The epidemiological satellite view of patients who were diagnosed with pancreatic adenocarcinoma between 1995 and 2005 reported by Turaga et al in this issue of Cancer 1 sheds light on the emotional course of a grave cancer. Pancreatic cancer long has been linked to depression and distress. The authors document a disproportionate standardized mortality ratio (SMR) for suicide >10 times that in the general population among patients with pancreatic cancer. What do we make of this signal?The paradox is that suicide among patients with pancreatic cancer actually is quite rare. Most oncologists, even those who are caring for patients with pancreatic cancer alone, could believe that no patients kill themselves when faced with this diagnosis. Among greater than 36,000 patients, there were 30 who killed themselves, such that suicide was the recorded cause of death. Of those 30 patients, 28 were men, and they were more apt to be men without a spouse-single, divorced, or widowed. All but 4 patients were aged >60 years.In the general United States population, suicide occurs most often in older white men. 2 Substance abuse and major depressive disorder are major risk factors. Suicide attempts are all the more successful with firearms. Risk factors for depression are personal lifetime history, a family history of depressive disorder, prior suicide attempts, lack of social support, and stressful life events.The diagnosis of cancer, needless to say, is a stressful life event. Among US patients who are diagnosed with cancer overall, the risk of suicide doubles, 3 and older white men have the greatest risk, as in the general population. High relative risks of suicide are different for different tumor types. The highest rates in the most common tumors recorded in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute from 1973 to 2002 were for tumors of the lung and bronchus (SMR, 5.74), stomach (SMR, 4.68), oral cavity and pharynx (SMR, 3.66), and larynx (SMR, 2.83) 3 ; however, no rates were as high as the rate for pancreatic cancer.Patients face the existential plight most acutely in the first 100 days after diagnosis. 4 The newness of the diagnosis and the perception of advanced disease can be overwhelming and can influence the risk of suicide. This pattern also is observed among men with prostate cancer. Suicide was the cause of death for 148 of 342,500 patients who were diagnosed with prostate cancer between 1979 and 2004 who were followed in the SEER Program. Patients who were diagnosed with prostate cancer at a mean age of 70 years, similar to the mean age at diagnosis among patients with pancreatic cancer, had a greater risk of suicide during the first year, and especially during the first 3 months after diagnosis 5 : the SMR adjusted for age was 1.4 compared with all US men, which was much less marked (but still elevated) than that in patients with pancreatic cancer. The highest relative risk of suicide was during the first weeks after diagnosis. Similarly, the first week after d...