Strategies for early detection of resectable pancreatic cancer

Table 1 Risk factors for pancreatic cancer

Variables	Association	Ref.
Non-genetic risk factors
Age	Ages 55-64 yr: 20.7% of cases; ages 65-74 yr: 25.8% of cases; ages 75-84 yr: 27.8% of cases; age 85 + yr: 13.3% of cases	[4]
Gender	The incidence rate is 13.8 per 100000 men and 10.8 per 100000 women	[4]
Smoking	Most established risk factor for PC. Risk increases significantly with greater intensity: ≥ 30 cigarettes/day (OR = 1.75, 95%CI: 1.27-22.42); duration ≥ 50 yr (OR = 2.13, 95%CI: 1.25-3.62); and cumulative smoking dose ≥ 40 pack-years (OR = 1.78, 95%CI: 1.35-2.34)	[11]
Obesity	Obese individuals (BMI ≥ 30) have a slightly higher risk (RR: 1.19) of developing PC compared with normal-weight individuals (BMI < 25)	[12]
Race	15.5 males and 12.6 females per 100000 in African-Americans, while 8.4 males and 6.9 females per 100000 for Asians/Pacific Islanders	[4]
Diabetes mellitus (DM)	Meta-analysis from 35 cohort studies revealed a RR ratio of 1.94 (95%CI: 1.66-62.27) between type 2 DM and PC. 40%-100% increases in the risk of PC are observed with established diabetes	[12,14]
New-onset diabetes	New-onset diabetes is associated with a four- to seven-fold increase in risk, such that 1%-2% of patients with recent-onset diabetes will develop PC within 3 yr	[30]
Intraductal papillary mucinous neoplasms	Standardized incidence ratio 16	[13]
Hereditary cancer syndromes
Familal pancreatic cancer	1 first-degree relative: 4.6-fold increased risk (95%CI: 0.5-16.4); ≥ 2 first-degree relatives: 6.4-fold increased risk (95%CI: 1.8-16.4); ≥ first-degree relatives: 32-fold increased risk (95%CI: 10.2-74.7)	[15,16]
Chronic pancreatitis	An incidence ratio of 14-18 observed for the development of PC in CP cases, which is further increased by cigarette smoking	[17,18]
Hereditary pancreatitis	A 53-fold (95%CI: 23-105) increased risk for developing PC and a lifetime risk (age 70 yr) of PC of 30%-40% in comparison with normal. RR increases further in smokers	[19,20]
Peuts-Jeghers	132-fold (95%CI: 44-261) increased risk of PC compared with the general population	[21,22]
Lynch syndrome	8.6-fold (95%CI: 4.7-15.7) increased risk for developing PC compared with the general population. An estimated 3.68% (95%CI: 1.45%-45.88%) lifetime (age 70 yr) risk of PC	[24,25]
Hereditary breast and ovarian cancer	BRCA2 germline mutation carriers have a 5% lifetime risk of PC in comparison with 1.78% for controls. BRCA1 mutation is 2.26-times that of the normal population	[26,27]

PC: Pancreatic cancer.