This review summarizes data on the occurrence, the trends, and the life-style, environmental, occupational and genetic determinants of pancreatic cancer. Epidemiologic evidence implicates tobacco smoking as one cause. The evidence regarding alcohol consumption is inconsistent. Although both positive and inconclusive findings are encountered, the bulk of the evidence on coffee consumption is negative. Fat intake is linked with obesity and diabetes mellitus, which are risk factors for pancreatic cancer. Fruit and vegetable consumption appears to be protective. No occupational or environmental agent has been confirmed to increase the risk, but epidemiologic evidence is inconsistent. Little is known about the role of genetic polymorphisms of metabolic enzymes in pancreas carcinogenesis. Pancreatic cancer shows high rates of mutations of Ki-ras and losses or mutations of tumor suppressor genes (p53, p16'NK4A, and SMAD4PDPC-4). Ki-ras mutations have been associated with life-style factors in relation to pancreatic cancer, but the evidence is still scant and inconsistent.Key terms environmental exposure, epidemiology, occupational exposure, pancreatic neoplasms, rewiew, risk factors.A total of 181 000 new cases of pancreatic cancer (International Classification of Diseases: code 157 in 9th revision and code C25 in 10th revision) are annually diagnosed worldwide (1). Owing to its high fatality, pancreatic cancer is the 5th leading cause of cancer deaths in industrialized nations. Most pancreatic cancers derive from the exocrine component. Endocrine tumors arising in islet cells constitute about 5% of all pancreatic cancers (2).The causes of pancreatic cancer are obscure for the most part. This review summarizes data on the occurrence, the trends, and the life-style, environmental, occupational and genetic determinants of exocrine pancreatic cancer.
Descriptive epidemiologyBecause of the rapid fatality from pancreatic cancer, its incidence and mortality rates follow each other closely ' and increase steeply among people 40-70 years of age.