Pancreatic Cancer
Pancreatic cancer is the second most common GI cancer in the U.S. Almost 30,000 cases a year. Virtually 100% fatal. Primarily a disease of the developed countries. Here are the statistics; down at the bottom worldwide, but it’s number two in the U.S. and because of rounding to two decimal places, the incidence rate and the death rate are the same. This is virtually the same geographical distribution as for colorectal cancer. Risk factors in pancreatic cancer: cigarette smoking is important. There has been demonstrated roughly a twofold risk ratio for cigarette smokers, and this has been shown to be dose related. There was a Japanese study that looked at people who smoked more than two packs a day with a risk ratio up around 3 or 4. Dietary carcinogens are certainly important, but there are few good studies to define them, other than the general kind of study that you do by plotting protein intake or calorie intake on one axis and rate of cancer on the other. But the same risk factors that apply to the other GI cancers, in terms of diet, are probably important in pancreatic cancer.
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Chronic pancreatitis, acquired or the usual pancreatitis that you see in the alcoholic is a minor risk factor. It is a risk factor, it has been shown to be, but familial relapsing pancreatitis, hereditary pancreatitis is a major risk factor. Probably not important are alcohol consumption, coffee consumption and diabetes. There have been lots of studies that link diabetes to pancreatic cancer but in general the studies that have looked prospectively have failed to see an increase in the rate of pancreatic cancer in patients who have had long-standing diabetes. So it is assumed that they are either common risks or that some of the diabetes that is associated with pancreatic cancer is a result of the cancer itself.