroenterol 20(2):349–364PubMedCrossRefGoogle Scholar
  22. Zell JA, Rhee JM, Ziogas A, Lipkin SM, Anton-Culver H (2007) Race socioeconomic status treatment and survival time among pancreatic cancer cases in California. Cancer Epidemiol Biomarkers Prev 16(3):546–552PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Vinamrata Singal
    • 1
  • Ashwani K. Singal
    • 2
    Email author
  • Yong-Fang Kuo
    • 3
  1. 1.Departments of Neuroscience and Cell BiologyUniversity of Texas Medical BranchGalvestonUSA
  2. 2.Department of Gastroenterology-HepatologyMayo ClinicRochesterUSA
  3. 3.Department of Internal Medicine BiostatisticsUniversity of Texas Medical BranchGalvestonUSA

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