Incidence Rates Of Pancreatic Cancer Research Articles

Impact of Gender, Race/ethnicity, and Age on Incidence Rates of Two Leading Gastrointestinal Cancers in the US

Introduction: Colorectal cancer (CRC) and pancreatic cancer are the two leading gastrointestinal malignancies in the US. The purpose of this study is to investigate the impact of gender, race/ethnicity and age on the incidence of CRC and pancreatic cancer from 2000-2013 using the Surveillance, Epidemiology, and End Results (SEER) database. The trends for these two cancers from 1975-2013 were also investigated. Methods: Patients diagnosed with CRC and pancreatic cancer from 2000-2013 were identified from the SEER Registry. We retrospectively evaluated age-specific, sex-specific, and race/ethnicity variations in incidence rates during 2000-2013 for people above the age of 20. For this analysis, we used ethnic groups consisting of white, black, Asian, American Indian, and Hispanic. We also calculated trends in percent change (PC) for the entire period between 1975-2013. The ethnic groups used in this analysis consisted of black, white, and “other,” where “other” included American Indians, Alaskans and Asian/Pacific Islanders. Results: A total of 579,029 people with CRC, and 150,929 people with pancreatic cancer were identified. When men and women were stratified by age, the incidence rate of both cancers increased with age among all race/ethnic groups. All incidence rates were per 100,000/year. For CRC, black Americans had the highest incidence rate of 93.1 and 70.5, for men and women respectively from 2000-2013. All ethnic groups showed decreasing trends in 2000-2013 for both men and women with CRC. Both black and “other” men had a PC of 21.2, and 16.2, respectively showing increasing incidence rates from 1975-1999. Black women had a PC of 6.4 demonstrating increasing incidence rates from 1975-1999 but a PC of -33.7 showing decreasing incidence rates from 2000-2013.Table 1: Trends in Incidence Rates for Colorectal Cancer from 1975-2013Table 2: Trends in Incidence Rates for Pancreatic Cancer from 1975-2013Black men and women had the highest incidence rates of pancreatic cancer at 24.0 and 20.1, respectively from 2000-2013. There is an increasing trend seen for both men and women in all ethnic groups for pancreatic cancer from 2000-2013. Conclusion: Among CRC and pancreatic cancer in the US, increasing age is associated with increasing incidence of each of these cancers. Black men and women have the highest incidence rates for CRC and pancreatic cancer. This may support interventions to inform certain race/ethnic populations about the importance of screening and prevention for CRC and pancreatic cancer, two leading causes of gastrointestinal malignancies earlier in life.

Incretin based drugs and the risk of pancreatic cancer: international multicentre cohort study

Objective To determine whether the use of incretin based drugs compared with sulfonylureas is associated with an increased risk of incident pancreatic cancer in people with type 2 diabetes.Design Population...

Long-term trends in the incidence and relative survival of pancreatic cancer in Canada: A population-based study.

The poor survival among pancreatic cancer patients accounts for a disproportionate number of cancer deaths, and there has been little or no improvement in the long-term survival of these patients. This study examines the long-term trends in incidence and relative survival of patients diagnosed with pancreatic cancer in Canada between 1992 and 2008. We used pancreatic cancer data from the Canadian Cancer Registry. Incidence rate per age group was estimated over the aforementioned period. A flexible parametric model was used to estimate trends in one- and five-year relative survival for each age group and sex. Excess mortality rate was estimated to illustrate additional mortality due to a cancer diagnosis. In total, 34,577 patients with pancreatic cancer were identified, of which 49.3% were male. Mean age at diagnosis was 70.1 (SD=12.3) years. Approximately 60.0% of patients were older than 70yearsat diagnosis. There has been no change in the incidence rate of pancreatic cancer in Canada; however, it significantly decreased for men (80+) (p=0.011). Although one-year relative survival increased over time for all patients, five-year relative survival increased only 5% for the youngest age group (<50 years). Overall survival of patients with pancreatic cancer remains low, although advances in chemotherapy and palliative care may have provided some improvement. Excess mortality remains highest shortly after diagnosis, which is likely attributable to the late diagnosis of pancreatic cancer.

Epidemiology of pancreatic cancer.

Cancer of the pancreas remains one of the deadliest cancer types. Based on the GLOBOCAN 2012 estimates, pancreatic cancer causes more than 331000 deaths per year, ranking as the seventh leading cause of cancer death in both sexes together. Globally, about 338000 people had pancreatic cancer in 2012, making it the 11th most common cancer. The highest incidence and mortality rates of pancreatic cancer are found in developed countries. Trends for pancreatic cancer incidence and mortality varied considerably in the world. A known cause of pancreatic cancer is tobacco smoking. This risk factor is likely to explain some of the international variations and gender differences. The overall five-year survival rate is about 6% (ranges from 2% to 9%), but this vary very small between developed and developing countries. To date, the causes of pancreatic cancer are still insufficiently known, although certain risk factors have been identified, such as smoking, obesity, genetics, diabetes, diet, inactivity. There are no current screening recommendations for pancreatic cancer, so primary prevention is of utmost importance. A better understanding of the etiology and identifying the risk factors is essential for the primary prevention of this disease.

Racial disparities of pancreatic cancer in Georgia: a county-wide comparison of incidence and mortality across the state, 2000-2011.

Understanding the geographic distribution of pancreatic cancer is important in assessing disease burden and identifying high-risk populations. This study examined the geographic trends of pancreatic cancer incidence, mortality, and mortality-to-incidence ratios (MIRs) in Georgia, with a special focus on racial disparities of disease. Directly age-adjusted pancreatic cancer incidence and mortality rates for Georgia counties (N = 159) were obtained for 2000-2011. Maps of county age-adjusted disease rates and MIRs were generated separately for African Americans and Caucasians. Cluster analyses were conducted to identify unusual geographic aggregations of cancer cases or deaths. Pearson correlation coefficients were calculated to examine associations between county health factors (e.g., health behaviors, clinical care, and physical environment) and pancreatic cancer incidence or mortality rates. African Americans displayed a significantly higher age-adjusted incidence (14.6/100,000) and mortality rate (13.3/100,000), compared to Caucasians. Cluster analyses identified five significant incidence clusters and four significant mortality clusters among Caucasians; one significant incidence cluster and two significant mortality clusters were identified among African Americans. Weak but significant correlations were noted between physical environment and pancreatic cancer incidence (ρ = 0.16, P = 0.04) and mortality (ρ = 0.18, P = 0.02) among African Americans. A disproportion burden of pancreatic cancer incidence and mortality was exhibited among African Americans in Georgia. Disease intervention efforts should be implemented in high-risk areas, such as the southwest and central region of the state. Future studies should assess health behaviors and physical environment in relationship with the spatial distribution of pancreatic cancer.

Cloud cover-adjusted ultraviolet B irradiance and pancreatic cancer incidence in 172 countries

BackgroundControversy exists regarding whether vitamin D deficiency could influence the etiology of pancreatic cancer. Several cohort studies have found that high serum 25-hydroxyvitamin D [25(OH)D] concentrations are associated with low risk of pancreatic cancer, while others have not. HypothesisLow ultraviolet B irradiance is associated with high incidence of pancreatic cancer. MethodsAge-standardized pancreatic cancer incidence rates were obtained from GLOBOCAN in 2008. The association between cloud-adjusted UVB irradiance and age-standardized incidence rates of pancreatic cancer was analyzed using regression. ResultsOverall, the lower the cloud-adjusted UVB irradiance, the higher the incidence rate of pancreatic cancer. Residents of countries with low UVB irradiance had approximately 6 times the incidence rates as those in countries with high UVB irradiance (p<0.0001 for males and p<0.0001 for females). This association persisted after adjustment for traditional risk factors of pancreatic cancer (p=0.0182 for males and p=0.0029 for females). ConclusionsThere was an inverse association of cloud-adjusted UVB irradiance with incidence of pancreatic cancer that persisted after adjustment. This result is consistent with an inverse association of overall vitamin D deficiency in countries with lower UVB irradiance with risk of pancreatic cancer. Further research on the role of 25(OH)D in reduction of pancreatic cancer in individuals would be desirable to expand the limited avenues available for prevention of this highly fatal disease.This article is part of a Special Issue entitled ‘17th Vitamin D Workshop’.

Mitochondrial uncoupling protein 2 and pancreatic cancer: a new potential target therapy.

Overall 5-years survival of pancreatic cancer patients is nearly 5%, making this cancer type one of the most lethal neoplasia. Furthermore, the incidence rate of pancreatic cancer has a growing trend that determines a constant increase in the number of deceases caused by this pathology. The poor prognosis of pancreatic cancer is mainly caused by delayed diagnosis, early metastasis of tumor, and resistance to almost all tested cytotoxic drugs. In this respect, the identification of novel potential targets for new and efficient therapies should be strongly encouraged in order to improve the clinical management of pancreatic cancer. Some studies have shown that the mitochondrial uncoupling protein 2 (UCP2) is over-expressed in pancreatic cancer as compared to adjacent normal tissues. In addition, recent discoveries established a key role of UCP2 in protecting cancer cells from an excessive production of mitochondrial superoxide ions and in the promotion of cancer cell metabolic reprogramming, including aerobic glycolysis stimulation, promotion of cancer progression. These observations together with the demonstration that UCP2 repression can synergize with standard chemotherapy to inhibit pancreatic cancer cell growth provide the molecular rationale to consider UCP2 as a potential therapeutic target for pancreatic cancer. In this editorial, recent advances describing the relationship between cancer development and mitochondrial UCP2 activity are critically provided.

Isoquercitrin inhibits the progression of pancreatic cancer in vivo and in vitro by regulating opioid receptors and the mitogen-activated protein kinase signalling pathway.

Pancreatic cancer is a common malignant tumour that affects individuals worldwide. In recent years, the incidence and mortality rates of pancreatic cancer have continuously increased. Currently, the primary clinical treatment methods for pancreatic cancer include surgical resection, chemotherapy and radiotherapy. However, these treatment methods rarely produce satisfactory therapeutic outcomes. Extensive research has also proven that the effective components of several traditional Chinese medicines, particularly flavonoids extracted from plants, have significant antitumour effects. Isoquercitrin, which is one of the flavonoids found in Bidens pilosa extracts, has a significant antitumour effect. However, the antitumour effect of isoquercitrin and its mechanism of action remain unclear. The objective of the present study was to investigate the effect of isoquercitrin on the progression of pancreatic cancer and to further understand the biological characteristics of the participation of isoquercitrin in the progression of pancreatic cancer. In vitro, we found that a therapeutic dose of isoquercitrin significantly inhibited proliferation, promoted apoptosis and induced cell cycle arrest within the G1 phase in pancreatic cancer cells. Isoquercitrin activated caspase-3, -8 and -9 and reduced the mitochondrial membrane potential. In addition, isoquercitrin inhibited the expression level of the δ opioid receptor; however, isoquercitrin had no effect on the κ and µ opioid receptors. Furthermore, isoquercitrin inhibited extracellular signal-regulated kinase (ERK) phosphorylation and promoted c-Jun N-terminal kinase (JNK) phosphorylation. In vivo, we found that a therapeutic dose of isoquercitrin significantly inhibited xenograft growth in nude mice. In summary, the present study demonstrated that isoquercitrin inhibits human pancreatic cancer progression in vivo and in vitro and that its molecular mechanism may be closely related to opioid receptors and to the activation of the mitogen-activated protein kinase (MAPK) signalling pathway.

Evaluation of circulating ADH and MIC-1 as diagnostic markers in Egyptian patients with pancreatic cancer

BackgroundDespite the incidence rate of pancreatic cancer (PC) is uncommon in developing countries, it is considered as one of the most lethal disease. Improving patients' survival requires diagnosis of the disease at early stage. Therefore, it is imperative to identify more specific and sensitive marker(s) to be used for early detection of PC. ObjectivesOur aim is to evaluate the potential role of circulating ADH and MIC-1 to be used as diagnostic markers in Egyptian patients and assess their value either alone or combined with CA19-9 in early detection of PC. MethodsAlcohol dehydrogenase (ADH), macrophage inhibitory cytokine (MIC-1) and CA19-9 were measured by ELISA in serum procured from PC patients (n = 50) versus normal subjects (n = 20). ResultsOur results demonstrate that the circulating levels of ADH, MIC-1 and CA19-9 in blood of PC were significantly higher than in healthy controls (HCs) (p < 0.001). The highest marker sensitivity observed at early stage was MIC-1 (90%) and specificity was ADH (83%). The level of all three markers was elevated significantly in early stage of PC in comparison to HCs. The addition of ADH and MIC-1 to CA19-9 significantly improved the efficacy of diagnosis (p = 0.023). ConclusionOur data demonstrate that not only the combination of ADH and MIC-1 to CA19-9 can be used in early detection of PC but also can improve the overall quality of diagnosis of this lethal disease.

86 Comparison of Incidence Rates of Acute Pancreatitis and Pancreatic Cancer Among the General Population and Type 2 Diabetes Mellitus Patients Between Different Databases in the SAFEGUARD Project

86 Comparison of Incidence Rates of Acute Pancreatitis and Pancreatic Cancer Among the General Population and Type 2 Diabetes Mellitus Patients Between Different Databases in the SAFEGUARD Project

Pancreatic Cancer Incidence and Mortality Patterns in China, 2009

To estimate the incidence and mortality rates for pancreatic cancer in China. After checking and reviewing the cancer registry data in 2009 from 72 cancer registry centers, we divided cancer registry areas into urban and rural areas. Incidence/mortality rates, age-specific incidence/mortality rates, age- standardized incidence/mortality rates, proportions, and cumulative incidence/mortality rates for pancreatic cancer were calculated. The total number of newly diagnosed pancreatic cancer cases and deaths in 2009 were 6,220 and 5,650, respectively. The crude incidence rate in all cancer registry areas was 7.28/100,000 (males 8.24, females 6.29). The age-standardized incidence rate by Chinese standard population (ASR) was 3.35/100,000, with ranking at 7th among all cancers. Pancreatic cancer incidence rate was 8.19/100,000 in urban areas whereas it was 5.41/100 000 in rural areas. Cancer mortality rate in all cancer registry areas was 6.61/100,000 (males 7.45; females 5.75), with ranking at 6th among all cancers, and 7.42/100 000 in urban but 4.94/100000 in rural areas. Pancreatic cancer incidence and mortality rates have shown a gradual increase in China. Owing to the difficulty of early diagnosis, identification of high-risk population and modification of risk factors are important to reduce the burden of pancreatic cancer.

106 Responses of pancreatic cancer cells under cryoablative conditions

Pancreatic cancer (PaCa) incidence and mortality rates continue to increase, driving the need for improved diagnostics and more effective therapies.Combinatorial approaches in PaCa have focused on the use of multiple chemotherapeutic drugs, while cryotherapeutic options have been underutilized.Given past success in prostate cancer, in this study we investigated the potential for multi-modal treatment utilizing cryoablation in conjunction with low dose chemotherapy for the treatment of PaCa.Both standard tissue culture models and the 3-D tissue engineered (PaCaTEM) approach were studied, providing a more robust assessment of the cellular responses to cryotherapy and the associated adjuncts.The human PaCa cell line (Bx-PC3) was evaluated in vitro and in a vivo-like tissue engineered model (PaCaTEM). Bx-PC3 were exposed to a range of freezing temperatures from −10 °C to −20 °C and compared to non-frozen controls with and without pretreatment with 0.025 μg/ml 5-FU. PaCaTEM models were frozen in situ following a single 5 min freeze protocol using the supercritical nitrogen (SCN) cryoablation system with a 1.5 mm × 3 cm cryoprobe.Cell survival following the treatment regimes were assessed in the in vitro studies using the metabolic activity indicator, alamarBlue and microfludic flow cytometry (MFC). Assessment of PaCaTEM samples included monitoring of iceball size and isothermal distribution during the freezing process followed by fluorescence microscopic examination of cell death at 1 and 24 h (Vybrant apoptosis assay).Freezing exposure to −10 °C did not impact overall Bx-PC3 viability, however exposure to −15 °C and −20 °C resulted in a significant loss of viability (90% and 98%, respectively), which was found to be more effective with concomitant 5-FU . At temperatures of −25 °C and colder in vitro, no metabolic activity remained throughout the observational period.Temporal analysis of the cell death response to freezing by MFC revealed that an initiation and sustained levels of both apoptosis and necrosis.Focusing on the −15 °C isotherm, apoptotic cell death was found to peak at 4 h and necrosis at 8 h post-thaw.Within the PaCaTEM samples, a 3.0 cm (±0.2 cm) diameter iceball was observed.Fluorescence imaging of the PaCaTEM revealed complete PaCa cell ablation to a diameter of 1.9 cm (±0.2 cm)’ correlating with the −25C isotherm.A transitional zone of cell death extending to the margin of the iceball was also observed.The results of this study indicate that cryoablation, alone or as a combinatorial therapy, may serve as an effective tool for the targeted ablation of pancreatic cancer.At minimum, −25 °C should be achieved as a target tissue temperature at the margin of a tumor to assure complete PaCa destruction. Source of funding: CPSI Biotech. Conflict of interest: None declared. ksnyder@cpsibiotech.com

The Incidence and Survival Rate of Population-Based Pancreatic Cancer Patients: Shanghai Cancer Registry 2004–2009

BackgroundPancreatic cancer is a devastating disease with dismal prognosis. Large population-based evidence on its survival rate and influence factors is lacking in China.ObjectiveThis study aimed to depict the demographic factors, tumor characteristics, incidence rate and survival rate of pancreatic cancer cases in urban China.MethodsThe demographic factors, tumor characteristics were collected for all the pancreatic cancer cases identified during 2004 to 2009 from the Shanghai Cancer Registry. The survival time was ascertained through linkage of the Shanghai Cancer Registry and the Shanghai Vital Statistics Registry. The deadline of death certificates was the end of December 2012. Kaplan-Meier method and Cox proportional-hazards regression model were used to explore the survival rate and influence factors.Results11,672 new pancreatic cancer cases were identified among Shanghai residency during 2004 to 2009. The crude incidence rate of pancreatic cancer was increasing from 12.80/100,000 in 2004 to 15.66/100,000 in 2009, while the standardized incidence rate was about 6.70/100,000 and didn't change a lot. The overall 5-year survival rate was 4.1% and the median survival time was 3.9 (95% Confidence Interval (CI) 3.8–4.0) months. Subjects had received surgical resection had improved survival (HR = 0.742, 95% CI: 0.634–0.868) than its counterparts. In adjusted multivariable Cox proportional-hazard models, factors associated with poor survival included older age at diagnosis (age > = 70 years: hazard ratio (HR) = 1.827, 95% CI: 1.614–2.067), male sex (HR = 1.155, 95% CI: 1.041–1.281), distant disease at diagnosis (HR = 1.257, 95% CI: 1.061–1.488), positive lymph node (HR = 1.236, 95% CI: 1.085–1.408), tumor stage (Stage IV HR = 2.817, 95% CI: 2.029–3.909).ConclusionThe age-adjusted incidence rate was stable and overall survival rate was low among pancreatic cancer patients of Shanghai residency. Early detection and improved treatment strategies are needed to improve prognosis for this deadly disease.

Abstract 2153: Cdc7 Inhibition as a novel approach for pancreas cancer therapy.

Abstract Pancreatic cancer is the fourth leading cause of cancer death in the USA. In 2012, about 43,920 people will be diagnosed with pancreatic cancer and about 37,390 people will die of this disease. Unfortunately, because of high fatality rates, pancreatic cancer incidence rates are almost equal to mortality rates. About 90% of pancreatic tumors bharbor activating mutations in the KRAS2 oncogene. Furthermore, 95% of pancreatic tumors display inactivation of the CDKN2A gene (encoding the protein inhibitor of cyclin-dependent kinase 4), resulting in the loss of p16 protein, an important regulator of the G1 to S phase cell-cycle transition. Cdc7 is a highly conserved serine-threonine kinase required for the initiation of DNA replication, is a target of the S-phase checkpoint pathway, and has an important role in promoting a proper response to DNA damage in eukaryotic organisms. Downregulation or inhibition of Cdc7 kinase activity resulted in slowing of S-phase progression and cell cycle arrest followed by accumulation of nuclear damage. This kinase has been shown to be over-expressed in many different tumors including the majority of solid tumors and hematologic malignancies. In our laboratory a novel natural product small molecule Cdc7 kinase inhibitor (MSK-777) has been identified, developed and shown to be efficacious in standard cell based cytotoxicity assays (solid and liquid tumors) and multiple different animal models of cancer. We have begun to examine to efficacy of Cdc7 kinase inhibition as a possible therapeutic approach for pancreatic cancer by examining the sensitivity of MSK-777 in three different human pancreatic carcinoma cell lines, Capan-1, BxPC3, and PANC-1. These cells were treated at different time points with MSK-777, control (DMSO), or hydroxyurea and collected for viable cell counts, fluorescence-activated cell sorting (FACS) of DNA, and protein studies using western blotting. Cell viability analyses revealed that MSK-777 had a dramatic effect after 24 hours, reducing cell viability to less then 20% in BxPC3 cells. FACS results demonstrated that MSK-777 exposure resulted in cell cycle arrest at G1/S in Capan-1 and PANC-1 cells by 48 hours while BxPC3 cells showed a significant sub-G1 population by 24 hours, indicating apoptotic cell death. Western blotting showed that in BxPC3 cells phosphorylation of the mini-chromosome maintenance 2 protein (Mcm2) disappeared by 24 hours, indicating inactivation of the helicase that unwinds the strands of DNA during replication. Western blots of Capan-1 and PANC-1 cells showed lower levels of phosphorylated Mcm2 by 48 hours. We are currently examining the efficacy of MSK-777 in mouse models of orthotopically injected pancreatic cancer cells and will be presenting these results. Based on these collective results, inhibition of Cdc7 kinase activity with MSK-777 represents a novel and promising therapy for this deadly disease. Citation Format: Lucia Regales, Ruth Santos, Diana Carrillo, Mark G. Frattini. Cdc7 Inhibition as a novel approach for pancreas cancer therapy. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2153. doi:10.1158/1538-7445.AM2013-2153

New Insights into Pathogenesis, Diagnosis, and Treatment of Pancreatic Disorders

New Insights into Pathogenesis, Diagnosis, and Treatment of Pancreatic Disorders

Influence of Diet and Tobacco Smoking on Pancreatic Cancer Incidence in Poland in 1960–2008

The aim of the study was to investigate the relationship between pancreatic cancer incidence and selected dietary factors, alcohol consumption, and tobacco smoking in Poland in 1960–2008. Data on pancreatic cancer morbidity were derived from the National Cancer Registry and on food consumption from the national food balance sheets. In 1960–1989 correlations were found between pancreatic cancer incidence rates and energy (0.60 for males and 0.57 for females), cholesterol (0.87 and 0.80), fibre (−0.84 and −0.89) and folate (−0.45 and −0.49) intake, the consumption of total fats (0.94 and 0.91), animal fats (0,90 and 0,82), sugar (0.88 and 0.87), cereals (−0.93 and −0.91), and alcohol (0.86 and 0.82). In 1990–2008 morbidity correlated with the consumption of red meat (0.67 and 0.48), poultry (−0.88 and −0.57), and fruit (−0.62 and −0.50). Correlation with tobacco smoking was observed in the whole studied period (0.55 and 0.44). Increased incidence of pancreatic cancer in 1960–1995 was probably related to adverse dietary patterns up to 1989, especially high consumption of fats, sugar, and alcohol. Further positive changes in the diet such as lowering red meat consumption and increasing fruit consumption could influence incidence reduction in recent years. Also changes in tobacco smoking could affect the morbidity.

Ultraviolet B Irradiance and Vitamin D Status are Inversely Associated With Incidence Rates of Pancreatic Cancer Worldwide

To determine if an inverse association exits between latitude, ultraviolet B (UVB) irradiance and incidence rates of pancreatic cancer worldwide. Multiple linear regression was used to investigate the relationship and between UVB irradiance incidence rates of pancreatic cancer and while controlling for cigarette, alcohol and sugar consumption, and proportion overweight. Serum 25-hydroxyvitamin D [25(OH)D] levels were estimated, and their association with incidence rates also was analyzed. Incidence rates were higher at higher latitudes (R2 for latitude for men, 0.51; P < 0.001; R2 for latitude for women, 0.32; P < 0.001). Ultraviolet B irradiance also was independently inversely associated with incidence in men (P < 0.01) and women (P = 0.02). Alcohol (P < 0.0001) and cigarette (P < or = 0.01) consumption were positively associated with incidence in men (R2 for overall model for men, 0.76; P < 0.0001). Alcohol (P < 0.0001) and sugar (P = 0.001) consumption were positively associated with incidence rates in women (R2 for overall model for women, 0.64; P < 0.0001). Incidence rates were half as high in countries with estimated serum 25(OH)D >30 ng/mL (75 nmol/L) than in those with < or =30 ng/mL. Countries with lower UVB irradiance had higher incidence rates of pancreatic cancer in both hemispheres, with occasional exceptions.

Sixty-One Years of Pancreatic Cancer in Denmark From 1943 to 2003

We report the incidence rates of pancreatic cancer in Denmark during 61 years of data registration, from 1943 to 2003. On the basis of reports in the nationwide, population-based Danish Cancer Registry, we calculated age-standardized, period-specific incidence rates of pancreatic cancer. A total of 32,654 incident cases of pancreatic cancer were evaluated (male-female ratio, 1.4). The age-standardized incidence rate of pancreatic cancer increased steadily in the beginning of the study period from 3.75/100,000 person-years in 1943 to 1947 to the maximum of 9.96/100,000 person-years in 1968 to 1972 among men and from 2.95 in 1943 to 1947 to the maximum of 7.04 in 1978 to 1982 among women. The incidence rates declined between 1968 to 1972 and 1988 to 1992 for men and between 1978 to 1982 and 2003 for women. Most tumors were located in the exocrine pancreas, and most were adenocarcinomas. More than 40% were located in the head of the pancreas; 14% were localized, 21% were regionally spread, and 36% were metastatic at the time of diagnosis. During the period 1978 to 2003, the percentages of histologically or cytologically verified adenocarcinomas remained relatively steady, approximately 30%. The incidence rate of pancreatic cancer increased at the beginning of the 61 years of registration and declined slightly thereafter.

ABO Blood Group and the Risk of Pancreatic Cancer

Other than several rare, highly penetrant familial syndromes, genetic risk factors for sporadic pancreatic cancer are largely unknown. ABO blood type is an inherited characteristic that in previous small studies has been associated with the risk of gastrointestinal malignancies. We separately examined the relationship between ABO blood type and the risk of incident pancreatic cancer in two large, independent, prospective cohort studies (the Nurses' Health Study and Health Professionals Follow-up Study) that collected blood group data on 107 503 US health professionals. Hazard ratios for pancreatic cancer by ABO blood type were calculated using Cox proportional hazards models with adjustment for other known risk factors, including age, tobacco use, body mass index, physical activity, and history of diabetes mellitus. All statistical tests were two-sided. During 927 995 person-years of follow-up, 316 participants developed pancreatic cancer. ABO blood type was associated with the risk of developing pancreatic cancer (P = .004; log-rank test). Compared with participants with blood group O, those with blood groups A, AB, or B were more likely to develop pancreatic cancer (adjusted hazard ratios for incident pancreatic cancer were 1.32 [95% confidence interval {CI} = 1.02 to 1.72], 1.51 [95% CI = 1.02 to 2.23], and 1.72 [95% CI = 1.25 to 2.38], respectively). The association between blood type and pancreatic cancer risk was nearly identical in the two cohorts (P(interaction) = .97). Overall, 17% of the pancreatic cancer cases were attributable to inheriting a non-O blood group (blood group A, B, or AB). The age-adjusted incidence rates for pancreatic cancer per 100 000 person-years were 27 (95% CI = 23 to 33) for participants with blood type O, 36 (95% CI = 26 to 50) for those with blood type A, 41 (95% CI = 31 to 56) for those with blood type AB, and 46 (95% CI = 32 to 68) for those with blood type B. In two large, independent populations, ABO blood type was statistically significantly associated with the risk of pancreatic cancer. Further studies are necessary to define the mechanisms by which ABO blood type or closely linked genetic variants may influence pancreatic cancer risk.

Pancreatic Cancer in Canada: Incidence and Mortality Trends from 1992 to 2005

Pancreatic cancer is the fourth-ranking cause of death among all major malignancies in Canada and has the lowest five-year survival rate. To examine incidence and mortality trends of pancreatic cancer in Canada from 1992 to 2005, with particular emphasis on the role of cigarette smoking. Data from Health Canada and Statistics Canada were analyzed for age-adjusted incidence and mortality trends from 1992 to 2005. The future burden of pancreatic cancer in Canada was based on population projections. The incidence rate of pancreatic cancer for women between 1992 and 2005 remained stable (8.49 and 8.48 cases per 100,000, respectively), and there was a decrease in the incidence for men from 11.1 per 100,000 in 1992 to 9.89 per 100,000 in 2005. This reduction may be the result of a decrease in smoking rates among Canadian men. The mortality rate of this cancer remains high. Approximately 99% of all pancreatic cancer cases occur in individuals older than 50 years of age.The total number of annual cases of pancreatic cancer in Canada is expected to more than double from 2636 cases in 2006 to 5619 in the year 2031. The incidence of pancreatic cancer in Canada from 1992 to 2005 remained relatively stable, although the incidence decreased somewhat in men, perhaps as a result of a change in smoking behaviour. The total number of cases of pancreatic cancer is expected to more than double by 2031.