Pancreatic cancer and obesity: epidemiology, mechanism, and preventive strategies

  • Prashanth RawlaEmail author
  • Krishna Chaitanya Thandra
  • Tagore Sunkara
Clinical Review


The prevalence of obesity has seen a global increase in the past decades, escalating to one of the major epidemiological challenges today. Global economic growth has caused changes in dietary and physical activity patterns fueling obesity across age, gender, and income groups. The implications are many, as obesity has been associated with numerous serious health conditions, ultimately affecting morbidity and mortality. There is a growing recognition of the risk a high body mass index confers on the development and outcome of several malignancies, including pancreatic cancer. Pancreatic cancer is a highly lethal disease with exceptionally poor outcome, with incidences rising worldwide. Due to vague symptoms and no screening recommendations, a vast majority of patients are diagnosed at late stages, with already advanced disease and no opportunity for surgical intervention. Obesity mediates risk for pancreatic cancer through insufficiently understood mechanisms, possibly including inflammation and hormonal misbalance. As excess abdominal adiposity is among the few modifiable risk factors for pancreatic cancer onset, enduring weight loss could manifest an effective preventive measure. Lifestyle modifications on a population level aimed to reduce obesity could also scale down the grim pancreatic cancer rates. In cases when these measures alone are insufficiently effective, bariatric surgery can be an advantageous alternative. Extremely obese patients exhibit many health benefits following bariatric surgery along with weight loss, consequently reducing the chances of pancreatic cancer, especially if additionally adopting healthy lifestyle habits.


Obesity Pancreatic cancer Epidemiology Weight loss Bariatric surgery 


Author contributions

Conception and design, analysis and interpretation, drafting of the article, critical revision of the article and final approval of the article: PR, KCT, TS.


No funding to disclose.

Compliance with ethical standards

Conflict of interest

None of the authors have a conflict of interest.

Ethics approval

No ethics approval needed.


  1. 1.
    Arroyo-Johnson C, Mincey KD. Obesity epidemiology worldwide. Gastroenterol Clin North Am. 2016;45:571–9.CrossRefGoogle Scholar
  2. 2.
    Hruby A, Hu FB. The epidemiology of obesity: a big picture. Pharmacoeconomics. 2015;33:673–89.CrossRefGoogle Scholar
  3. 3.
    Polednak AP. Estimating the number of U.S. incident cancers attributable to obesity and the impact on temporal trends in incidence rates for obesity-related cancers. Cancer Detect Prev. 2008;32:190–9.CrossRefGoogle Scholar
  4. 4.
  5. 5.
    Kelly T, Yang W, Chen CS, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008;32:1431–7.CrossRefGoogle Scholar
  6. 6.
    von Ruesten A, Steffen A, Floegel A, et al. Trend in obesity prevalence in European adult cohort populations during follow-up since 1996 and their predictions to 2015. PLoS One. 2011;6:e27455.CrossRefGoogle Scholar
  7. 7.
    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311:806–14.CrossRefGoogle Scholar
  8. 8.
    Collaborators GBDO, Afshin A, Forouzanfar MH, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27.CrossRefGoogle Scholar
  9. 9.
    Liang YJ, Xi B, Song AQ, et al. Trends in general and abdominal obesity among Chinese children and adolescents 1993–2009. Pediatr Obes. 2012;7:355–64.CrossRefGoogle Scholar
  10. 10.
    Biadgilign S, Mgutshini T, Haile D, et al. Epidemiology of obesity and overweight in sub-Saharan Africa: a protocol for a systematic review and meta-analysis. BMJ Open. 2017;7:e017666.CrossRefGoogle Scholar
  11. 11.
    Nishida C, Mucavele P. Monitoring the rapidly emerging public health problem of overweight and obesity: the WHO global database on body mass index. SCN News 2005;29:5–11.Google Scholar
  12. 12.
    Ilic M, Ilic I. Epidemiology of pancreatic cancer. World J Gastroenterol. 2016;22:9694–705.CrossRefGoogle Scholar
  13. 13.
    Michaud DS. Obesity and pancreatic cancer. Recent Results Cancer Res. 2016;208:95–105.CrossRefGoogle Scholar
  14. 14.
    Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.CrossRefGoogle Scholar
  15. 15.
    Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.CrossRefGoogle Scholar
  16. 16.
    Vrieling A, Bueno-de-Mesquita HB, Boshuizen HC, et al. Cigarette smoking, environmental tobacco smoke exposure and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2010;126:2394–403.Google Scholar
  17. 17.
    Michaud DS. Epidemiology of pancreatic cancer. Minerva Chir. 2004;59:99–111.Google Scholar
  18. 18.
    Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144:1252–61.CrossRefGoogle Scholar
  19. 19.
    Ferlay J, Partensky C, Bray F. More deaths from pancreatic cancer than breast cancer in the EU by 2017. Acta Oncol. 2016;55:1158–60.CrossRefGoogle Scholar
  20. 20.
    Bosetti C, Bertuccio P, Negri E, et al. Pancreatic cancer: overview of descriptive epidemiology. Mol Carcinog. 2012;51:3–13.CrossRefGoogle Scholar
  21. 21.
    Fogel EL, Shahda S, Sandrasegaran K, et al. A multidisciplinary approach to pancreas cancer in 2016: a review. Am J Gastroenterol. 2017;112:537–54.CrossRefGoogle Scholar
  22. 22.
    Arslan AA, Helzlsouer KJ, Kooperberg C, et al. Anthropometric measures, body mass index, and pancreatic cancer: a pooled analysis from the Pancreatic Cancer Cohort Consortium (PanScan). Arch Intern Med. 2010;170:791–802.CrossRefGoogle Scholar
  23. 23.
    Genkinger JM, Spiegelman D, Anderson KE, et al. A pooled analysis of 14 cohort studies of anthropometric factors and pancreatic cancer risk. Int J Cancer. 2011;129:1708–17.CrossRefGoogle Scholar
  24. 24.
    Jiao L, Berrington de Gonzalez A, Hartge P, et al. Body mass index, effect modifiers, and risk of pancreatic cancer: a pooled study of seven prospective cohorts. Cancer Causes Control. 2010;21:1305–14.CrossRefGoogle Scholar
  25. 25.
    Berrington de Gonzalez A, Sweetland S, Spencer E. A meta-analysis of obesity and the risk of pancreatic cancer. Br J Cancer. 2003;89:519–23.CrossRefGoogle Scholar
  26. 26.
    Larsson SC, Orsini N, Wolk A. Body mass index and pancreatic cancer risk: a meta-analysis of prospective studies. Int J Cancer. 2007;120:1993–8.CrossRefGoogle Scholar
  27. 27.
    Pang Y, Holmes MV, Kartsonaki C, et al. Young adulthood and adulthood adiposity in relation to incidence of pancreatic cancer: a prospective study of 0.5 million Chinese adults and a meta-analysis. J Epidemiol Community Health. 2017;71:1059–67.Google Scholar
  28. 28.
    Carreras-Torres R, Johansson M, Gaborieau V, et al. The role of obesity, type 2 diabetes, and metabolic factors in pancreatic cancer: a mendelian randomization study. J Natl Cancer Inst 2017;109:djx012.CrossRefGoogle Scholar
  29. 29.
    Parkin DM, Boyd L, Walker LC. 16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer. 2011;105(Suppl 2):77–81.CrossRefGoogle Scholar
  30. 30.
    Reeves GK, Pirie K, Beral V, et al. Cancer incidence and mortality in relation to body mass index in the Million women study: cohort study. BMJ. 2007;335:1134.CrossRefGoogle Scholar
  31. 31.
    Aune D, Greenwood DC, Chan DS, et al. Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol. 2012;23:843–52.CrossRefGoogle Scholar
  32. 32.
    Calle EE, Rodriguez C, Jacobs EJ, et al. The American cancer society cancer prevention study II nutrition cohort: rationale, study design, and baseline characteristics. Cancer. 2002;94:2490–501.CrossRefGoogle Scholar
  33. 33.
    Luo J, Margolis KL, Adami HO, et al. Obesity and risk of pancreatic cancer among postmenopausal women: the Women’s Health Initiative (United States). Br J Cancer. 2008;99:527–31.CrossRefGoogle Scholar
  34. 34.
    Genkinger JM, Kitahara CM, Bernstein L, et al. Central adiposity, obesity during early adulthood, and pancreatic cancer mortality in a pooled analysis of cohort studies. Ann Oncol. 2015;26:2257–66.CrossRefGoogle Scholar
  35. 35.
  36. 36.
    Cascetta P, Cavaliere A, Piro G, et al. Pancreatic cancer and obesity: molecular mechanisms of cell transformation and chemoresistance. Int J Mol Sci. 2018;19:3331.CrossRefGoogle Scholar
  37. 37.
    Incio J, Liu H, Suboj P, et al. Obesity-induced inflammation and desmoplasia promote pancreatic cancer progression and resistance to chemotherapy. Cancer Discov. 2016;6:852–69.CrossRefGoogle Scholar
  38. 38.
    Aleman JO, Eusebi LH, Ricciardiello L, et al. Mechanisms of obesity-induced gastrointestinal neoplasia. Gastroenterology. 2014;146:357–73.CrossRefGoogle Scholar
  39. 39.
    Larsson SC, Wolk A. Red and processed meat consumption and risk of pancreatic cancer: meta-analysis of prospective studies. Br J Cancer. 2012;106:603–7.CrossRefGoogle Scholar
  40. 40.
    Coss A, Cantor KP, Reif JS, et al. Pancreatic cancer and drinking water and dietary sources of nitrate and nitrite. Am J Epidemiol. 2004;159:693–701.CrossRefGoogle Scholar
  41. 41.
    Risch HA. Etiology of pancreatic cancer, with a hypothesis concerning the role of N-nitroso compounds and excess gastric acidity. J Natl Cancer Inst. 2003;95:948–60.CrossRefGoogle Scholar
  42. 42.
    Makki K, Froguel P, Wolowczuk I. Adipose tissue in obesity-related inflammation and insulin resistance: cells, cytokines, and chemokines. ISRN Inflamm. 2013;2013:139239.CrossRefGoogle Scholar
  43. 43.
    Harbuzariu A, Rampoldi A, Daley-Brown DS, et al. Leptin-Notch signaling axis is involved in pancreatic cancer progression. Oncotarget. 2017;8:7740–52.CrossRefGoogle Scholar
  44. 44.
    Loebig M, Klement J, Schmoller A, et al. Evidence for a relationship between VEGF and BMI independent of insulin sensitivity by glucose clamp procedure in a homogenous group healthy young men. PLoS One. 2010;5:e12610.CrossRefGoogle Scholar
  45. 45.
    Chang HH, Moro A, Takakura K, et al. Incidence of pancreatic cancer is dramatically increased by a high fat, high calorie diet in KrasG12D mice. PLoS One. 2017;12:e0184455.CrossRefGoogle Scholar
  46. 46.
    Cormie P, Spry N, Jasas K, et al. Exercise as medicine in the management of pancreatic cancer: a case study. Med Sci Sports Exerc. 2014;46:664–70.CrossRefGoogle Scholar
  47. 47.
    Niels T, Tomanek A, Schneider L, et al. Exercise improves patient outcomes in advanced pancreatic cancer patient during medical treatment. Pancreat Disord Ther. 2018;8:193.Google Scholar
  48. 48.
    M. D. Anderson Cancer Center. PancFit: multimodal exercise during preoperative therapy for pancreatic cancer. 2019. NLM identifier: NCT03187951. Accessed 1 Feb 1 2019.
  49. 49.
    Puzziferri N, Roshek TB III, Mayo HG, et al. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014;312:934–42.CrossRefGoogle Scholar
  50. 50.
    Sjostrom L, Gummesson A, Sjostrom CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10:653–62.CrossRefGoogle Scholar
  51. 51.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.CrossRefGoogle Scholar
  52. 52.
    Christou NV, Lieberman M, Sampalis F, et al. Bariatric surgery reduces cancer risk in morbidly obese patients. Surg Obes Relat Dis. 2008;4:691–5.CrossRefGoogle Scholar
  53. 53.
    Schauer DP, Feigelson HS, Koebnick C, et al. Bariatric surgery and the risk of cancer in a large multisite cohort. Ann Surg. 2019;269:95–101.CrossRefGoogle Scholar
  54. 54.
    He R, Yin Y, Yin W, et al. Prevention of pancreatic acinar cell carcinoma by Roux-en-Y gastric bypass surgery. Nat Commun. 2018;9:4183.CrossRefGoogle Scholar
  55. 55.
    Zhou X, Qian B, Ji N, et al. Pancreatic hyperplasia after gastric bypass surgery in a GK rat model of non-obese type 2 diabetes. J Endocrinol. 2016;228:13–23.CrossRefGoogle Scholar
  56. 56.
    Jiao L, Chen L, White DL, et al. Low-fat dietary pattern and pancreatic cancer risk in the women’s health initiative dietary modification randomized controlled trial. J Natl Cancer Inst 2018;110:49–56.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine/HospitalistSOVAH HealthMartinsvilleUSA
  2. 2.Department of Pulmonary and Critical Care MedicineSentara Virginia Beach General HospitalVirginia BeachUSA
  3. 3.Division of Gastroenterology and HepatologyMercy Medical CenterDes MoinesUSA

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