S119 Disparities in Race, Ethnicity, Sex, and Age Inclusion in Pancreatic Cancer Screening Studies: A Systematic Review and Meta-Analysis

Introduction: Inclusion of underrepresented groups in cancer research is a priority. Better characterization of pancreatic cancer screening study participants is needed before results can be generalized. We sought to assess sex, racial, and ethnic make-up of high-risk individuals (HRIs) included in pancreatic cancer surveillance studies. Methods: A systematic search of Cochrane Library, Ovid Embase, Google Scholar, Ovid Medline, PubMed, Scopus, and Web of Science Core Collection from inception to 2022 was conducted. Original studies on pancreatic cancer screening were identified and assessed for reporting and inclusion on race, ethnicity, sex, and age. The pooled proportions of study participants for these characteristics were calculated and compared with population-based benchmarks (Table 1). Results: A total of 26 of 27 studies were included in the meta-analysis. Information on participant sex was reported by (26), race (12), and ethnicity (8) of studies. Of the included studies, 14 were from US, 2 from Canada, 5 from Europe (1 Italy, 2 Netherlands, 1 Denmark, 1 Sweden), 3 from Asia (Japan, Taiwan, Israel), 1 from Argentina and 1 from Australia. Race was reported by 9 of 14 US studies. Almost all study participants were White with a pooled prevalence of 90.0% (95% CI: 84.1%-95.8%). Ethnicity was reported by only 6 of 14 US studies. The pooled prevalence of non-Latino was 96.7% (95% CI: 92.7%-100%). Proportion of study participants by race and ethnicity (vs. proportion of race in the US general population) was as follows: White 92.1% (58%), Black 3.3% (12.1%), American Indian/Alaska Native 0% (0.7%), Asian 1.1% (5.9%) and Latino 3.2% (18.7%) which shows non-White racial groups substantially underrepresented (Figure 1). There was no trend in improved race and ethnicity reporting with year of study publication (P=0.6). Of the 4952 HRIs in the 26 studies, pooled prevalence of females was 63.2% (95% CI: 59.9%-66.6%). Female representation in the US was significantly higher compared to studies from other countries (65.9% vs 58.5%, P=.00). All studies had majority of female participants except Denmark (49.2%), Argentina (48.7%) and Israel (43%) studies. There was no improvement in participant sex reporting with ascending study publication year (P=0.5). When reported, mean or median participant age was < 60 years. Conclusion: Substantial disparities in race, ethnicity, sex, and age reporting and inclusion in pancreatic cancer studies were noted, underscoring the need for efforts to improve diversity in future studies.Figure 1.: A) Forest plot showing proportion of White study participants in all studies compared with studies from the United States (US) only. B) Forest plot showing proportion on non-Hispanic participants in all studies compared with studies from the United States (US) only. C) Proportion of study participants by race and ethnicity compared with their proportions in the general United States population. Table 1. - Description of Study Design, High Risk Individual Baseline Features Including Sex, Race, and Ethnicity Study Continent of origin Study design Study setting Surveillance modality Population (n) HRI description Female, n (%) Age, mean (SD) Follow up (mo) Race, n (%) Ethnicity, n (%) Funding Brentnall 1999 USA North America Prospective cohort Single center EUS and ERCP +Cross-sectional 14 NR 9 (64) NR 15 NR NR NR Shin 2011 USA North America Prospective cohort Single center Cross-sectional 41 FPC-41 27 (65.8) 50.1 (-) - NR NR NR Ludwig 2011 USA North America Prospective cohort Single center EUS+Cross-sectional 109 FPC-102BRCA2-7 78 (73) 58 (11) 30 White-100Unknown-9 NR None Al-Sukhni 2012Canada North America Prospective cohort Single center EUS+Cross-sectional 262 FPC-159BRCA1-5BRCA2-68PJS-7P16-11HP-2 173 (66) 54 (-) 50.4 NR NR Pancreas Cancer Canada; NIH-PACGENE (Grant # 5R01CA097975-08); Princess Margaret HospitalFoundation Invest-in-Research Fund Sud 2014USA North America Retrospective cohort Single center EUS 30° PJS-2; BRCA-7; p16-1; LS-1 28 (93.3) 51.28 (-) - NR NR NR Del Chiaro 2015Sweden Europe Prospective cohort Single center Cross-sectional 40 FPC-38 p16-4, BRCA2-3, BRCA1-1,HBOC-4 24 (60) 49.9 (-) 12.9 NR NR NR Vasen 2016Netherlands, Germany & Spain Europe Prospective cohort Multi center EUS+Cross-sectional 411 p16-178HBOC-19FPC-214 232 (56.4) 52.3 (-) p16=4.3HBOC=2.8FPC=2.725 NR NR ZonMW, DeutscheKrebshilfe (Grant No. 111092), theInstitute of Health Carlos III (Grants No.PI09/02221 and PI12/01635), the RedTematica de Investigación Cooperativa en ´Cancer (Grants No. RD12/0036/0034 and ´RD12/0036/0073), and the EuropeanCooperation in Science and Technology action (Grant No. BM1204). Lachter 2018Israel Asia Retrospective-prospective cohort Single center EUS+Cross-sectional 123 FPC-113BRCA2-9BRCA1-3PALB2-2MSH6-3 53 (45) 57 (-) 24 NR NR NR Barnes 2018USA North America Prospective cohort Single center Cross-sectional 75° FPC-33,BRCA2-18,BRCA1-6, CDKN2A-4,PALB2-3,ATM-8STK11-1,Lynch-2FAMMM:4 46 (61.3) 56 (14)* 60 NR NR American Cancer Association Pilot Grant, WeCare Foundation, Ronald Burkland Eich Pancreatic Research Fund, AdvancingHealthier Wisconsin. DaVee 2018USA North America Retrospective cohort Single center EUS+Cross-sectional 86 FPC-37,BRCA2-50,BRCA1-14, p53-12,ATM-1,STK11-5,LS-3, APC-1 68 (79.1) 49.8 (-) 29.8 White-67 (77.9)Black.4 (4.6)Asian-5(5.8) Hispanic -10 (11.6) NR #2A2A2A 2A2A2A;Paiella 2019Italy #2A2A2A;Europe Prospective cohort Multicenter EUS+Cross-sectional 187 FPC-165; BRCA1-5; BRCA2-5; FAMMM-3; PJS-5; PRSS1-4 100 (53.4) 51 (12) 7.44 NR NR None Sheel 2019UK Europe Prospective cohort Multicenter EUS+ Cross-sectional 321 DNA - 53 (-) 24 NR NR Bar-Mashiah 2020USA North America Retrospective cohort Single center EUS+Cross-sectional 74 BRCA1-8; BRCA2-13; ATM-1; LS-2; FPC-50 45 (60.8) NR 31.2 White-62 (83.7)Black.6 (8.1)Asian-1(1.35)Unknown- 4 (5.4) Hispanic-4(5.4) Digestive Diseases Research Fund Overbeek 2021Netherlands Europe Prospective cohort Multicenter EUS + Cross-sectional 366 FPC-201, CDKN2A-96, BRCA2-45, BRCA1-7, STK11-9, TP53-5, PABL2-2, ATM-1 209 (57) 54 (9.9) 63 NR NR ZonMW (120520016) and a charity donation from ’Kom in beweging tegen alvleesklierkanker Siegel 2022USA North America Prospective cohort Single center EUS+Cross-sectional 173 FPC-28, BRCA2b-46,CDKN2A-21,BRCA1c-16,ATM-11MSH6-9,PALB2-7,MSH2-4,MLH1-2,PMS2-1,PJS-1,TP53-1 111 (64.2) 56.3 (11.5) 39.6 White-170 (98.2)Black.0Asian-2(1.15)Unknown- 1 (.57) Hispanic-2 (1.15) None Ashida 2022Japan Asia Prospective cohort Single center EUS+Cross-sectional 43 FPC 25 (58.1) 54 (-)* - NR NR NR Wang 2022Canda North America Prospective cohort Single center EUS+Cross-sectional 75 FPC-32, BRCA2-18, BRCA1-8, STK11-5, PALB2-4, ATM-4, CDKN2A-1, PRSS1-1, MLH1-1, TP53-1 45 (60) - 32 NR Kandiah 2022USA North America Prospective cohort Single center EUS+Cross-sectional 75 FPC-44, BRCA1 11, BRCA2 7, ATM 5, PALB2 1, Lynch 1, APC 2, MUTYH 1 44 (58.7) 59.5 (39.8) - White-72 (96) Hispanic-3 (4) Tribute to Pamela/The Naughton Family Fund, the Rallye for Pancreatic Cancer, and the Cornelia T. Bailey Foundation Zubarik 2011USA North America Prospective cohort Multicenter EUS 26 FPC-26 NR NR - NR NR Vermont CancerCenter/Lake Champlain Cancer Research Organization Lucas 2014USA North America Prospective cohort Single center EUS+Cross-sectional 20 HBOC-20 BRCA1-6, BRCA2- 14. 18 (90) 53(-) - White-19 (95)Unknown-1 (5) Hispanic-0 American College of Gastroenterology ClinicalResearch Award Hirshberg Foundation . Joergensen 2016Denmark Europe Prospective cohort Single center EUS 71 FPC-40PRSS1-31 35 (60.3) 51.1 (14)IQR 60 NR NR NR Dbouk 2022USA North America Prospective cohort Multicenter EUS+Cross-sectional 1731 FPC-981PJS-26BRCA1-76BRCA2- 285PALB2-64ATM-96CDKN2A-73Lynch-58 1095 (63.3) 59.2 (10) 31.2 White-1638 (94.6)Black.56 (3.2)Asian-21(1.2)Multiracial-16 (0.9) Hispanic-41(2.9) NIH Grant Nos. Pancreatic Cancer Action Network , the VFoundation , Susan Wojcicki and Dennis Troper , theLustgarten Foundation , Smith Family Research Fund, the Bowen-Chapman Fund, and by a Stand Up To Cancer-Lustgarten Foundation Pancreatic Cancer Interception TranslationalCancer Research Grant. McNamara 2019USA North America Retrospective cohort Single center EUS 329 FPC-71BRCA1-62BRCA2- 109ATM-7CDKN2A-5APC-2 243 (73.8) 65.5 (-) 12 White-277 (84.19)Black.18(5.4)Unknown-12 (3.6) Hispanic-22 (6.6) Supported in part by: The State of Florida and the Florida Academic Cancer Center Alliance (FACCA) and the Total Cancer Care Protocol at the H. Lee Moffitt Cancer Center & Research Institute, an NCI designated Comprehensive Cancer Center (P30-CA076292). Thiruvengadam 2019USA North America Retrospective cohort Single center EUS 65 FPC-25PJS-2CDKN2A-1BRCA1/2PALB2-29Lynch-5ATM-3 47 (72.3) 57.1 (12.1) - White-45 (69) NR NR Murali 2021Australia Oceania Retrospective cohort Single center EUS+Cross-sectional 285 FPC-203PJS-3CDKN2A-9BRCA2- 55PALB2-12Lynch-1PRSS1-2 178 (62.5) 55.5(27-79) NR White268 (94)Asian 2 (.7)Unknown 13 (4.5) Hispanic 2 (.7) AFPaCC was enabled by a Cancer Institute NSW Translational Health Services Research Grant. The APGI is supported by The Avner Pancreatic Cancer Foundation. The Clinical Research Coordinator positions in both Sydney and Melbourne are currently supported by PanCare. Chang 2017Taiwan Asia Prospective cohort Single center Cross sectional 303 FPC-66BRCA1/2- 1PRSS1-47PINK1-17 187 (61.7) 51.1(-) 24-36 NR NR NR Hwang 2019Argentina South America Prospective cohort Multicenter EUS + cross sectional 39 FPC-20PJS-3CDKN2A-9BRCA2- 55PALB2-12Lynch-1PRSS1-2 19 (49.7) 52.4 range (18-83) NR NR NR Received funding from Argentinian Society of Gastroenterolgy

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