Incidence and Risk Factors for Pancreatic Cancer in Southeast Appalachian, KY 1998-2002

Abstract

Purpose: The American Cancer Society estimates that 32,180 men and women will be diagnosed with and 31,800 men and women will die of pancreatic cancer (PC) in 2005 in our nation. Based on the NCI's SEER cancer statistics review, in the United States, between 1998–2002, the median age at diagnosis for PC was 72 yrs of age. Approximately 0.6% was diagnosed under the age 34. 2.7% between 35 and 44; 9.8% between 45 and 54; 17.5% between 55 and 64; 27.9% between 65 and 74; 29.4% between 75 and 84; and 12.2% at 85 or more yrs of age. PC has lowest five year survival rate of any cancer and is more common in men and African-Americans. While its incidence is increasing in women, it appears to have stabilized in men. In the U.S., PC is the fourth leading cause of death in males and ranks fifth in females. The common risk factors for pancreatic cancer are a H/o of cigarette smoking, cirrhosis of the liver, DM, chronic pancreatitis, and upper GI surgery. Recently, a family h/o of PC has been shown to contribute significantly to individual risk. Methods: We performed a retrospective analysis of 24 cases of PC in the southeast Appalachian region that occurred between 1996 and 2003, derived from the Kentucky Cancer Tumor Registry. Among cases, 29% were female and 71% were male. The median age at diagnosis for PC was 66 yrs. Results: In our study, 33% of cases had a h/o of alcohol use, 54% were smokers, 45% were diabetic, 38% had a h/o of GERD, and 13% had a h/o of chronic pancreatitis. There was a family h/o of cancer in first degree relatives among 58% (N = 14) of cases. The distribution of these familial cancers was lung 20% (N = 5), prostate 16% (N = 3), colon 16% (N = 3), pancreatic 12% (N = 3), ovarian 8% (N = 2), breast 8% (N = 2), bone 8% (N = 2), stomach 8% (N = 2), throat 4% (N = 1), and brain 4% (N = 1). Our data also demonstrated that 8% (N = 2) of cases had a second primary cancer site, one with lung and a second with endometrial cancer. Conclusions: The median age of PC incidence in the United States is 72, while in Southeast Appalachian Kentucky, it was 66 yrs. We observed a greater incidence of sporadic (non-familial) pancreatic cancer than the overall U.S. population, as well as a greater incidence of non-familial (non-pancreatic) cancers among first degree relatives of PC cases. While our findings are interesting when considering the genetic homogeneity of this particular population of Appalachian, our results are limited by the relatively small number of cancer cases observed.