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Epidemiology and risk factors of pancreatic cancer
(Lancet 2016;388:73)
- Incidence: Estimated ∼60,430 new cases/y & ∼48,220 deaths/y in the United States (NCI SEER); increasing incidence, particularly early onset (<50 yo) (Lancet 2019;4(3):E137); 4th most common cause of CA deaths in U.S. men & women; estimated to be 2nd leading cause of CA-related mortality by 2030 (Cancer Res 2014;74:2913)
- Acquired RFs: Age (median: 70 yo), race, tobacco, EtOH, ↑ BMI, chronic pancreatitis, occupational exposure, DM
- Acquired risk factors: smoking (RR ~1.5; 25% cases), obesity, chronic pancreatitis, T2DM
- Hereditary (5–10%) RFs: ↑ Risk w/ FHx, ∼5–15% pts have genetic predisposition - Inherited susceptibility to pancreatic CA (NEJM 2008;359:2143)
- Familial atypical multiple-mole melanoma syn, CDKN2A (p16) (15% lifetime risk)
- Hereditary breast CA syn, BRCA2 (5% lifetime risk) > BRCA1 > PALB2
- Lynch syn, MSH2, & MLH1
- Peutz–Jeghers syn, STK11 (30% lifetime risk)
- Ataxia–telangiectasia, ATM
- Hereditary chronic pancreatitis syn, germline muts in cationic trypsinogen (PRSS1) or secretory trypsin inhibitor (SPINK1) (40% lifetime risk)
- NOTE FDRs of individuals w/ familial pancreatic CA → EUS + MRI (Gut 2013;62:339)