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Delineating the underlying reasons for the racial disparity in gastric cancer incidence in the United States

描绘美国胃癌发病率种族差异的根本原因

基本信息

批准号：
10518553
负责人：
MEIRA EPPLEIN
金额：
$ 72.48万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2027-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10518553
关键词：
Affect Antibiotics Antibodies Antibody Response Asian population Atrophic Atrophic Gastritis Bacteria Biological Biological Assay Biological Markers Bismuth Black Populations Body mass index Cancer Etiology Cells Characteristics Chronic stress Clinical Trials Cohort Studies Communities Country Crowding Data Development Diagnosis Diagnostic Diet Disease Far East Funding Future Genes Goals Helicobacter Infections Helicobacter pylori Helicobacter pylori induced gastric cancer Hepatitis B Hepatitis C virus Hispanic Populations Household Human papilloma virus 31 Immune response Incidence Individual Infection Infectious Agent Inflammation Knowledge Laboratory Study Lesion Malignant Neoplasms Mass Screening Mediating Minority Groups Modeling Neighborhoods Nested Case-Control Study Not Hispanic or Latino Patients Pattern Pepsinogen A Pepsinogens Persons Population Heterogeneity Prevalence Prevention Guidelines Prospective cohort Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Proteins Proton Pump Inhibitors Race Risk Risk Factors Role Screening for Gastric Cancer Smoking Smoking Status Societies Specimen Stomach Survival Rate Time United States Virulence Factors Women&apos s Health black men cancer diagnosis cancer risk carcinogenicity cohort cost effective ethnic minority falls gastric cancer prevention high risk improved individualized prevention malignant stomach neoplasm men mortality mortality disparity multi-ethnic novel people of color premalignant racial and ethnic racial difference racial disparity residential segregation risk prediction screening guidelines social health determinants tool

项目摘要

ABSTRACT The burden of gastric cancer falls disproportionately on racial/ethnic minorities in the US, with incidence rates among Blacks, Asians, and Hispanics two- to three-fold higher than that among non-Hispanic whites. Further, individuals who self- identify as belonging to any of these three groups are also more likely to die from gastric cancer, and comparing Black men to White men, specifically, this mortality disparity is greater than that for all other cancers. In the US, gastric cancer has a particularly low survival rate (32% at 5-years) as it is generally asymptomatic until late-stage, when treatment is no longer effective. Each year in the US, 26,000 people are diagnosed with gastric cancer, and over 10,000 people die of the disease. Moreover, the racial disparity in gastric cancer continues to grow over time. And yet, the underlying reasons for this racial disparity in gastric cancer incidence in the US are substantially understudied. The predominant cause of gastric cancer is infection with the common bacterium, Helicobacter pylori (H. pylori). H. pylori is more prevalent among people of color than non-Hispanic whites, and, in fact, H. pylori is the world’s single leading carcinogenic infectious agent, responsible for an estimated 36.9% of the over 2.2 million infection-associated cancers diagnosed in 2018, more even than those attributed to human papillomavirus (31.5%), or the Hepatitis B and C viruses combined (23.5%). Currently, however, little is known about whether the disparity in gastric cancer is a result of differences in H. pylori prevalence, host response to H. pylori, or differences in other risk factors that might affect the development of gastric cancer. These potential other risk factors include key individual and neighborhood characteristics that differ greatly by race, such as household crowding and residential segregation, which could increase the risk of H. pylori infection, contribute to chronic stress, and induce a more severe immune response. Our goal is to fill the gap in knowledge of risk factors for H. pylori- associated gastric cancer to provide the understanding of the underlying factors that indicate who is at high risk of gastric cancer in the US. To do this, we will build a nested case-control study of approximately 800 non-cardia gastric cancer cases and 2:1 matched controls, utilizing prospective cohort data from a diverse population in the US (67% non-white) from 4 NCI-funded cohorts with pre-diagnostic specimens available: Multiethnic Cohort Study (MEC); Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO); Southern Community Cohort Study (SCCS); and Women’s Health Initiative (WHI). We will assay these biospecimens for antibody levels to H. pylori-specific proteins and for pepsinogen (a validated marker of gastric atrophy), thoroughly assess individual and neighborhood factors that are associated with gastric cancer risk, and determine what drives the differences in race by H. pylori antibody levels and atrophy and resulting gastric cancer risk. Finally, we will develop an integrated “cells to society” modeling framework to assess the impact of social determinants of health on the patterns of H. pylori antibody levels, gastric atrophy and resulting disparities in gastric cancer. Ultimately, these findings will provide the information needed to allow for targeting of high-risk patients for the clinical trials necessary to create screening guidelines for the prevention and early detection of gastric cancer in the US, and will help clinicians with precision prevention by laying the groundwork for the building of a risk prediction tool.

摘要