Pancreas Cancer: An Epidemiologic Perspective
Paul K. Mills, Ph.D., M.P.H.
Department of Internal Medicine
UCSF Fresno
Cancer Registry of Central California
Five Year Relative Survival With Pancreas Cancer in California, 2000-2008
Time Trends in Pancreas Cancer Incidence Rates in the U.S.,
1973-2007, SEER data
Twelve Most Frequent Cancers in California, by Incidence Counts and Deaths,
2010
25000
20000
15000
Count
10000
Cases
Deaths
5000
0
Number of New Pancreas Cancer Cases and Deaths, 2009, by Location
Location
New cases
Deaths
SAMC, Fresno
40
31
Fresno County
80
65
California
3,881
3,543
United States
42,470
35,240
World
?????
227,000
Age Adjusted Pancreas Cancer Incidence Rates in
California, 1988-2009 by Race/ethnicity and sex
Age –adjusted Pancreas cancer Mortality rates, Worldwide, 2008 (Globocan)
Age adjusted pancreas cancer mortality rates in the U.S., 2007,
All races
Age adjusted pancreas cancer incidence rates, U.S., 2008, All
Races
Age adjusted pancreas cancer incidence rates in California, 2005-2009, all
race/ethnicities
Age adjusted pancreas cancer incidence among NH Blacks in
California, 2005-2009
Age adjusted pancreas cancer mortality rates in California, NH
Blacks, 2005-2009
Age specific incidence rates of Pancreas cancer in California,
1988-2008
Recent trends in cancer mortality rates in the U.S., 2003-2007
Joinpoint analysis of U.S. Panceas cancer incidence rates, 19752007
Endocrine vs. exocrine Incidence Rates, U.S., 1977-2005, SEER Data
Age Adjusted Incidence and Mortality Rates from Pancreas Cancer, California,
1988-2008
12
11.5
11
10.5
Rate/100,000
Inicdence Rate
10
Mortality rate
9.5
9
8.5
Year of Dx or Death
Pancreas cancer Stage at Diagnosis, 1988-2008,
California
Rate
6
5
4
Rate/100,000 3
2
1
0
Localized
Regional, direct
extension only
Regional, regional
lymph nodes only
Regional, direct
extension and
regional lymph nodes
Distant
Unstaged
Stage at Diagnosis, Pancreas Cancer, 1988-2008, by Race/Ethnicity, California
1995-2009 SAMC Pancreas Cancer
Stage at Diagnosis by 5 Year Intervals
N=528
1995-1999
2000-2004
2005-2009
N=172
N=164
N=192
60%
55%
52%
49%
50%
40%
30%
20% 19%
20%
13%
7%
10%
8%
1% 1% 2%
4%
0
I
17% 16%
12%
9%
10%
5%
0%
II
III
Stage at Diagnosis
IV
Unk/NA
Molecular Genetics of Pancreatic Cancer
Gene
Prevalence
K-ras2 mutation
80-95%
CDKN2 (P16) mutation, deletion or
hypermethylation
85-98%
P53 mutation
50%
Smad4 homozygous deletions or
mutations
55%
BRCA-2 mutations
??
Risk Factors for Pancreas Cancer
Risk factor
Altered risk
Smoking
2-3 X
Caloric intake, physical activity, obesity
~2X
Chronic pancreatitis
2X
Family Hx pancreas ca
7X
Diabetes
2-3X
Primary scherosing cholangitis
Hereditary pancreatitis
60X
Smoking—IARC Statement, (2004)
• “Cancer of the pancreas is causally associated with cigarette
smoking. The risk increases with duration of smoking and
number of cigarettes smoked daily. The risk remains elevated
after allowing for potentially confounding factors such as
alcohol consumption. The relative risk decreased with
increasing time since quitting smoking”
Precursor Lesions for pancreas Cancer
Lesion
Pancreatic intraepithial Neoplasia
Chronic inflammation
Mechanism
Prevention and Deterrence of Pancreas Cancer
• Smoking is the most significant reversible risk factor for pancreas cancer.
Estimates indicate that smoking accounts for up to 30% of cases of
pancreas cancer.
• A diet high in energy intake and low in fresh fruits and vegetables
increases risk of pancreas cancer.
• Alcohol consumption does not increase risk of pancreas cancer unless it
leads to chronic pancreatitis.
• Aspirin consumption????