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World J Gastroenterol. Aug 28, 2014; 20(32): 11182-11198
Published online Aug 28, 2014. doi: 10.3748/wjg.v20.i32.11182
Pancreatic ductal adenocarcinoma: Risk factors, screening, and early detection
Andrew E Becker, Yasmin G Hernandez, Harold Frucht, Aimee L Lucas
Andrew E Becker, Yasmin G Hernandez, Aimee L Lucas, Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Harold Frucht, Division of Digestive and Liver Diseases, Columbia University College, New York, NY 10032, United States
Author contributions: All authors were involved in the design of the manuscript; Becker AE wrote the manuscript; Lucas AL, Hernandez YG and Frucht H reviewed and revised the manuscript.
Correspondence to: Aimee L Lucas, MD, MS, Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1069, New York, NY 10029, United States. aimee.lucas@mssm.edu
Telephone: +1-212-2410101 Fax: +1-646-5378647
Received: November 1, 2013
Revised: February 15, 2014
Accepted: April 15, 2014
Published online: August 28, 2014
Processing time: 303 Days and 15.4 Hours
Abstract

Pancreatic cancer is the fourth most common cause of cancer-related deaths in the United States, with over 38000 deaths in 2013. The opportunity to detect pancreatic cancer while it is still curable is dependent on our ability to identify and screen high-risk populations before their symptoms arise. Risk factors for developing pancreatic cancer include multiple genetic syndromes as well as modifiable risk factors. Genetic conditions include hereditary breast and ovarian cancer syndrome, Lynch Syndrome, familial adenomatous polyposis, Peutz-Jeghers Syndrome, familial atypical multiple mole melanoma syndrome, hereditary pancreatitis, cystic fibrosis, and ataxia-telangiectasia; having a genetic predisposition can raise the risk of developing pancreatic cancer up to 132-fold over the general population. Modifiable risk factors, which include tobacco exposure, alcohol use, chronic pancreatitis, diet, obesity, diabetes mellitus, as well as certain abdominal surgeries and infections, have also been shown to increase the risk of pancreatic cancer development. Several large-volume centers have initiated such screening protocols, and consensus-based guidelines for screening high-risk groups have recently been published. The focus of this review will be both the genetic and modifiable risk factors implicated in pancreatic cancer, as well as a review of screening strategies and their diagnostic yields.

Keywords: Pancreatic neoplasms; Pancreas cancer screening; Genetic predisposition to disease; Hereditary breast and ovarian cancer syndrome; Lynch syndrome; Peutz-Jeghers; BRCA; PALB2; p16; Pancreatitis

Core tip: Risk factors for developing pancreatic cancer include multiple genetic syndromes as well as modifiable risk factors. These factors can raise the risk of developing pancreatic cancer up to 132-fold over the general population. Several large-volume centers have initiated screening protocols, and consensus-based guidelines for screening high-risk groups have recently been published. The focus of this review will be both the genetic and modifiable risk factors implicated in pancreatic cancer, as well as a review of screening strategies and their diagnostic yields.