Epidemiology and Prospects for Prevention of Pancreatic Cancer 2nd ed

Abstract

The overall incidence of pancreatic cancer in the United States is approximately 8–10 cases per 100,000 person-years. African Americans have higher incidence rate than other ethnic groups. Men have a slightly higher incidence than women. Age is the most significant risk factor for pancreatic cancer. Genetic predispositions account for 5–10% of cases. Cigarette smoking is the only confirmed environmental risk factor and long-term smoking cessation reduces the risk. The causal relationship between high body mass index and risk has been established. Diabetes could be the manifestation of pancreatic cancer, but long-standing type II diabetes mellitus has been implicated as a risk factor. Other suspected risk factors for pancreatic cancer include alcohol and pancreatitis. Heavy alcohol use, especially heavy liquor use, may serve as a cofactor in pancreatic cancer development. However, the confounding effect by smoking cannot be excluded. Chronic pancreatitis may increase the risk for pancreatic cancer but the confounding effect of alcohol cannot be excluded. Dietary factors that have been suggested to associate with increased risk of pancreatic cancer include: high intake of total energy, total fat, red meat, animal protein and dietary mutagens. Dietary intake of folate and flavonoid may be protective against pancreatic cancer but the results are inconclusive. The association of pancreatic cancer with passive smoking, non-cigarette tobacco product use, carbohydrate intake, coffee consumption, physical activity, infectious factors, allergy, occupation and use of NSAIDs or statins are all inconclusive. Other than tobacco carcinogen, epidemiologic studies support that insulin resistance, energy imbalance and inflammation may be the underlying mechanisms in pancreatic cancer development. In view of the high mortality of pancreatic cancer, an appropriate strategy for reducing the burden of this cancer is to reduce exposure to known risk factors such as cigarette smoking, obesity and diabetes. Lifestyle changes hold the hope for primary prevention of pancreatic cancer. Well-designed epidemiologic studies will speed up our understanding on the etiology of pancreatic cancer.