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{{Pancreatic cancer}}
{{Pancreatic cancer}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; {{AE}} {{ARK}}


==Overview==
==Overview==
Pancreatic cancer is associated with number of predisposing risk factors such as age, gender, ethnicity and environmental exposures.
[[Pancreatic cancer]] is associated with number of predisposing [[Risk factor|risk factors]] such as age, gender, ethnicity, and environmental exposures. The most potent [[Risk factor|risk factors]] for [[pancreatic cancer]] include [[smoking]], [[alcoholism]], increased [[Body mass index|BMI]], [[diabetes mellitus]], [[chronic pancreatitis]] and a [[family history]] of [[pancreatic cancer]]. Individuals with [[hereditary pancreatitis]], familial [[pancreatic cancer]], [[Peutz-Jeghers|Peutz-Jeghers disease]], [[familial atypical multiple mole melanoma syndrome]] (FAMMM), [[von Hippel-Lindau syndrome]], [[multiple endocrine neoplasia type 1]], [[cystic fibrosis]] of the [[pancreas]] and familial [[cancer]] syndromes such as [[Hereditary nonpolyposis colorectal cancer|lynch syndrome]], [[familial adenomatous polyposis]] (FAP) and hereditary [[Breast cancer|breast]] and [[ovarian cancer]]-[[BRCA1]] and [[BRCA2]] mutations are also at an increased risk of [[pancreatic cancer]]. Other medical conditions which pose as a [[risk factor]] for [[pancreatic cancer]] are [[inflammatory bowel disease]], [[periodontal disease]] and [[peptic ulcer disease]].


==Risk Factors==
==Risk Factors==
Risk factors for pancreatic cancer include:<ref>http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_pancreatic_cancer_34.asp?sitearea=</ref>
*The most potent risk factors for [[pancreatic cancer]] include [[smoking]], [[alcoholism]], increased [[Body mass index|BMI]], [[diabetes mellitus]], [[chronic pancreatitis]] and a [[family history]] of [[pancreatic cancer]].
*Age
*Individuals with the following conditions are also at an increased risk of [[pancreatic cancer]]:<ref name="pmid26320426">{{cite journal| author=Goral V| title=Pancreatic Cancer: Pathogenesis and Diagnosis. | journal=Asian Pac J Cancer Prev | year= 2015 | volume= 16 | issue= 14 | pages= 5619-24 | pmid=26320426 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26320426  }} </ref><ref name="PandolGukovskaya2012">{{cite journal|last1=Pandol|first1=Stephen|last2=Gukovskaya|first2=Anna|last3=Edderkoui|first3=Mouad|last4=Dawson|first4=David|last5=Eibl|first5=Guido|last6=Lugea|first6=Aurelia|title=Epidemiology, risk factors, and the promotion of pancreatic cancer: Role of the stellate cell|journal=Journal of Gastroenterology and Hepatology|volume=27|year=2012|pages=127–134|issn=08159319|doi=10.1111/j.1440-1746.2011.07013.x}}</ref><ref name="LowenfelsMaisonneuve2005">{{cite journal|last1=Lowenfels|first1=Albert B.|last2=Maisonneuve|first2=Patrick|title=Risk factors for pancreatic cancer|journal=Journal of Cellular Biochemistry|volume=95|issue=4|year=2005|pages=649–656|issn=0730-2312|doi=10.1002/jcb.20461}}</ref>
*Male gender
*African ethnicity
*[[Tobacco smoking|Smoking]]
*Diets high in meat
*[[Obesity]]
*[[Diabetes]]
*[[Chronic pancreatitis]] has been linked, but is not known to be causal.
*Occupational exposure to certain [[pesticide]]s, [[dye]]s, and chemicals related to gasoline
*Family history, including [[autosomal recessive]] [[ataxia-telangiectasia]] and autosomal dominantly inherited mutations in the [[BRCA2]] [[gene]], [[Peutz-Jeghers syndrome]] due to mutations in the STK11 tumor suppressor gene, [[hereditary non-polyposis colon cancer]] (Lynch syndrome), familial adenomatous polyposis, and the familial atypical multiple mole melanoma-pancreatic cancer syndrome (FAMMM-PC) due to mutations in the ''[[CDKN2A]]'' tumor suppressor gene.<ref>{{cite journal |author=Efthimiou E, Crnogorac-Jurcevic T, Lemoine NR, Brentnall TA |year=2001 |month=Feb |title=Inherited predisposition to pancreatic cancer |journal=Gut |volume=48 |issue=2 |pages=143-7 |id=PMID 11156628 |url=}}</ref>
*''[[Helicobacter pylori]]'' infection
*Gingivitis or periodontal disease<ref>{{cite journal |author=Michaud DS, Joshipura K, Giovannucci E, Fuchs CS |title=A prospective study of periodontal disease and pancreatic cancer in US male health professionals |journal=J. Natl. Cancer Inst. |volume=99 |issue=2 |pages=171-5 |year=2007 |pmid=17228001 |doi=10.1093/jnci/djk021}}</ref>


===Alcohol===
It is controversial whether alcohol consumption is a risk factor for pancreatic cancer. Drinking alcohol excessively is a major cause of [[chronic pancreatitis]], which in turn predisposes to pancreatic cancer, but chronic pancreatitis that is due to alcohol doesn't increase risk as much as other types of chronic pancreatitis.<ref name=cruk>[[Cancer Research UK]] [http://www.cancerhelp.org.uk/help/default.asp?page=3102#alcohol Pancreatic cancer risks and causes]</ref> Overall, the association is consistently weak and the majority of studies have found no association.<ref name=aa21>[[National Institute on Alcohol Abuse and Alcoholism]] [http://pubs.niaaa.nih.gov/publications/aa21.htm Alcohol and Cancer - Alcohol Alert No. 21-1993]</ref><ref>[[American Cancer Society]] [http://www.cancer.org/docroot/NWS/content/update/NWS_1_1xU_Coffee_and_Alcohol_Do_Not_Pose_a_Risk_for_Pancreatic_Cancer.asp Coffee and Alcohol Do Not Pose a Risk for Pancreatic Cancer]</ref><ref>Villeneuve PJ, Johnson KC, Hanley AJ, Mao Y [http://www.ncbi.nlm.nih.gov/pubmed/10777010 Alcohol, tobacco and coffee consumption and the risk of pancreatic cancer: results from the Canadian Enhanced Surveillance System case-control project. Canadian Cancer Registries Epidemiology Research Group] ''Eur J Cancer Prev'' 2000 Feb;9(1):49-58. PMID: 10777010</ref><ref name=Michaud/>


Some studies suggest a relationship,<ref>Ahlgren, J. D., ''et al''. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8623060&dopt=Abstract Epidemiology and risk factors in pancreatic cancer] ''Seminars in Oncology'', 1996, ''23(2)'', 241-250.</ref> with risk increasing with increasing amount of alcohol intake.<ref>Cuzick J, Babiker AG [http://www.ncbi.nlm.nih.gov/pubmed/2925272 Pancreatic cancer, alcohol, diabetes mellitus and gall-bladder disease] ''Int J Cancer'' 1989 Mar 15;43(3):415-21</ref><ref>Harnack LJ, Anderson KE, Zheng W, Folsom AR, Sellers TA, Kushi LH [http://www.ncbi.nlm.nih.gov/pubmed/9419407 Smoking, alcohol, coffee, and tea intake and incidence of cancer of the exocrine pancreas: the Iowa Women's Health Study] ''Cancer Epidemiol Biomarkers Prev'' 1997 Dec;6(12):1081-6 PMID: 9419407</ref> Risk is greatest in heavy drinkers<ref>Schottenfeld, D. and J. Fraumeni, ed. Cancer epidemiology and prevention. 2nd ed., ed. Vol. 1996, Oxford University Press: Oxford</ref><ref name=Ye>W Ye, J Lagergren, E Weiderpass, O Nyrén, H-O Adami, A Ekbom [http://gut.bmj.com/cgi/content/abstract/51/2/236 Alcohol abuse and the risk of pancreatic cancer] ''Gut'' 2002;51:236-239</ref><ref name=Silverman>Silverman DT, Brown LM, Hoover RN, Schiffman M, Lillemoe KD, Schoenberg JB, Swanson GM, Hayes RB, Greenberg RS, Benichou J, et al [http://www.ncbi.nlm.nih.gov/pubmed/7585527?dopt=Abstract Alcohol and pancreatic cancer in blacks and whites in the United States] ''Cancer Res'', 1995. 55(21): p. 4899-905. PMID: 7585527</ref> mostly on the order of four or more drinks per day.<ref>G W Olsen, J S Mandel, R W Gibson, L W Wattenberg and L M Schuman [http://www.ajph.org/cgi/reprint/79/8/1016 A case-control study of pancreatic cancer and cigarettes, alcohol, coffee and diet] ''American Journal of Public Health'' Vol. 79, Issue 8 1016–1019</ref> There appears to be no increased risk for people consuming up to 30g of alcohol a day,<ref name=Michaud>Michaud DS, Giovannucci E, Willett WC, Colditz GA, Fuchs CS [http://www.ncbi.nlm.nih.gov/pubmed/11352851 Coffee and alcohol consumption and the risk of pancreatic cancer in two prospective United States cohorts] ''Cancer Epidemiol Biomarkers Prev'' 2001 May;10(5):429-37 PMID: 11352851</ref><ref>[http://info.cancerresearchuk.org/cancerstats/types/pancreas/riskfactors/ Pancreatic cancer risk factors]</ref> so most of the U.S. consumes alcohol at a level that "is probably not a risk factor for pancreatic cancer."<ref name=Silverman/>
**[[Hereditary pancreatitis]]
**Familial [[pancreatic cancer]]
**[[Peutz-Jeghers syndrome|Peutz-Jeghers disease]]
**Familial atypical mole melanoma syndrome (FAMMM)
**[[Cystic fibrosis]] of pancreas
**Familial [[cancer]] syndromes such as:
***[[Lynch syndrome]]
***[[Familial adenomatous polyposis]] ([[FAP]])
***[[Von Hippel-Lindau disease|Von Hippel-Lindau syndrome]]
***[[Multiple endocrine neoplasia type 1]]
***Hereditary [[Breast cancer|breast]] and [[ovarian cancer]]-[[BRCA1]] and [[BRCA2]] mutations


Several studies caution that their findings could be due to confounding factors.<ref name=Ye/><ref>Zatonski WA, Boyle P, Przewozniak K, Maisonneuve P, Drosik K, Walker AM [http://www.ncbi.nlm.nih.gov/pubmed/8436433 Cigarette smoking, alcohol, tea and coffee consumption and pancreas cancer risk: a case-control study from Opole, Poland] ''Int J Cancer'' 1993 Feb 20;53(4):601-7 PMID: 8436433</ref> Even if a link exists, it "could be due to the contents of some alcoholic beverages"<ref>Durbec JP, Chevillotte G, Bidart JM, Berthezene P, Sarles H. [http://www.ncbi.nlm.nih.gov/pubmed/6849792 Diet, alcohol, tobacco and risk of cancer of the pancreas: a case-control study] ''Br J Cancer'' 1983 Apr;47(4):463-70.</ref> other than the alcohol itself. One Dutch study even found that drinkers of white wine had lower risk.<ref>Bueno de Mesquita HB, Maisonneuve P, Moerman CJ, Runia S, Boyle P. [http://www.ncbi.nlm.nih.gov/pubmed/1537615 Lifetime consumption of alcoholic beverages, tea and coffee and exocrine carcinoma of the pancreas: a population-based case-control study in The Netherlands] ''Int J Cancer'' 1992 Feb 20;50(4):514-22 PMID: 1537615</ref>
*Risk factors for [[Pancreatic cancer]] are illustrated in the following tables:
 
*'''Risk factors for Pancreatic Cancers:'''<ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref>
 
{|
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Risk factors for Pancreatic Cancer'''
|+
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Risk factors'''
|-
| style="background:#F5F5F5; + " |
*[[Smoking]]
|-
| style="background:#F5F5F5; + " |
*[[Alcohol]]
|-
| style="background:#F5F5F5; + " |
*Increased [[Body mass index|BMI]]
|-
| style="background:#F5F5F5; + " |
*[[Diabetes mellitus]]
|-
| style="background:#F5F5F5; + " |
*[[Chronic pancreatitis]]
|-
| style="background:#F5F5F5; + " |
*Family history of pancreatic cancer
|-
|+
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Familial Cancer Syndromes'''
|+
|-
| style="background:#F5F5F5; + " |
*[[BRCA1]], [[BRCA2]]
|-
| style="background:#F5F5F5; + " |
*[[Familial adenomatous polyposis]] (FAP)
|-
| style="background:#F5F5F5; + " |
*[[Peutz-Jeghers syndrome]]
|-
| style="background:#F5F5F5; + " |
*Familial atypical multiple mole melanoma syndrome (FAMMM)
|-
| style="background:#F5F5F5; + " |
*[[Hereditary nonpolyposis colorectal cancer|Lynch syndrome]]
|-
| style="background:#F5F5F5; + " |
*[[Von Hippel-Lindau disease|Von Hippel-Lindau syndrome]]
|-
| style="background:#F5F5F5; + " |
*[[Multiple endocrine neoplasia type 1]]
|-
| style="background:#F5F5F5; + " |
*[[Gardner's syndrome|Gardner syndrome]]
|-
|+
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Other medical conditions'''
|+
|-
| style="background:#F5F5F5; + " |
*[[Inflammatory bowel disease]]
|-
| style="background:#F5F5F5; + " |
*Periodontal disease
|-
| style="background:#F5F5F5; + " |
*[[Peptic ulcer disease]]
|-
|}
 
<br />
*'''Risk Factors and Inherited Syndromes associated with Pancreatic Cancer:'''<ref name="pmid25207767">{{cite journal| author=Ryan DP, Hong TS, Bardeesy N| title=Pancreatic adenocarcinoma. | journal=N Engl J Med | year= 2014 | volume= 371 | issue= 11 | pages= 1039-49 | pmid=25207767 | doi=10.1056/NEJMra1404198 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25207767  }} </ref>
 
{|
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Risk Factors and Inherited Syndromes associated with Pancreatic Cancer'''
|+
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + | '''Risk Factor'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + | '''Approximate Risk'''
|-
| style="background:#DCDCDC; + " | [[Smoking]]
| style="background:#F5F5F5; + " | 2-3 %
|-
| style="background:#DCDCDC; + " | Long-standing [[Diabetes mellitus]]
| style="background:#F5F5F5; + " | 2 %
|-
| style="background:#DCDCDC; + " | Nonhereditary and [[chronic pancreatitis]]
| style="background:#F5F5F5; + " | 2-6 %
|-
| style="background:#DCDCDC; + " | [[Obesity]], Inactivity or both
| style="background:#F5F5F5; + " | 2 %
|-
| style="background:#DCDCDC; + " | Non O Blood Group
| style="background:#F5F5F5; + " | 1-2 %
|+
| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Genetic Syndrome and Associated Gene or Genes'''
|+
|-
| style="background:#DCDCDC; + " | [[Hereditary pancreatitis]] (PRSS1, SPINK1)
| style="background:#F5F5F5; + " | 50 %
|-
| style="background:#DCDCDC; + " | ''Familial atypical multiple mole and melanoma syndrome'' (p16)
| style="background:#F5F5F5; + " | 10-20 %
|-
| style="background:#DCDCDC; + " | Hereditary [[Breast cancer|breast]] and [[ovarian cancer]] syndromes ([[BRCA1]], [[BRCA2]], PALB2)
| style="background:#F5F5F5; + " | 1-2 %
|-
| style="background:#DCDCDC; + " | [[Peutz-Jeghers syndrome]] (STK11 [LKB1])
| style="background:#F5F5F5; + " | 30-40 %
|-
| style="background:#DCDCDC; + " | [[Hereditary nonpolyposis colorectal cancer]] ([[Lynch syndrome]]) ([[MLH1]], [[MSH2]], [[MSH6]])
| style="background:#F5F5F5; + " | 4 %
|-
| style="background:#DCDCDC; + " | [[Ataxia telangiectasia|Ataxia-telangiectasia]] (ATM)
| style="background:#F5F5F5; + " | Unknown
|-
| style="background:#DCDCDC; + " | [[Li-Fraumeni syndrome]] (P53)
| style="background:#F5F5F5; + " | Unknown
|-
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 17:21, 14 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]

Overview

Pancreatic cancer is associated with number of predisposing risk factors such as age, gender, ethnicity, and environmental exposures. The most potent risk factors for pancreatic cancer include smoking, alcoholism, increased BMI, diabetes mellitus, chronic pancreatitis and a family history of pancreatic cancer. Individuals with hereditary pancreatitis, familial pancreatic cancer, Peutz-Jeghers disease, familial atypical multiple mole melanoma syndrome (FAMMM), von Hippel-Lindau syndrome, multiple endocrine neoplasia type 1, cystic fibrosis of the pancreas and familial cancer syndromes such as lynch syndrome, familial adenomatous polyposis (FAP) and hereditary breast and ovarian cancer-BRCA1 and BRCA2 mutations are also at an increased risk of pancreatic cancer. Other medical conditions which pose as a risk factor for pancreatic cancer are inflammatory bowel disease, periodontal disease and peptic ulcer disease.

Risk Factors


  • Risk factors for Pancreatic Cancers:[4]
Risk factors for Pancreatic Cancer
Risk factors
  • Family history of pancreatic cancer
Familial Cancer Syndromes
  • Familial atypical multiple mole melanoma syndrome (FAMMM)
Other medical conditions
  • Periodontal disease


  • Risk Factors and Inherited Syndromes associated with Pancreatic Cancer:[5]
Risk Factors and Inherited Syndromes associated with Pancreatic Cancer
Risk Factor Approximate Risk
Smoking 2-3 %
Long-standing Diabetes mellitus 2 %
Nonhereditary and chronic pancreatitis 2-6 %
Obesity, Inactivity or both 2 %
Non O Blood Group 1-2 %
Genetic Syndrome and Associated Gene or Genes
Hereditary pancreatitis (PRSS1, SPINK1) 50 %
Familial atypical multiple mole and melanoma syndrome (p16) 10-20 %
Hereditary breast and ovarian cancer syndromes (BRCA1, BRCA2, PALB2) 1-2 %
Peutz-Jeghers syndrome (STK11 [LKB1]) 30-40 %
Hereditary nonpolyposis colorectal cancer (Lynch syndrome) (MLH1, MSH2, MSH6) 4 %
Ataxia-telangiectasia (ATM) Unknown
Li-Fraumeni syndrome (P53) Unknown

References

  1. ↑ Goral V (2015). "Pancreatic Cancer: Pathogenesis and Diagnosis". Asian Pac J Cancer Prev. 16 (14): 5619–24. PMID 26320426.
  2. ↑ Pandol, Stephen; Gukovskaya, Anna; Edderkoui, Mouad; Dawson, David; Eibl, Guido; Lugea, Aurelia (2012). "Epidemiology, risk factors, and the promotion of pancreatic cancer: Role of the stellate cell". Journal of Gastroenterology and Hepatology. 27: 127–134. doi:10.1111/j.1440-1746.2011.07013.x. ISSN 0815-9319.
  3. ↑ Lowenfels, Albert B.; Maisonneuve, Patrick (2005). "Risk factors for pancreatic cancer". Journal of Cellular Biochemistry. 95 (4): 649–656. doi:10.1002/jcb.20461. ISSN 0730-2312.
  4. ↑ Bond-Smith G, Banga N, Hammond TM, Imber CJ (2012). "Pancreatic adenocarcinoma". BMJ. 344: e2476. doi:10.1136/bmj.e2476. PMID 22592847.
  5. ↑ Ryan DP, Hong TS, Bardeesy N (2014). "Pancreatic adenocarcinoma". N Engl J Med. 371 (11): 1039–49. doi:10.1056/NEJMra1404198. PMID 25207767.

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