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Epidemiology, Risk Factors and Clinical Presentation

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New Concepts in Diagnosis and Therapy of Pancreatic Adenocarcinoma

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

Pancreatic cancer (PDAC) is a deadly disease. It has an incidence ranging 8–12 per 100,000 per year, with a similar mortality, as more than 95% of patients diagnosed with PDAC will ultimately die. Prevention policies are therefore particularly important and they should be distinguished in: (1) Primary prevention, aimed at reducing risk factors for PDAC and possibly favouring protective habits. (2) Secondary prevention, aimed at the early diagnosis through appropriate screening tests in subjects with a particularly high risk. The most important risk factors for pancreatic cancer are family history of pancreatic cancer, smoking, obesity, diabetes, alcohol and chronic pancreatitis. Diabetes of recent onset should be considered a possible alarm symptom. In patients with defined genetic syndromes such as “familiar pancreatic cancer”, and Peutz–Jeghers syndrome screening for pancreatic cancer as a part of research protocols are performed in selected Centres. There are no sufficient data to suggest that vitamins or aspirin may have a role for PDAC chemoprevention.

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References

  • Anderson KE, Sinha R, Kulldorff M, Gross M, Lang NP, Barber C, Harnack L, DiMagno E, Bliss R, Kadlubar FF (2002) Meat intake and cooking techniques: associations with pancreatic cancer. Mutat Res 506–507:225–231

    Article  PubMed  Google Scholar 

  • Berrington de Gonzalez A, Sweetland S, Spencer E (2003) A meta-analysis of obesity and the risk of pancreatic caner. Br J Cancer 89:519–523

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  • Berrino F, De Angelis R, Sant M et al (2007) Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995–99: results of the EUROCARE-4 study. Lancet Oncol 8:773–783

    Article  PubMed  Google Scholar 

  • Bjelakovic G, Nikolova D, Simonetti RG, Gluud C (2004) Antioxidant supplements for prevention of gastrointestinal cancers: a systematic review and meta-analysis. Lancet 364(9441):1219–1228

    Article  PubMed  CAS  Google Scholar 

  • Bonovas S, Filioussi K, Sitaras NM (2008) Statins are not associated with a reduced risk of pancreatic cancer at the population level, when taken at low doses for managing hypercholesterolemia: evidence from a meta-analysis of 12 studies. Am J Gastroenterol 103(10):2646–2651

    Article  PubMed  CAS  Google Scholar 

  • Borg A, Sandberg T, Nilsson K et al (2000) High frequency of multiple melanomas and breast and pancreas carcinomas in CDKN2A mutation-positive melanomafamilies. J Natl Cancer Inst 92:1260–1266

    Article  PubMed  CAS  Google Scholar 

  • Brand RE, Lerch MM, Rubinstein WS, Neoptolemos JP, Whitcomb DC, Hruban RH, Brentnall TA, Lynch HT, Canto MI, Participants of the Fourth International Symposium of Inherited Diseases of the Pancreas (2007) Advances in counselling and surveillance of patients at risk for pancreatic cancer. Gut 56(10):1460–1469

    Article  PubMed Central  PubMed  Google Scholar 

  • Brand RE, Greer JB, Zolotarevsky E, Brand R, Du H, Simeone D, Zisman A, Gorchow A, Lee SY, Roy HK, Anderson MA (2009) Pancreatic cancer patients who smoke and drink are diagnosed at younger ages. Clin Gastroenterol Hepatol 7:1007–1012

    Article  PubMed Central  PubMed  Google Scholar 

  • Brentnall TA, Bronner MP, Byrd DR, Haggitt RC, Kimmey MB (1999) Early diagnosis and treatment of pancreatic dysplasia in patients with a family history of pancreatic cancer. Ann Intern Med 131(4):247–255

    Article  PubMed  CAS  Google Scholar 

  • Canto MI, Goggins M, Hruban RH, Petersen GM, Giardiello FM, Yeo C, Fishman EK, Brune K, Axilbund J, Griffin C, Ali S, Richman J, Jagannath S, Kantsevoy SV, Kalloo AN (2006) Screening for early pancreatic neoplasia in high-risk individuals: a prospective controlled study. Clin Gastroenterol Hepatol 4(6):684–687

    Article  Google Scholar 

  • Capurso G, Delle Fave G, Lemoine N (2004) Re: etiology of pancreatic cancer, with a hypothesis concerning the role of N-nitroso compounds and excess gastric acidity. J Natl Cancer Inst 96:75

    Article  PubMed  CAS  Google Scholar 

  • Capurso G, Schünemann HJ, Terrenato I, Moretti A, Koch M, Muti P, Capurso L, Delle Fave G (2007) Meta-analysis: the use of non-steroidal anti-inflammatory drugs and pancreatic cancer risk for different exposure categories. Aliment Pharmacol Ther 26(8):1089–1099

    Article  PubMed  CAS  Google Scholar 

  • Couch FJ, Johnson MR, Rabe KG et al (2007) The prevalence of BRCA2 mutations in familial pancreatic cancer. Cancer Epidemiol Biomarkers Prev 16:342–346

    Article  PubMed  CAS  Google Scholar 

  • Del Chiaro M, Zerbi A, Falconi M, Bertacca L, Polese M, Sartori N, Boggi U, Casari G, Longoni BM, Salvia R, Caligo MA, Di Carlo V, Pederzoli P, Presciuttini S, Mosca F (2007) Cancer risk among the relatives of patients with pancreatic ductal adenocarcinoma. Pancreatology 7(5–6):459–469

    PubMed  Google Scholar 

  • de Martel C, Llosa AE, Friedmana GD, Vogelman JH, Orentreich N, Stolzenberg-Solomon RZ et al (2008) Helicobacter pylori infection and development of pancreatic cancer. Cancer Epidemiol Biomarkers Prev 17:1188–1194

    Article  PubMed  Google Scholar 

  • Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18:581–592

    Article  PubMed  CAS  Google Scholar 

  • Gandini S, Lowenfels AB, Jaffee EM, Armstrong TD, Maisonneuve P (2005) Allergies and the risk of pancreatic cancer: a meta-analysis with review of epidemiology and biological mechanisms. Cancer Epidemiol Biomarkers Prev 14(8):1908–1916

    Article  PubMed  Google Scholar 

  • Garcea G, Dennison AR, Steward WP et al (2005) Role of inflammation in pancreatic carcinogenesis and the implications for future therapy. Pancreatology 5:514–529

    Article  PubMed  CAS  Google Scholar 

  • Genkinger JM, Spiegelman D, Anderson KE, Bergkvist L, Bernstein L, van den Brandt PA, English DR, Freudenheim JL, Fuchs CS, Giles GG, Giovannucci E, Hankinson SE, Horn-Ross PL, Leitzmann M, Männistö S, Marshall JR, McCullough ML, Miller AB, Reding DJ, Robien K, Rohan TE, Schatzkin A, Stevens VL, Stolzenberg-Solomon RZ, Verhage BA, Wolk A, Ziegler RG, Smith-Warner SA (2009) Alcohol intake and pancreatic cancer risk: a pooled analysis of fourteen cohort studies. Cancer Epidemiol Biomarkers Prev 18(3):765–776

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  • Giardiello FM, Brensinger JD, Tersmette AC et al (2000) Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology 119:1447–1453

    Article  PubMed  CAS  Google Scholar 

  • Giovannucci E, Michaud D (2007) The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas. Gastroenterology 132:2208–2225

    Article  PubMed  CAS  Google Scholar 

  • Hassan MM, Bondy ML, Wolff RA, Abruzzese JL, Vauthey JN, Pisters PW et al (2007a) Risk factors for pancreatic cancer: case-control study. Am J Gastroenterol 102:1–12

    Article  Google Scholar 

  • Hassan MM, Abbruzzese JL, Bondy ML, Wolff RA, Vauthey JN, Pisters PW et al (2007b) Passive smoking and the use of noncigarette tobacco products in association with risk for pancreatic caner: a case-control study. Cancer 109:2547–2556

    Article  PubMed Central  PubMed  Google Scholar 

  • Howes N, Lerch MM, Greenhalf W, Stocken DD, Ellis I, Simon P et al (2004) Clinical and genetic characteristics of hereditary pancreatitis in Europe. Clin Gastroenterol Hepatol 2: 252–261

    Article  PubMed  CAS  Google Scholar 

  • Huxley R, Ansare-Moghaddam A, Berrington de Gonzalez A, Barzi F, Woodward M (2005) Type-II diabetes and pancreatic cancer: a meta-analysis of 36 studies. Brit J Cancer 92:2076–2083

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  • Iodice S, Gandini S, Maisonneuve P, Lowenfels AB (2008) Tobacco and the risk of pancreatic caner: a review and meta-analysis. Langebecks Arch Surg 393:535–545

    Article  Google Scholar 

  • Klein AP, Brune KA, Petersen GM, Goggins M, Tersmette AC, Offerhaus GJ, Griffin C, Cameron JL, Yeo CJ, Kern S, Hruban RH (2004) Prospective risk of pancreatic cancer in familial pancreatic cancer kindreds. Cancer Res. 64(7):2634–2638

    Article  PubMed  CAS  Google Scholar 

  • Lal G, Liu G, Schmocker B et al (2000) Inherited predisposition to pancreatic adenocarcinoma: role of family history and germ-line p16, BRCA1 and BRCA2 mutations. Cancer Res 60:409–416

    PubMed  CAS  Google Scholar 

  • Langer P, Kann PH, Fendrich V, Habbe N, Schneider M, Sina M, Slater EP, Heverhagen JT, Gress TM, Rothmund M, Bartsch DK (2009) 5 Years of prospective screening of high risk individuals from familial pancreatic cancer – families. Gut 58:1410–1418

    Article  PubMed  CAS  Google Scholar 

  • Larsson SC, Giovannucci E, Wolk A (2006) Folate intake, MTHFR polymorphisms, and risk of esophageal, gastric, and pancreatic cancer: a meta-analysis. Gastroenterology 131(4): 271–1283

    Article  PubMed  CAS  Google Scholar 

  • Larsson SC, Orsini N, Wolk A (2007) Body mass index and pancreatic cancer risk: a meta-analysis of prospective studies. Int J Cancer 120:1993–1998

    Article  PubMed  CAS  Google Scholar 

  • Li D, Morris JS, Liu J, Hassan MM, Day RS, Bondy ML, Abbruzzese JL (2009a) Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA 301(24):2553–2562

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  • Li D, Yeung SC, Hassan MM, Konopleva M, Abbruzzese JL (2009b) Antidiabetic therapies affect risk of pancreatic cancer. Gastroenterology 137:482–488

    Article  PubMed Central  PubMed  Google Scholar 

  • Jiao L, Silverman DT, Schairer C, Thie’baut A, Hollenbeck AR, Leitzmann MF, Schatzkin A, Stolzenberg-Solomon RZ (2009a) Alcohol use and risk of pancreatic cancer. The NIH-AARP Diet and Health Study. Am J Epidemiol 169:1043–1051

    Article  PubMed Central  PubMed  Google Scholar 

  • Lowenfels AB, Maisonneuve P, DiMagno EP et al (1997) Hereditary pancreatitis and the risk of pancreatic cancer. International Hereditary Pancreatitis Study Group. J Natl Cancer Inst 89:442–6

    Article  PubMed  CAS  Google Scholar 

  • Lowenfels AB, Maisonneuve P, Whitcomb DC et al (2001) Cigarette smoking as a risk factor for pancreatic cancer in patients with hereditary pancreatitis. JAMA 286: 169–70

    Article  PubMed  CAS  Google Scholar 

  • Lynch HT, Voorhees GJ, Lanspa SJ et al (1985) Pancreatic carcinoma and hereditary nonpolyposis colorectal cancer: a family study. Br J Cancer 52:271–3

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  • Luo J, Nordenvall C, Nyrén O, Adami HO, Permert J, Ye W (2007) The risk of pancreatic cancer in patients with gastric or duodenal ulcer disease. Int J Cancer 120:368–7

    Article  PubMed  CAS  Google Scholar 

  • Jemal A, Seigel R, Ward E, Murray T, Xu J, Thun MJ (2007) Cancer statistics, 2007. CA Cancer J Clin 57:43–66

    Article  PubMed  Google Scholar 

  • Jiao L, Mitrou PN, Reedy J, Graubard BI, Hollenbeck AR, Schatzkin A, Stolzenberg-Solomon R (2009b) A combined healthy lifestyle score and risk of pancreatic cancer in a large cohort study. Arch Intern Med 169:764–70

    Article  PubMed Central  PubMed  Google Scholar 

  • Maisonneuve P, FitzSimmons SC, Neglia JP et al (2003) Cancer risk in nontransplanted and transplanted cystic fibrosis patients: a 10-year study. J Natl Cancer Inst 95:381–7

    Article  PubMed  Google Scholar 

  • Maitra A, Ashfaq R, Gunn CR et al (2002) Cyclooxygenase 2 expression in pancreatic adenocarcinoma and pancreatic intraepithelial neoplasia: an immunohistochemical analysis with automated cellular imaging. Am J Clin Pathol 118:194–201

    Article  PubMed  CAS  Google Scholar 

  • McKay CJ, Glen P, McMillan DC (2008) Chronic inflammation and pancreatic cancer. Best Pract Res Clin Gastroenterol 22:65–73

    Article  PubMed  CAS  Google Scholar 

  • McWilliams R, Highsmith WE, Rabe KG, de Andrade M, Tordsen LA, Holtegaard LM, Petersen GM (2005) Cystic fibrosis transmembrane regulator gene carrier status is a risk factor for young onset pancreatic adenocarcinoma. Gut 54(11):1661–2

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  • McWilliams RR, Bamlet WR, Rabe KG, Olson JE, de Andrade M, Petersen GM (2006) Association of family history of specific cancers with a younger age of onset of pancreatic adenocarcinoma. Clin Gastroenterol Hepatol 4(9):1143–7

    Article  PubMed Central  PubMed  Google Scholar 

  • Michaud DS, Giovannucci E, Willett WC, Colditz GA, Fuchs CS (2003) Dietary meat, dairy products, fat, and cholesterol and pancreatic cancer risk in a prospective study. Am J Epidemiol 157:1115–25

    Article  PubMed  Google Scholar 

  • Mulder I, Hoogenveen RT, van Genugten ML (2002) Smoking cessation would substantially reduce the future incidence of pancreatic cancer in the European Union. Eur J Gastroenterol Hepatol 14:1343–53

    Article  PubMed  Google Scholar 

  • Ojajärvi IA, Partanen TJ, Ahlbom A, Boffetta P, Hakulinen T, Jourenkova N et al (2000) Occupational exposures and pancreatic cancer: a meta-analysis. Occup Environ Med 57:316–24

    Article  PubMed Central  PubMed  Google Scholar 

  • Pannala R, Leirness JB, Bamlet WR, Basu A, Petersen GM, Chari ST (2008) Prevalence and clinical profile of pancreatic cancer-associated diabetes mellitus. Gastroenterology 134:981–87

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  • Pannala R, Basu A, Petersen GM, Chari ST (2009) New-onset diabetes: a potential clue to the early diagnosis of pancreatic cancer. Lancet Oncol 10:88–95

    Article  PubMed Central  PubMed  Google Scholar 

  • Pezzilli R, Morselli-Labate AM, Migliori M, Manca M, Bastagli L, Gullo L (2005) Obesity and the risk of pancreatic cancer: an italian multicenter study. Pancreas 31:221–224

    Article  PubMed  Google Scholar 

  • Pogue-Geile KL, Chen R, Bronner MP, Crnogorac-Jurcevic T, Moyes KW, Dowen S, Otey CA, Crispin DA, George RD, Whitcomb DC, Brentnall TA (2006) Palladin mutation causes familial pancreatic cancer and suggests a new cancer mechanism. PLoS Med 3(12):e516

    Article  PubMed Central  PubMed  Google Scholar 

  • Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M (2008) Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371(9612):569–78

    Article  PubMed  Google Scholar 

  • Rulyak SJ, Lowenfels AB, Maisonneuve P, Brentnall TA (2003) Risk factors for the development of pancreatic cancer in familial pancreatic cancer kindreds. Gastroenterology 124:1292–99

    Article  PubMed  Google Scholar 

  • Schernhammer ES, Kang JH, Chan AT et al (2004) A prospective study of aspirin use and the risk of pancreatic cancer in women. J Natl Cancer Inst 96:22–8

    Article  PubMed  CAS  Google Scholar 

  • Stevens RJ, Roddam AW, Beral V (2007) Pancreatic cancer in type 1 and young-onset diabetes: systematic review and meta-analysis. Br J Cancer 12(96):507–9

    Article  Google Scholar 

  • Stolzenberg-Solomon RZ, Blaser MJ, Limburg PJ, Perez-Perez G, Taylor PR, Virtamo J et al (2001) Helicobacter pylori seropositivity as a risk factor for pancreatic cancer. J Natl Cancer Inst 93:937–41

    Article  PubMed  CAS  Google Scholar 

  • Talamini G, Falconi M, Bassi C, Sartori N, Salvia R, Caldiron E et al (1999) Incidence of cancer in the course of chronic pancreatitis. Am J Gastroenterol 92:1253–60

    Article  Google Scholar 

  • van Asperen CJ, Brohet RM, Meijers-Heijboer EJ et al (2005) Cancer risks in BRCA2 families: estimates for sites other than breast and ovary. J Med Genet 42:711–19

    Article  PubMed Central  PubMed  Google Scholar 

  • Vasen HFA, Gruis NA, Frants RR et al (2000) Risk of developing pancreatic cancer in families with familial atypical multiple mole melanoma associated with a specific19 deletion of p16 (p16-LEIDEN). Int J Cancer 87:809–11

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Digestive and Liver Disease Unit, II Medical School, University “La Sapienza”, Rome, Italy

    Gabriele Capurso, Gianfranco Delle Fave & Emilio Di Giulio

  2. Department of Gastroenterology, “Nuovo Regina Margherita” Hospital, Rome, Italy

    Cesare Hassan

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  1. Gabriele Capurso
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  2. Cesare Hassan
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  3. Gianfranco Delle Fave
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  4. Emilio Di Giulio
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Corresponding author

Correspondence to Gabriele Capurso .

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Editors and Affiliations

  1. , Radiological, Oncological, and Pathologi, Sapienza , Università di Roma, Polo Pontino, Latina, Italy

    Andrea Laghi

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Capurso, G., Hassan, C., Fave, G.D., Di Giulio, E. (2010). Epidemiology, Risk Factors and Clinical Presentation. In: Laghi, A. (eds) New Concepts in Diagnosis and Therapy of Pancreatic Adenocarcinoma. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2010_7

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  • DOI: https://doi.org/10.1007/174_2010_7

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