Pancreatic cancer is a formidable adversary in the world of oncology, known for its stealthy onset and grim prognosis. In the European Union, it is the fourth leading cause of cancer deaths, with a dismal 5-year survival rate of only 9%, making it the deadliest cancer in Europe. In 2018 alone, pancreatic cancer claimed about 128,000 lives and saw 132,600 new diagnoses across Europe, highlighting the urgent need for better awareness, early detection, and effective treatment strategies.
Age and Risk
One of the most significant risk factors for pancreatic cancer is age. Nearly half of all new cases in the UK are diagnosed in individuals aged 75 and over, with the highest incidence rates observed in those aged 85 to 89. This age-related risk emphasises the importance of monitoring older adults for symptoms and risk factors associated with pancreatic cancer.
Mutations
The majority of pancreatic cancer cases, over 80%, arise due to sporadically occurring mutations. These mutations occur randomly and are not inherited, making it challenging to predict who might develop the disease. Conversely, a small percentage of cases are due to inherited genetic mutations, with the most common being variants in the BRCA1 and BRCA2 genes. While these inherited mutations do increase the risk of developing pancreatic cancer, the overall risk remains relatively low. Nonetheless, individuals from families with a history of pancreatic cancer should consider genetic counselling and potentially enrolling in investigational screening registries to monitor their health closely.
Other Risk Factors
In sporadic cases of pancreatic cancer, several lifestyle and environmental factors significantly contribute to risk. Tobacco use, for example, is a well-established risk factor. Additionally, infections like Helicobacter pylori and dietary habits, such as high consumption of red meat and alcohol and diets low in fruits and vegetables, play critical roles.
Obesity/being overweight, and type 2 diabetes are also important risk factors, linking metabolic health to the likelihood of developing pancreatic cancer.
Chronic pancreatitis, a condition characterised by long-term inflammation of the pancreas, is another significant risk factor. This inflammation can cause changes in pancreatic cells that may eventually lead to cancer.
The Challenges of Diagnosis
One of the most challenging aspects of pancreatic cancer is its diagnosis. The signs and symptoms are often vague and non-specific, leading to frequent misdiagnosis. Many patients are not diagnosed until the cancer has reached an advanced stage, by which time surgical options – the only potential cure – are usually no longer viable. Consequently, more than half of those diagnosed with pancreatic cancer die within three months, highlighting the critical need for early detection.
Early detection is paramount for improving long-term survival rates in pancreatic cancer. Surgery remains the best option for a positive outcome, but it is only feasible in the early stages of the disease. Therefore, finding ways to diagnose pancreatic cancer earlier is essential.
New-onset diabetes can be an early indicator of pancreatic cancer, although it is a common condition, and most individuals with diabetes do not develop pancreatic cancer. Recent research by Oxford scientists*, published in the British Journal of Cancer, has identified a more effective method for identifying people with new-onset diabetes who are at higher risk for pancreatic cancer. This research suggests that, in addition to the current NICE guidelines which recommend abdominal imaging for people aged 60 and over with new-onset type 2 diabetes and weight loss, other factors such as recent indigestion, heartburn, nausea, abdominal pain, platelet count, and blood clot history should also be considered to provide a more accurate risk assessment.
*Clift et al. Predicting the risk of pancreatic cancer in adults with new-onset diabetes: development and internal–external validation of a clinical risk prediction model. Br J Cancer 130, 1969–1978 (2024).
The Burden of Pancreatic Cancer
In 2018, pancreatic cancer caused an estimated 128,000 deaths across Europe and was diagnosed in 132,600 individuals. In the UK, Cancer Research UK statistics reveal that there are approximately 10,800 new pancreatic cancer cases each year, making it the 10th most common cancer in the country and accounting for 3% of all new cancer cases. Since the early 1990s, the incidence rates of pancreatic cancer in the UK have increased by a sixth. Over the past decade, these rates have risen by around 9%, and projections indicate a further 5% increase between 2023-2025 and 2038-2040. This means there could be around 16,000 new cases of pancreatic cancer annually in the UK by 2038-2040.
Given these sobering statistics, it is evident that pancreatic cancer presents a significant public health challenge. Addressing the risk factors, improving early detection methods, and raising awareness are vital steps toward reducing the incidence and improving the survival rates of this devastating disease.
