world cancer report - iarc

PANCREATIC CANCER
SUMMARY
> Pancreatic cancer is the 14th most common
cancer worldwide, with approximately
216,000 new cases per year.
Highest incidence rates occur in more
developed countries.
> In countries with high smoking prevalence,
more than 40% of cases is attributable
to tobacco consumption. Familial
risk, often involving hereditary pancreatitis,
is evident in up to 10% of cases.
> No effective early diagnostic test or population-based
screening procedure is
available.
> KRAS and p53 gene mutations are implicated
in the development of the most
common type, ductal adenocarcinoma.
> Five-year survival rates are poor (less
than 5%) and the vast majority of pancreatic
cancer patients die within a year
of clinical diagnosis.
Definition
Most (90%) pancreatic tumours are adenocarcinomas
arising from the ductal
epithelium of the exocrine pancreas.
Some 70% of these tumours develop in
the head of the pancreas. Endocrine
tumours of the pancreas, which are rare,
arise from the islets of Langerhans.
Epidemiology
Pancreatic cancer is the 14 th most common
cancer worldwide, with more than
216,000 new cases occurring each year.
Groups with the highest incidence include
black male Americans, New Zealand
Maoris, Korean Americans and native
female Hawaiians, as well as the male
population of Kazakhstan. The lowest
rates are in Ahmedabad Indians and in the
populations of some African countries
such as Tanzania and Guinea, and in those
248 Human cancers by organ site
< 2.1
< 5.6
Fig. 5.119 Global burden of pancreatic cancer in women. Incidence rates are generally high in the
Americas, Europe and Australia.
of Papua New Guinea and Sri Lanka [1]
(Fig. 5.119). In the developed world, incidence
has risen three-fold since the
1920s, stabilizing in the late 1970s.
Pancreatic cancer is significantly more
common in younger men than in younger
women, the sex ratio varying from
between 1.25-1.75:1 [2]. However, the
gender bias decreases with increasing
age. Prognosis is very poor and pancreatic
cancer causes some 213,000 deaths
each year. In the USA, cancer of the pancreas
is now the fourth leading cause of
cancer-related death in both men and
women.
Etiology
About 30% of cases of pancreatic cancer
are attributable to smoking. Cigarette
smokers develop this disease two to three
times more often than non-smokers. A
number of dietary factors have been putatively
connected with pancreatic cancer,
including a diet low in fibre and high in
meat and fat, and a diet rich in the heterocyclic
amines present in cooked meat
< 9
< 1.5
Age-standardized incidence/100,000 population
< 98.9
and fish. Smoking and diet are believed to
account for much of the increased incidence
observed since the 1920s. Coffee
consumption was once thought to be a
risk factor, but recent studies have not
established significant associations.
Working in mines, metalworks, sawmills,
chemical plants, coke plants, rubber factories,
and the petrochemical industry
have been variously indicated as risk factors,
as has exposure to solvents, napthylamine,
benzidine, and polychlorinated
biphenyl used in transformers. Other risk
factors include chronic and hereditary
pancreatitis, diabetes (although the significance
of the latter is much weaker if
cases of recent onset are excluded) and
cirrhosis. The sex ratio of pancreatic cancer
incidence has suggested a role for sex
hormones in disease development [3].
Detection
The diagnosis of pancreatic cancer is
rarely made at an early stage and the
most frequently recognized clinical symptoms
are usually portents of advanced dis-