Making Sense of Racial Disparities in Gastrointestinal Cancer Mortality
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EDITORIAL
Making Sense of Racial Disparities in Gastrointestinal Cancer Mortality Adeyinka O. Laiyemo
Received: 18 September 2012 / Accepted: 19 September 2012 / Published online: 20 October 2012 Ó Springer Science+Business Media New York 2012
Studies have demonstrated that colorectal cancer incidence and mortality are higher among blacks in the United States as compared to other race-ethnicities [1–3]. However, there is limited information regarding racial differences in the burden of other gastrointestinal cancers. Evaluating the burden of gastrointestinal cancers among different race-ethnicities may enhance our understanding of the etiology of the disease processes and guide strategies to adopt in order to reduce the burden of these diseases among minority populations. In this issue of the journal, Jinjuvadia et al. [4] used the third National Health and Nutrition Examination Survey (NHANES III) and related mortality data files to evaluate racial differences in mortality from gastrointestinal cancers. The authors reported a two-fold increased risk of death from gastrointestinal cancers among non-Hispanic blacks (blacks) when compared to non-Hispanic whites (whites). In particular, there were statistically significant increased mortalities from esophageal, pancreatic, and colorectal cancers among blacks. In exploratory analysis in which the authors evaluated racial differences by sex, they reported an increased mortality risk from gastric cancer, primary liver cancer, and colorectal cancer among black men as compared to white men. Overall, black women had a non-statistically significant increased mortality risk, but were significantly more likely to die from esophageal and pancreatic cancers when compared to white women. Interestingly, there was no cancer mortality that was higher among whites in any of the analysis presented in this study. However, this current analysis in a nationally representative data is limited by the
A. O. Laiyemo (&) Division of Gastroenterology, Department of Medicine, Howard University College of Medicine, 2041 Georgia Avenue NW, Washington, DC 20060, USA e-mail: [email protected]
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low absolute numbers of cancers diagnosed in the follow-up period, and lack of information on patients’ comorbidities, stage of cancer diagnosis, and cancer treatments received. Nonetheless, it provided insight into disproportionately increased burden of gastrointestinal cancers among blacks. Making sense of the suggested disparities in this study requires a detailed analysis of the potential explanations for the findings. There are three major issues that may be involved in the different risks of death from these cancers: a)
Higher prevalence of predisposing risk factors: A higher prevalence of putative risk factors that have been shown to increase the risk of particular cancers will be associated with a disproportionately higher risk of developing the disease. For instance, infections with viral hepatitis B and hepatitis C have been associated with increased risk of hepatocellular carcinom
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