Pancreas Cancer: An Epidemiologic Perspective Paul K. Mills, Ph.D., M.P.H. Department of Internal Medicine UCSF Fresno Cancer Registry of Central California

Five Year Relative Survival With Pancreas Cancer in California,

Time Trends in Pancreas Cancer Incidence Rates in the U.S., , SEER data

Twelve Most Frequent Cancers in California, by Incidence Counts and Deaths, 2010

Number of New Pancreas Cancer Cases and Deaths, 2009, by Location LocationNew casesDeaths SAMC, Fresno4031 Fresno County8065 California3,8813,543 United States42,47035,240 World?????227,000

Age Adjusted Pancreas Cancer Incidence Rates in California, by Race/ethnicity and sex

Age –adjusted Pancreas cancer Mortality rates, Worldwide, 2008 (Globocan)

Age adjusted pancreas cancer mortality rates in the U.S., 2007, All races

Age adjusted pancreas cancer incidence rates, U.S., 2008, All Races

Age adjusted pancreas cancer incidence rates in California, , all race/ethnicities

Age adjusted pancreas cancer incidence among NH Blacks in California,

Age adjusted pancreas cancer mortality rates in California, NH Blacks,

Age specific incidence rates of Pancreas cancer in California,

Recent trends in cancer mortality rates in the U.S.,

Joinpoint analysis of U.S. Panceas cancer incidence rates,

Endocrine vs. exocrine Incidence Rates, U.S., , SEER Data

Age Adjusted Incidence and Mortality Rates from Pancreas Cancer, California,

Pancreas cancer Stage at Diagnosis, , California

Stage at Diagnosis, Pancreas Cancer, , by Race/Ethnicity, California

SAMC Pancreas Cancer Stage at Diagnosis by 5 Year Intervals N=528 N=192N=164N=172

Molecular Genetics of Pancreatic Cancer GenePrevalence K-ras2 mutation80-95% CDKN2 (P16) mutation, deletion or hypermethylation 85-98% P53 mutation50% Smad4 homozygous deletions or mutations 55% BRCA-2 mutations??

Risk Factors for Pancreas Cancer Risk factorAltered risk Smoking2-3 X Caloric intake, physical activity, obesity~2X Chronic pancreatitis2 X Family Hx pancreas ca7X Diabetes2-3X Primary scherosing cholangitis Hereditary pancreatitis60X

Smoking—IARC Statement, (2004) “Cancer of the pancreas is causally associated with cigarette smoking. The risk increases with duration of smoking and number of cigarettes smoked daily. The risk remains elevated after allowing for potentially confounding factors such as alcohol consumption. The relative risk decreased with increasing time since quitting smoking”

Precursor Lesions for pancreas Cancer LesionMechanism Pancreatic intraepithial Neoplasia Chronic inflammation

Prevention and Deterrence of Pancreas Cancer Smoking is the most significant reversible risk factor for pancreas cancer. Estimates indicate that smoking accounts for up to 30% of cases of pancreas cancer. A diet high in energy intake and low in fresh fruits and vegetables increases risk of pancreas cancer. Alcohol consumption does not increase risk of pancreas cancer unless it leads to chronic pancreatitis. Aspirin consumption????