Epidemiology of pancreatic cancer: an overview

Abstract

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.

Metformin and Cancer Risk in Diabetic Patients: A Systematic Review and Meta-analysis

“…This general mechanism of inhibition of the signaling pathways implicated in actively proliferating cell renders metformin particularly attractive as a part of a global prevention strategy in a large group of high-risk individuals, for example, subjects with metabolic syndrome with multiple risk for different major diseases, including cardiovascular disease, diabetes, and cancer (68, 69). On the other hand, the observation that metformin was associated with greater risk reduction in specific major cancer killers such as colon, pancreatic, and breast cancer is consistent with the notion that diabetes or elevated insulin and glucose levels play an important role in the development of these tumors (2,3,7) and has important clinical research implications. For instance, metformin has been shown to reverse the effects of the high-energy diet on the growth of colon cancer cells (70,71) and, in a recent pilot clinical trial on 26 nondiabetic patients with aberrant crypt foci, metformin at a dose 250 mg/d for 1 month suppressed the mean number of aberrant crypt foci per patient, compared with control/untreated subjects (72).…”

“…Hyperinsulinemia adversely affects prognosis in cancer patients (3,(7)(8)(9)(10)(11) and is an independent risk factor for several types of neoplasms, thus explaining the obesity-cancer association (12). Insulin can promote tumorigenesis through a direct effect on epithelial tissues acting on the insulin/insulin-like growth factor family of receptors (13), or indirectly by affecting the levels of other modulators, such as insulin-like growth factors, sex hormones, and adipokines (14,15).…”

“…A large proportion of all cancers in Western countries is attributable to Western lifestyle, characterized by physical inactivity and early onset of metabolic syndrome and insulin resistance with diabetes, cardiovascular disease, and cancer (1)(2)(3)(4)(5)(6)(7). Hyperinsulinemia adversely affects prognosis in cancer patients (3,(7)(8)(9)(10)(11) and is an independent risk factor for several types of neoplasms, thus explaining the obesity-cancer association (12).…”

Epidemiology of Pancreatic and Periampullary Cancer

“…As current therapeutic results are so dismal, it is essential to review the epidemiologic factors that influence the development of this disease in order to implement preventive and screening strategies that can reduce the burden of this lethal cancer [2].…”

Borderline Resectable Pancreatic Cancer

“…Pancreatic cancer comprises of a large variety of individual cancer types; however 80 % are adenocarcinomas [4]. Surgery remains the mainstay of treatment for pancreatic cancer.…”