Pancreatic Cancer

Pancreatic cancer is more common in men than women.  The average lifetime risk of pancreatic cancer is about 1:64, but each person’s chance of getting this cancer can be affected by risk factors:

1.    Tobacco Use

Smoking is one of the most important risk factors for pancreatic cancer.  The risk of getting pancreatic cancer is about twice as high among smokers compared to those who have never smoked.  About 25% of pancreatic cancers are thought to be caused by cigarette smoking.  Cigar smoking and the use of smokeless tobacco products also increases the risk.  However, the risk of pancreatic cancer starts to drop once a person stops smoking. 

2.    Overweight

Being overweight is a risk factor for pancreatic cancer.  Obese people are about 20% more likely to develop pancreatic cancer.

3.    Diabetes

Pancreatic cancer is more common in people with diabetes.  The cause of this is not known.  Most of this risk is found in patients with type 2 diabetes.  This type of diabetes is increasing in children and adolescents.  It is not clear if people with type 1 diabetes have a higher risk. 

4.    Chronic Pancreatitis

A long term inflammation of the pancreas is linked with an increased risk of pancreatic cancer.  Chronic pancreatitis is often seen with heavy alcohol use and smoking. 

5.    Workplace Exposure to Certain Chemicals

Heavy exposure at work to certain chemicals used in the dry cleaning and metalworking industries may raise a person’s risk of pancreatic cancer. 

6.    Age

The risk of developing pancreatic cancer goes up with people’s age.  Almost all patients are older than 45 and about two thirds are at least 65 years old.  The average age of the time of diagnosis is 70. 

7.    Gender

Men are slightly more likely to develop pancreatic cancer than women.  This may be due at least in part to higher tobacco use in men, which raises pancreatic cancer risk.

8.    Race

African Americans are more likely to develop pancreatic cancer than whites. The reason for this is not clear but it may be due in part to having higher rates of other risk factors for pancreatic cancer such as diabetes, smoking and being overweight.

9.    Family History

Pancreatic cancer does seem to run in some families.  In some of these families, high risk is due to an inherited syndrome.  In other families, the gene causing increased risk is not known.  Although family history is a risk factor, most people who get pancreatic cancer do not have any family history of it. 

10. Inherited Genetic Syndromes

Inherited gene changes mutations can be passed from parent to child.  These gene changes may cause as many as 10% of pancreatic cancers.  Sometimes these gene changes result in syndromes that include increased risk of other cancers.  Examples of genetic syndromes that can cause pancreatic cancer include: 1. Hereditary breast and ovarian cancer syndrome, such a BRCA 1 or BRCA 2 genes.  2. Hereditary breast cancer caused by the PLB2 gene. 

3. Familial atypical multiple mole melanoma, FAMMM syndrome caused by mutations in the p16/CDKN2A gene and associated with skin and eye melanomas.  4. Familial pancreatitis usually caused by mutations in the PR 551 gene. 5. Lynch Syndrome and Peutz-Jeghers syndrome

11. Chronic Pancreatitis

Chronic pancreatitis is sometimes due to an inherited gene mutation.  People with inherited familial form of pancreatitis have a higher lifetime risk of pancreatic cancer.

Factors with Unclear Effect on Risk

1.    Diet

Diets with bread and processed meats such as sausage and bacon and saturated fats may increase the risk of pancreatic cancer.  Sugary drinks may also increase this risk.  However, more research is needed in this area.

2.    Physical Inactivity

Lack of physical activity might increase pancreatic cancer as some research has shown but not all studies have found this.  Regular physical activity may help to reduce the risk of pancreatic cancer. 

3.    Coffee

Some older studies suggest that drinking coffee might increase the risk of pancreatic cancer, but more recent studies have not confirmed this.

4.    Alcohol

Some studies have shown a link between heavy alcohol use and pancreatic cancer.  Heavy alcohol can, of course, cause chronic pancreatitis which is known to increase pancreatic risk.

5.    Infections

Some research suggests that infection with Helicobacter pylori or infection with hepatitis B may increase the risk of getting pancreatic cancer, however, more research is required. 

So, from these, although pancreatic cancer cannot be prevented, risk factors such as age, gender, race and family history cannot be controlled but you can stop smoking, watch your diet and body weight and increase your physical activity.  I suggest lowering alcohol consumption and limiting any exposure to certain chemicals in the workplace. 

Can Pancreatic Cancer be Found Early?

Pancreatic cancer is hard to find early.  The pancreas lies deep within the body and so early tumours cannot be seen or felt during routine physical examinations. Often there are no symptoms until the cancer has become very large or has already spread.

Currently there are no recommended routine screening suggestions for pancreatic cancer for those with an average risk.  This is because no screening test has been shown to lower the risk of dying from pancreatic cancer.

For those, however, with an increased risk, tests such as endoscopic ultrasound or MRI scan may be used for someone with a strong family history of pancreatic cancer or with a known genetic syndrome that increases their risk.  With the use of these tests, treatable cancers in some members of higher risk families have been found.

Anyone with jaundice age 40 and up should be urgently referred for assessment, but any patients age 60 with weight loss and any symptoms of diarrhoea, back pain, abdominal pain, nausea, vomiting or constipation should also be considered for urgent referral.

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