Pancreatic cancer: Recent epidemiological trends and risk determinants

Table 1 Modifiable and non-modifiable risk factors for pancreatic cancer

Risk factors for pancreatic cancer
Modifiable risk factors	Tobacco use	Smoking is causally associated with pancreatic cancer, contributing to 20%-30% of cases in the United States and Europe. The risk increases with smoking duration and pack-years and persists for 10 years after cessation. Passive smoking also raises risk
	Alcohol consumption	Heavy alcohol consumption (> 3 drinks/day) is associated with an increased risk, particularly in men and heavy liquor drinkers. However, a clear linear relationship remains debated
	Obesity	Obesity (BMI > 30) increases pancreatic cancer risk by approximately 20%. Abdominal fatness and metabolic obesity phenotypes are also linked to higher risk
	Occupational and environmental exposures	Exposure to hydrocarbons, pesticides, and heavy metals (such as in aluminum smelting, textile industries, and printing industries) may contribute to pancreatic cancer risk
Non-modifiable risk factors	Age	Risk increases significantly with age, particularly in those > 60 years old
	Gender	Higher incidence in men than women, possibly due to sex hormone differences
	Race and ethnicity	Higher incidence in Black populations, lower in Asian and Pacific Islanders, with genetic and environmental factors contributing
	Family history	Having a first-degree relative with pancreatic cancer increases risk 5%-10%. Familial cases tend to develop precursor lesions more frequently
	Genetic factors	Mutations in BRCA1, BRCA2, PALB2, ATM, MLH1, and MSH2 increase risk. Lynch syndrome and Peutz-Jeghers syndrome are also associated
	Diabetes mellitus	Diabetes nearly doubles the risk of pancreatic cancer. Mechanisms include insulin resistance, chronic inflammation, and IGF-1 pathway activation

BMI: Body mass index; IGF-1: Insulin-like growth factor-1.