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Early diagnosis of pancreatic cancer; looking for a needle in a haystack?
  1. Marco J Bruno
  1. Correspondence to Dr Marco J Bruno, Department of Gastroenterology and Hepatology, Erasmus University Medical Center, ‘s Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands; m.bruno{at}erasmusmc.nl

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The paper by Kanda et al highlights a potentially novel method for the early diagnosis of pancreatic neoplasia.1 Although our understanding of the pathological and molecular events of pancreatic cancer has advanced significantly over the past years, we are still far away from a clinically meaningful breakthrough in its treatment as demonstrated by the poor survival statistics which have hardly changed over the past decades.2 ,3 In light of this sobering observation, it is important to consider other ways of trying to lower the mortality of this dreadful disease. Primary prevention through life style changes of established risk factors like smoking has a considerable potential to reduce the number of pancreatic cancer deaths,4 but it is well known that such behavioural changes are difficult to accomplish. Secondary prevention by screening the general population for pancreatic cancer is not feasible at present because of its low incidence and the lack of a non-invasive, reliable and cheap screening tool. However, it is estimated that about 10% of all pancreatic cancer cases are caused by inherited (genetic) factors with some individuals carrying a life time risk up to 55%.5 Affected individuals are known mutation carriers of pancreatic cancer prone hereditary (tumour) syndromes (eg, familial atypical multiple mole melanoma syndrome, Peutz–Jeghers syndrome, breast cancer 1 and …

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