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Epidemiology of pancreatic cancer

World Journal of Surgery volume 8, pages 808–821 (1984)Cite this article

Abstract

In the United States the incidence of and mortality from pancreatic cancer have increased over the past several decades but have tended to level off in recent years. The rates are higher in blacks than in whites and higher in males than in females. Mortality rates increase with age but there appears to be a decline in elderly blacks, possibly on an artifactual basis. There is a suggestion that rates are higher in Jews. No consistent differences by socioeconomic status or by geographic location within the United States have been identified. Both genetic and environmental factors may be playing significant roles in this disease. Cigarette smoking may be etiologically related, or at the very least, may help to identify a group of patients at increased risk of pancreatic cancer. However, the relative risk estimated for cigarette smoking is much lower than that found for cancer of the lung. The leveling off in incidence and mortality rates for pancreatic cancer in recent years also differs from the time trends observed for lung cancer. However, this could result from differences in site-specific carcinogens and from the fact that the lung is the first organ to be exposed to cigarette smoke in the highest concentrations and prior to the metabolism of any of its components.

Dietary factors may have an important role in pancreatic cancer, but further research is needed to clarify this relationship. In particular, the possibility that dietary fats may be implicated and that vitamins or fiber may be protective in this disease remains to be explored. Finally, there is suggestive evidence that specific chemical exposures may be carcinogenic for the pancreas. Many of the data are from animal studies, and the findings from human studies are not entirely consistent.

Résumé

Aux États-Unis la fréquence et la mortalité du cancer du pancréas se sont élevées au cours des dernières décades avant de se stabiliser lors des dernières années. Les taux respectifs de la fréquence et de la mortalité sont plus importants chez les noirs que chez les blancs, chez les hommes que chez les femmes. La mortalité augment avec l'âge sauf chez les noirs mais ce fait est peut-être artificiel. La fréquence du cancer serait également plus importante chez les juifs. En revanche les facteurs socio-economiques et les conditions géographiques ne paraissent pas entrer en ligne de compte.

Les facteurs génétiques et d'environnement pourraient jouer un rôle. Le fait de fumer également, ou du moins il faut toujours penser au cancer du pancréas chez les fumeurs encore qu'ils soient surtout menacés de cancer du poumon. Les taux de la fréquence et de la mortalité du cancer du pancréas au cours des récentes années sont différents de ceux du cancer du poumon. Ce fait pourraît être la conséquence de variations des lieux d'action des agents carcinogènes, le poumon étant le viscère le plus exposé à l'action de la fumée.

Des facteurs diététiques pourraient aussi être en cause mais des recherches plus poussées sont nécessaires avant d'affirmer leur action. C'est ainsi que les graisses pourraient jouer un rôle nocif, alors que les vitamines et les végétaux pourraient exercer un rôle protecteur. Enfin, il paraît probable que certains agents chimiques exerçeraient un rôle carcinogénique. Les données de l'étude expérimentale aussi bien que celles de l'étude clinique les concernant ne sont pas encore suffisantes pour l'affirmer.

Resumen

En los Estados Unidos la incidencia y mortalidad del cáncer pancreático han aumentado en el curso de las últimas décadas, pero en los últimos años hay la tendencia a un nivelamiento. Las tasas son más elevadas en la raza negra que en la blanca, y en los hombres que en las mujeres. Las tasas de mortalidad aumentan con la edad, pero parece existir una declinación en los negros de edad avanzada, lo cual posiblemente puede ser artificioso. Existe la sugerencia de que las tasas son más altas en los judíos. En los Estados Unidos no se han identificado diferencias consistentes relativas al nivel socioeconómico o a la ubicación geográfica.

Factores tanto ambientales como genéticos pueden jugar un papel importante en esta enfermedad. El fumar cigarrillo puede estar etiológicamente relacionado, o, por lo menos, puede ser un factor que facilita la identificación de pacientes con un mayor riesgo de desarrollar cáncer pancreático. Sin embargo, el riesgo relativo estimado del fumador de cigarrillo es mucho menor que el que se ha demostrado para el cáncer pulmonar. El nivelamiento de las tasas de incidencia y de mortalidad del cáncer pancreático registrado en los anos recientes también difiere de las tendencias observadas en el cáncer del pulmón. Esto, sinembargo, puede resultar de diferencias en carcinógenos específicos y del hecho de que el pulmón es el primer órgano que se expone al humo del cigarrillo, en las mayores concentraciones, y antes de que ocurra el metabolismo de cualquiera de sus componentes.

Factores dietéticos pueden también jugar un papel importante en la etiología del cáncer pancreático, pero es necesario realizar mayor investigación para aclarar esta relación. En particular, debe explorarse la posibilidad de que las grasas de la dieta puedan ser implicadas y que las vitaminas o la fibra peudan tener un papel protector en esta enfermedad.

Finalmente existe evidencia que sugiere que la exposición a agentes químicos específicos puede ser carcinogénica para el páncreas. La mayor parte de esta information proviene de estudios en animales, y los hallazgós en los estudios en humanos no son consistentes.

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Affiliations

  1. Department of Epidemiology, School of Hygiene and Public Health, The Johns Hopkins University, 615 North Wolfe Street, 21205, Baltimore, Maryland, USA

    Leon Gordis M.D., Dr.P.H. & Ellen B. Gold Ph.D.

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  1. Leon Gordis M.D., Dr.P.H.
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  2. Ellen B. Gold Ph.D.
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Gordis, L., Gold, E.B. Epidemiology of pancreatic cancer. World J. Surg. 8, 808–821 (1984). https://doi.org/10.1007/BF01656020

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  • DOI: https://doi.org/10.1007/BF01656020

Keywords

  • Lung Cancer
  • Pancreatic Cancer
  • Vitamine
  • Avant
  • Vitaminas