Pancreatic
cancer (text produced by )
Incidence and mortality
Cancer of the pancreas is the tenth most frequent cancer in Europe,
accounting for some 3% of cancer in both sex (Ferlay 1999). In the
year 2000 an estimated 74,000 new cases were diagnosed in Europe (Ferlay
2001). There is substantial geographical variation in the annual incidence
of pancreatic cancer with the highest rates being seen in the USA,
particularly in black men (12 per 100,000)(Parkin 1997). In European
men, the annual incidence rates (world age-standardised) ranged between
8.7 (East) and 6.7 (North) per 100,000, while in women between 5.2
(North) and 4.6 (West). The lowest rates are generally found in Africa
and some Asian countries (less than 2), although Japan, which has
seen a substantial increase in rates in recent decades, now has rates
similar to those seen in the USA (Parkin 1997. Men have approximately
a one-half greater age adjusted incidence rate than women (Ferlay
1999). Incidence increases steeply with age from 2 per 100,000/year
in patients 40-44 years aged to 67 per 100,000/year in old patients
with more than 75 year of age (Ferlay 1999). In Europe, the highest
mortality rates occur in Austria and Sweden (around 11 per 100,000/year).
The corresponding rates in southern Europe (Spain, Portugal and Greece)
are generally lower. Mortality rates in Japan are now similar to rates
in Western countries (Ferlay 1999).
Survival
The prognosis of patients with pancreatic cancer is one of the worst
among all cancers. From the EUROCARE study, based on 31,312 European
cases (Faivre 1998), survival at 1, 3 and 5 years was 16, 5 and
4% respectively. Five-year survival was better in patients with
15-44 year of age, with 15% compared with 6% or less for the 45
and more years of age patients. Survival were similar in both sexes.
There were no changes in 1, 3 and 5-year relative survival rates
of pancreatic cancers over time. Most cases present with relatively
advanced disease and unresectable tumours. In Finland, between 1985
and 1994, 61% of the patients already had metastatic stage at diagnosis
(Dickman 1999).
Prevalence
Prevalence of pancreatic cancer, that is the number of people living
with a diagnosis of pancreatic cancer, is known for Italian cancer
registries (Micheli 1999). As for all very unfavourable cancers,
prevalence is very low: about 10 people every 100.000 living with
a diagnosis of pancreatic cancer.
Risk factors
The pancreas is intimately related to digestion and absorption,
and it is reasonable to place diet high among the possible casual
factors for pancreatic carcinoma. However, the pancreas is never
exposed, either directly or indirectly (via the liver), to ingested
or absorbed foods. So, the effects of diet on carcinogenesis in
the pancreas are via changes in the internal metabolic environment
of that organ, exposure to blood-borne agents or, more probably,
both. It appears probable that mutations in cellular proto-oncogenes
and tumour-suppressor genes are central to pancreatic carcinogenesis.
The role of diet is not established, but there are some carcinogens
e.g., aromatic and heterocyclic amines (from diet and cigarette
smoke), and some kinds of known DNA damage (particularly oxidative
damage), which could produce such mutations. The WCRF and AICR panel
of experts (WCRF& AICR 1997) reached the following conclusions
on dietary factors. Diet high in vegetables and fruits are probably
protective against pancreatic cancer. The panel noted that fibre
and vitamin C, as found in foods of plant origin, are possibly also
protective, and the diets containing substantial amounts of red
meat and cholesterol possibly increase risk. Alcohol, and regular
consumption of coffee, probably do not affect risk of this cancer.
The most effective dietary means of preventing pancreatic cancer
is consumption of diets high in vegetables and fruits and, possibly,
only occasional consumption of red meat. An establish non-dietary
cause of pancreatic cancer is smoking (Stewart 2003). About 30%
of cases of pancreatic cancer are attributable to smoking. Cigarette
smokers develop this disease 2 to 3 times more often than non-smokers.
Working in mines, metalworks, sawmills, chemical plants, coke plants,
rubber factories, and the petrochemical industry have been variously
indicated as risk factors, as has exposure to solvents, napthylamine,
benzidine, and polychlorinated biphenyl used in transformers. Chronic
and hereditary pancreatitis, cirrhosis and possibly diabetes are
other risk factors. The sex ratio of pancreatic cancer incidence
has suggested a role for sex hormones in disease development (Gold
1998).
Bibliografy
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and prevalence in the European Union. Lyon: IARC Press. 1999
- Ferlay J, Bray F, Pisani P, Parkin DM. Cancer incidence, mortality
and prevalence worldwide, version 1.0. Lyon: IARC Press. IARC
Cancer Base No. 5. 2001.
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Cancer incidence in five continents. Lyon: International Agency
for Research on cancer. Vol. VII. IARC Scient. Publ. No. 120.
1997.
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of patients with primary liver cancer, pancreatic cancer and biliary
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Soderman B, et al.Survival
of cancer patients in Finland 1955-1994. Acta Oncol 1999;
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Cancer Research, Food, Nutrition and Prevention of Cancer: a Global
Perspective. American Institute of Cancer Research, Washington.
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- Stewart BW, Kleihus P, Editors. World Cancer Report. Lyon:
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