review of literature on clinical pancreatology - The Pancreapedia

historically, but recent life-style changes suggest that this may no longer be the case. Thepurpose <strong>of</strong> this study was to estimate incidence and mortality rates among Aboriginal peopleliving on reserves and in northern villages in Québec during the period 1988-2004, and tocompare these estimates with those <strong>of</strong> the general population. Aboriginal people wereidentified based on geographic residence codes. Population data were taken from theCanadian census <strong>of</strong> 1991, 1996 and 2001. Incidence and mortality rates were calculated andage-standardized according to the World Standard Population. The Aboriginal incidence andmortality rates for cancer, all sites combined, was 322 per 100,000 (95 % confidence interval305 to 339) and 160 per 100,000 (95 % CI 148-173), respectively. These rates are notsignificantly different from those <strong>of</strong> the general population <strong>of</strong> Québec. However, there aredifferences according to cancer site and sex. Aboriginal men had a higher risk for liver, lungand kidney cancers and a lower risk for prostate, bladder, leukemia and non-Hodgkin'slymphoma cancers, whereas Aboriginal women had a higher risk for colorectal, lung, cervixand kidney cancers, and a lower risk for breast, uterus, bladder, brain, leukemia, stomachand pancreas cancers [333].Nenetskij Avtonomnyj Okrug (NAO), a part <strong>of</strong> Arkhangelskaja Oblast in north-west Russia,has a population <strong>of</strong> 42,000 inhabitants. The central oncological hospital <strong>of</strong> the oblastregisters all new cases <strong>of</strong> cancer. All new cases recorded in the study period among <strong>of</strong>ficialresidents <strong>of</strong> NAO were included in the study, except for secondary malignant neoplasm,cases revealed by autopsy and cancers diagnosed within 6 months <strong>of</strong> a previous cancerdiagnosis. The census and annual sex and age-group-specific population figures for NAOwere obtained from the regional statistics <strong>of</strong>fice. Crude and age-adjusted incidence rates (tothe world standard population) were estimated. The average crude cancer incidence per yearwas 204/100,000 among men and 194/100,000 among women. Adjusted for age, theincidence was 322/100,000 and 182/100,000, respectively. The most frequent primary site <strong>of</strong>cancer was trachea, bronchus and lung, which constituted 17 percent <strong>of</strong> all cases (<strong>of</strong> which87 % were among men), followed by stomach cancer (13 %). Breast cancer constituted 18percent <strong>of</strong> all cases among women. The results are consistent with reports <strong>of</strong> a low cancerrisk among women compared with men in Russia and compared with women in Westerncountries and with results that point out that public health measures are needed to curb thelung cancer epidemic among men in Russia. The high risks <strong>of</strong> pancreas, kidney andoesophagus cancers among men should be investigated further [334].Pancreatic compared to peripancreatic cancersCarcinomas co-occur in the pancreas, extrahepatic bile ducts, and ampulla <strong>of</strong> Vater. It wasinvestigated whether cancers originating in these sites represent a field effect similar to thatobserved in the lung and upper aerodigestive tract. To determine whether a field effect forcarcinogenesis exists in the ampulla <strong>of</strong> Vater, extrahepatic bile ducts, gallbladder, andpancreas data were obtained from National Cancer Institute's Surveillance Epidemiology andEnd Results Program from 1973 through 2005. Cases were compared by age frequencydensity plots, age-specific incidence rates, and logarithmic plots <strong>of</strong> the age-specific incidencerates and age <strong>of</strong> diagnosis. Incidence rates were 11.71, 1.43, 0.88, and 0.49 per 100,000persons at risk for pancreatic, gallbladder, extrahepatic bile ducts, and ampullarycarcinomas, respectively. Age frequency density plots were congruent for cancers originatingin all 4 sites. Logarithmic plots <strong>of</strong> the age-specific incidence rates with age <strong>of</strong> diagnosisproduced parallel linear rate patterns for the 4 sites indicative <strong>of</strong> similar populations for tumordevelopment. However, density and logarithmic plots <strong>of</strong> pancreatic endocrine carcinomas, atumor <strong>of</strong> different cellular differentiation and carcinogenic pathway, served as a comparison.The endocrine carcinomas showed a different age distribution and nonparallel rate patternswith ductal carcinomas. It was concluded that carcinomas <strong>of</strong> the pancreas, gallbladder,extrahepatic bile ducts, and ampulla have a common embryonic cellular ancestry,differentiation pathways, mucosal histologic patterns, and population-related tumor