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Gut 48:143-147 doi:10.1136/gut.48.2.143
  • Leading article

Inherited predisposition to pancreatic cancer

  1. E EFTHIMIOU,
  2. T CRNOGORAC-JURCEVIC,
  3. N R LEMOINE
  1. ICRF Molecular Oncology Unit
  2. Imperial College School of Medicine
  3. Hammersmith Hospital, London, UK
  4. Division of Gastroenterology
  5. University of Washington, Seattle 98195, USA
  1. Professor N R Lemoine, ICRF Molecular Oncology Unit, Department of Cancer Medicine, Imperial College School of Medicine, Hammersmith Campus, London W12 0NN, UK.n.lemoine{at}icrf.icnet.uk
  1. T A BRENTNALL
  1. ICRF Molecular Oncology Unit
  2. Imperial College School of Medicine
  3. Hammersmith Hospital, London, UK
  4. Division of Gastroenterology
  5. University of Washington, Seattle 98195, USA
  1. Professor N R Lemoine, ICRF Molecular Oncology Unit, Department of Cancer Medicine, Imperial College School of Medicine, Hammersmith Campus, London W12 0NN, UK.n.lemoine{at}icrf.icnet.uk

    Pancreatic cancer is the fifth leading cause of death from cancer in men and women in Europe and North America. The prognosis has not changed significantly despite improvements in diagnosis and perioperative management. Traditional chemotherapy and radiotherapy regimens have been rather ineffective in providing control of the disease.1

    The only consistent risk factor identified so far is smoking and possibly accounts for a quarter of all cases of pancreatic cancer.2 Diabetes mellitus is another factor associated with an increased risk for the development of pancreatic cancer although it is still unclear if diabetes is a cause or an effect of malignant disease in the organ.3 Surgical resection offers the best chance of prolongation in survival. Unfortunately, in more than 80% of cases, at the time of diagnosis the cancer is either locally advanced or disseminated thus excluding curative resection. Hope for making an appreciable impact on survival has been focused on two areas: early diagnosis of pancreatic precancer and introduction of new therapeutic modalities based on the molecular and genetic abnormalities identified in the disease.4

    Studies have shown an increased risk of pancreatic cancer among relatives of patients with pancreatic cancer (7.8% compared with 0.6% in controls), with no apparent differences in the environmental risk exposures observed in the two groups.5Similar observations were made by Fernandez et al in a study in which 362 histologically confirmed pancreatic cancer cases were compared with 1408 patients admitted to hospital for acute, benign, non-digestive tract disorders. A significant association was noted between a family history of pancreatic cancer and the risk of developing pancreatic cancer (odds ratio 3.0, 95% confidence intervals 1.4–6.6). Even after adjustment for factors such as tobacco consumption, alcohol intake, pancreatitis, and diabetes, the risk of pancreatic cancer remained almost the same in patients …