Pancreatic cancer: causes, risk factors and prevention

By 2030, pancreatic cancer is expected to rise to the second-leading cause of cancer-related death in the United States. Know the factors that put you at higher risk.

Pancreatic cancer was in the headlines recently with news of “Jeopardy!” host Alex Trebek’s stage 4 pancreatic cancer diagnosis. There were 55,440 new cases of pancreatic cancer in United States in 2018, with 44,330 deaths. Pancreatic cancer is associated with the lowest survival rates of any major cancer type. By 2030, pancreatic cancer is expected to rise to the second-leading cause of cancer-related mortality in the United States (after lung cancer).

There are a number of known genetic and environmental factors that can increase a person’s risk for pancreatic cancer.

“The factor that has been found recently to be predictive of pancreatic cancer risk is new-onset diabetes mellitus (NODM) with unintentional weight loss,” said Robert C. G. Martin II, M.D., Ph.D., director, Norton Center for Abdominal and Digestive Surgery, and surgical oncologist with UofL Physicians. “New-onset is defined as over the age of 45 to 50 with an unintentional weight loss of more than 10 pounds. Identifying these patients could be the first step in increasing the percentage of patients who are diagnosed at an early stage of disease and thus a vastly improved overall survival.”

Here’s a look at the risk factors you can change and those you can’t change. This information is from the American Cancer Society.

Pancreatic cancer risk factors that can be changed

Smoking

Smoking is one of the most important risk factors for pancreatic cancer. The risk of getting pancreatic cancer is about twice as high among smokers compared with those who have never smoked. About 25 percent of pancreatic cancers are thought to be caused by cigarette smoking. Cigar smoking and the use of smokeless tobacco products also increase the risk. However, the risk of pancreatic cancer starts to drop once a person stops smoking.

Being overweight

Being very overweight (obese) is a risk factor for pancreatic cancer. Obese people — those with body mass index (BMI) of 30 or more —  are about 20 percent more likely to develop pancreatic cancer.

Carrying extra weight around the waistline may be a risk factor even in people who are not very overweight.

Workplace exposure to certain chemicals

Heavy exposure at work to certain chemicals used in the dry cleaning and metalworking industries may raise a person’s risk of pancreatic cancer.

Pancreatic cancer care

For more information about the Norton Center for Abdominal and Digestive Surgery, call Carol Ranschaert, patient navigator, at:

(502) 629-6416

Pancreatic cancer risk factors that can’t be changed

Age

The risk of developing pancreatic cancer goes up as people age. Almost all patients are older than 45. About two-thirds are at least 65 years old. The average age at the time of diagnosis is 70.

Gender

Men are slightly more likely to develop pancreatic cancer than women. This may be due, at least in part, to higher tobacco use in men, which raises pancreatic cancer risk (see above).

Race

African Americans are slightly more likely to develop pancreatic cancer. The reasons for this aren’t clear, but it may be due in part to having higher rates of some other risk factors for pancreatic cancer, such as diabetes, smoking and being overweight.

Family history

Pancreatic cancer seems to run in some families. In some of these families, the high risk is due to an inherited syndrome. In other families, the gene causing the increased risk is not known. Although family history is a risk factor, most people who get pancreatic cancer do not have a family history of it.

Inherited genetic syndromes

Inherited gene changes (mutations) can be passed from parent to child. These gene changes may cause as many as 10 percent of pancreatic cancers. Sometimes these changes result in syndromes that include increased risks of other cancers (or other health problems). Examples of genetic syndromes that can cause pancreatic cancer include:

  • Hereditary breast and ovarian cancer syndrome, caused by mutations in the BRCA1 or BRCA2 genes
  • Hereditary breast cancer, caused by mutations in the PALB2 gene
  • Familial atypical multiple mole melanoma (FAMMM) syndrome, caused by mutations in the p16/CDKN2A gene and associated with skin and eye melanomas
  • Familial pancreatitis, usually caused by mutations in the PRSS1 gene
  • Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), most often caused by a defect in the MLH1 or MSH2 genes
  • Peutz-Jeghers syndrome, caused by defects in the STK11 gene. This syndrome is also linked with polyps in the digestive tract and several other cancers.

Changes in the genes that cause some of these syndromes can be found by genetic testing.

Related Content: New guidelines recommend genetic testing for more patients with breast cancer risk

Diabetes

Pancreatic cancer is more common in people with diabetes. The reason for this is not known. Most of the risk is found in people with Type 2 diabetes. This type of diabetes most often starts in adulthood and is often related to being overweight or obese. It’s not clear if people with Type 1 (juvenile) diabetes have a higher risk.

Chronic pancreatitis

Chronic pancreatitis, a long-term inflammation of the pancreas, is linked with an increased risk of pancreatic cancer (especially in smokers), but most people with pancreatitis never develop pancreatic cancer.

Chronic pancreatitis is sometimes due to an inherited gene mutation. People with this inherited (familial) form of pancreatitis have a high lifetime risk of pancreatic cancer.

Preventing pancreatic cancer

Although there is no guaranteed way to prevent pancreatic cancer, there are things you can do to lower your risk. These are related to changing the risk factors you can.

  • Don’t smoke.
  • Maintain a healthy weight.
  • Limit alcohol.
  • Limit exposure to chemicals in the workplace.

Screening for pancreatic cancer

Pancreatic cancer is hard to find early because the pancreas is located deep inside the body where tumors may not be felt or seen during regular physical exams.

Currently there are no routine screening guidelines for people who have an average risk of getting pancreatic cancer. However, patients with NODM should be evaluated with a high-quality tri-phasic computed tomography (CT) scan of the pancreas or a dynamic magnetic resonance imaging (MRI) scan. In addition, genetic testing may be used to detect inherited conditions that increase the risk of pancreatic cancer in those with a family history of cancer. Also, people at high risk for pancreatic cancer may benefit from newer tests, such as an endoscopic ultrasound or MRI, which may be able to find early, treatable pancreatic cancer.


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