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INTRODUCTION

Pancreatic cancer is the third leading cause of death from cancer in the United States with >53,000 Americans diagnosed and >43,000 dying from the disease each year. Unfortunately, pancreatic cancer is projected to be the second leading cause of death from cancer in the United States by 2030. Worldwide pancreatic cancer is the eleventh most common cancer with 338,000 new patients diagnosed and >334,000 deaths (seventh cause of cancer deaths). Pancreatic cancer currently has the worst survival rate of any cancer with an overall 5-year survival (regardless of stage) of ~8.2%. However, that situation is changing because some advances have been made against the disease with some improvements in survival (see below) that may affect the 5-year survival statistics. In particular, knowledge about specific molecular subsets of the disease has become crucial so that one can provide the best possible care for their patients with pancreatic cancer.

EPIDEMIOLOGY

Pancreatic cancer accounts for 3.2% of all new cancer cases in the United States and for 7.2% of all deaths from cancer in the United States. The lifetime risk of developing pancreatic cancer is ~1.6%. The incidence of pancreatic cancer has been increasing between 0.5 and 1% per year. Pancreatic cancer is more common with increasing age and more common in men than in women. The 5-year survival rate for all stages has increased from 3% in 1975 to 8.2% in 2013. The latest information from the U.S. Surveillance, Epidemiology, and End Results (SEER) database predicts that the 5-year survival for patients with localized pancreatic cancer is about 31.5%, 11.5% for those with regional disease, and 2–5% for patients with advanced metastatic disease. Pancreatic cancer is more common in developed countries (although generally it tracks with the prevalence of smoking). The incidence is highest in North America and Western Europe followed by other areas in Europe, Australia, New Zealand, and South-Central Asia. Of note is that the population at greatest risk are women living in Scandinavian countries, while the lowest risk is seen for women living in middle Africa.

RISK FACTORS

Age is one of the greatest risk factors for pancreatic cancer with median age at diagnosis of 70 years (the disease is most frequently diagnosed in the 65–74 age group). The number of new cases per 100,00 persons and the number of deaths per 100,000 persons are higher for males and blacks of both sexes. Both the number of cases and the number of deaths per 100,000 people are lower for American Indian/Alaskan natives and Asian Pacific Islanders. Both the number of cases and deaths are intermediate for the Hispanic population.

Environment

The greatest risk factor for pancreatic cancer is cigarette smoking. The risk correlates with the increased number of cigarettes smoked. It has been estimated that 30% of pancreatic cancer is caused by smoking. Exposure to cadmium as part of cigarette ...

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