Epidemiology of pancreatic cancer: an overview

• Published in: Nature reviews. Gastroenterology & hepatology Vol. 6; no. 12; pp. 699 - 708
• Main Authors: Raimondi, Sara, Maisonneuve, Patrick, Lowenfels, Albert B
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-12-2009; Nature Publishing Group
• Subjects: Adenocarcinoma - epidemiology; Adenocarcinoma - etiology; Adenocarcinoma - genetics; Biomedicine; Care and treatment; Development and progression; Gastroenterology; Genetic Predisposition to Disease; Health aspects; Hepatology; Humans; Incidence; Life Style; Medicine; Medicine & Public Health; Methods; Pancreatic cancer; Pancreatic Neoplasms - epidemiology; Pancreatic Neoplasms - etiology; Pancreatic Neoplasms - genetics; Polymorphism, Genetic; Prevalence studies (Epidemiology); review-article; Risk Factors; United States; Italy
• ISSN: 1759-5045; 1759-5053
• DOI: 10.1038/nrgastro.2009.177

Pancreatic cancer, although infrequent, has an extremely high mortality rate. The epidemiologic features of this rare cancer are still poorly known. In this Review Raimondi and colleagues discuss the environmental, lifestyle and genetic factors that increase or decrease the probability of developing pancreatic cancer and that may explain the different incidence rates observed in distinct subpopulations.
Pancreatic cancer, although infrequent, has an exceptionally high mortality rate, making it one of the four or five most common causes of cancer mortality in developed countries. The incidence of pancreatic cancer varies greatly across regions, which suggests roles for lifestyle factors, such as diet, or environmental factors, such as vitamin D exposure. Smoking is the most common known risk factor, and is the cause of 20–25% of all pancreatic tumors. Alcohol does not seem to be a risk factor, unless it leads to chronic pancreatitis, which is a probable risk factor. Long-standing diabetes increases the risk of pancreatic cancer, but can also be an early manifestation of pancreatic tumors. 5–10% of patients with pancreatic cancer have an underlying germline disorder, while the remaining percentage of cancer cases is thought to be caused by somatic mutations. Some individual studies suggest that mutations in various polymorphic genes can lead to small increases in the risk of pancreatic cancer, but these findings need to be replicated. Rising prevalence of smoking in developing countries, improved diagnosis and increasing population longevity are all likely to increase the global burden of pancreatic cancer in the coming decades.
Key Points
Despite its low incidence in developed countries, pancreatic cancer is associated with poor survival and ranks as the fourth or fifth most common cause of cancer mortality
Smoking causes 20–25% of pancreatic cancer cases and is the most frequent cause of this tumor, yet it is the most preventable
Chronic pancreatitis and diabetes are two benign diseases that have been linked to pancreatic cancer
5–10% of patients with pancreatic cancer have an underlying germline disorder, while the remaining cases seem to result from damage to genes occurred during life
Some apparently sporadic pancreatic cancers may in fact be caused by the interaction of polymorphic genes with other genes or with environmental factors
Potentially important risk factors that need further study include
Helicobacter pylori
and viral infections, and drugs such as aspirin, NSAIDS, and statins