Vick Alexis D, Hery Danielle N, Markowiak Stephen F, Brunicardi F Charles
From the College of Medicine and Life Sciences, and.
Department of Surgery, College of Medicine and Life Sciences, University of Toledo, ProMedica Health System, Toledo, OH.
Pancreas. 2019 Feb;48(2):242-249. doi: 10.1097/MPA.0000000000001238.
African Americans (AAs) have disproportionately higher incidence and lower survival rates from pancreatic cancer compared with whites. Historically, this disparity has been attributed to modifiable risk factors. Recent studies suggest that nonmodifiable aspects may also play an important role. We review these new contributions as potential targets for closing the disparity.
A PubMed search was conducted to review studies of nonmodifiable elements contributing to pancreatic cancer disparities in AAs.
Several nonmodifiable risks are associated with the racial disparity in pancreatic cancer. SSTR5 P335L, Kaiso, and KDM4/JMJD2A demonstrate differential racial expression, increasing their potential as therapeutic targets. Many social determinants of health and their associations with diabetes, obesity, and the microbiome are partially modifiable risk factors that significantly contribute to outcomes in minorities. Barriers to progress include the low minority inclusion in research studies.
Genomics, epigenetics, the microbiome, and social determinants of health are components that contribute to the pancreatic cancer disparity in AAs. These factors can be researched, targeted, and modified to improve mortality rates. Closing the disparity in pancreatic cancer will require an integrated approach of personalized medicine, increased minority recruitment to studies, and advanced health care/education access.
与白人相比，非裔美国人（AA）患胰腺癌的发病率高得不成比例，生存率却更低。从历史上看，这种差异一直归因于可改变的风险因素。最近的研究表明，不可改变的因素可能也起着重要作用。我们将这些新发现作为缩小差距的潜在目标进行综述。
进行了一项PubMed搜索，以综述有关导致AA胰腺癌差异的不可改变因素的研究。
几种不可改变的风险与胰腺癌的种族差异有关。SSTR5 P335L、Kaiso和KDM4/JMJD2A表现出不同的种族表达，增加了它们作为治疗靶点的潜力。许多健康的社会决定因素及其与糖尿病、肥胖症和微生物群的关联是部分可改变的风险因素，对少数群体的预后有重大影响。进展的障碍包括少数群体参与研究的比例较低。
基因组学、表观遗传学、微生物群和健康的社会决定因素是导致AA胰腺癌差异的因素。可以对这些因素进行研究、靶向和修改，以提高死亡率。缩小胰腺癌的差距需要个性化医疗、增加少数群体参与研究以及扩大获得先进医疗保健/教育的机会等综合方法。
