The first initiative targeted to increase the training of African-American scientists in pancreatic cancer research: the Mayo Clinic College of Medicine-Oakwood College alliance.

To the Editor: Pancreatic cancer ranks as the fourth leading cause of death by cancer in the United States. Approximately 30,000 people are diagnosed with pancreatic cancer, and 30,000 people die from this disease each year. Moreover, 19% of patients with cancer of the exocrine pancreas survive 1 year after diagnosis, and only 4% survive 5 years after diagnosis. Pancreatic cancer has been called a ‘‘silent’’ disease because it usually does not cause symptoms in early stages. In many cases, the cancer has already spread outside the pancreas by the time it is diagnosed. Pancreatic cancer offers a clear example of a tumor that, despite the advances in science and medicine, remains an almost insurmountable challenge for early diagnosis and curative treatment. In the last 3 years, an exemplary interaction among advocacy groups (Pancreatic Cancer Action Network), private foundations (Lustgarten Foundation for Pancreatic Cancer Research), federal agencies (National Cancer Institute), and scientists has been created with the goal of expediting research in pancreatic cancer at a revolutionary pace. Together, the work of these groups resulted in an National Cancer Institute–sponsored study and report that may serve as a guideline for future studies of pancreatic cancer. The following excerpt from the abstract of Pancreatic Cancer Progress Review Group (http://prg.cancr.gov/pancreatic/ finalreport.html) outlines the state of the problem and mirrors the vision and accuracy expressed in this report: ‘‘Pancreatic cancer is disproportionately underrepresented in both clinical and basic research compared with other cancer sites. Several factors may be contributing to this marginal research base in pancreatic cancer. Scientific investigators with interest and expertise in this area comprise a very small cadre. Pancreatic cancer care is complicated, requiring a multidisciplinary approach, and despite our best efforts, outcomes are nearly always disappointing. To build a robust laboratory, clinical, and population science research program for this disease demands unusual effort that currently is made more difficult by a lack of key resources, such as appropriate preservation of pancreatic tissue and key reagents for translational studies. No specialized scientific infrastructure exists to support training or funding for pancreatic cancer research. Yet novel approaches and unique commitments will be necessary to make progress against pancreatic cancer. Advances in other diseases suggest that increased investment in pancreatic cancer research can be expected to yield dramatic progression. ’’ Statistics have shown that African Americans suffering from cancer are 2 times more likely to die than patients from other minority groups. The incidence of pancreatic cancer in the African-American population exceeds those in the white population by about 50% to 90%. Studies show that established risk factors such as cigarette smoking, diabetes mellitus, family history, and alcohol consumption account for the increase in death incidence from pancreatic cancer in African Americans. Moreover, Pernick et al reported that African Americans have significantly higher K-ras mutations to valine and fewer to cysteine and arginine compared with whites, suggesting that genetic differences may be responsible for the increased incidence of pancreatic cancer in this population. Also, the K-ras mutations have been associated with extended exposure to pesticides (dichlorodiphenyl trichloroethane, dichlorodiphenyl dichloroethylene), giving support to the idea that K-ras mutations in pancreatic cancer may be related to lifestyle and environmental factors of African Americans. The National Center on Minority Health and Health Disparities conducted several studies aimed at increasing knowledge of, reducing, and/or eliminating health disparities in minority populations. One of these studies took place ~8 mi from Oakwood College in Triana, Alabama. It was found that the residents of this town were exposed to the pesticide DDT, and as a result, had a substantial increase in the incidence of breast cancer. Similarly, Shavers and Brown from the National Cancer Institute reported that there is evidence of racial disparities in the receipt of cancer treatment. The treatment difference may result in more frequent recurrence, shorter disease-free survival, and higher mortality. Studies have also shown that African Americans of lower socio-economic status are less likely to seek medical care and participate in health programs because of lack of educational information and mistrust in the health system. This evidence of biologic or genetic characteristics unique to African Americans and the disparities occurring from environmental risks and cultural factors warrant further study of pancreatic cancer in this community. Thus, it is critically important to train AfricanAmerican scientists, to educate their communities, and to combat the ravaging effects of this disease through pancreatic cancer research targeted to the AfricanAmerican community. Endeavors to overcome these barriers (clinical and nonclinical) are urgently needed to reach this underserved population and eliminate the disparity. The Intercultural Cancer Council, a nonprofit organization, promotes several programs to ‘‘eliminate the unequal burden of cancer among racial and ethnic minorities and medically underserved populations in the United States and its territories. ’’ The Intercultural Cancer Council invites minority students to their Biennial Symposium to receive and discuss information regarding the health disparities issues. However, to our knowledge, no formal training efforts have been targeted to the African-American community. It is therefore imperative to develop a center to train and educate African-American students about pancreatic cancer and its ravage among underserved populations. High priority