Updated risk factors to inform early pancreatic cancer screening and identify high risk patients

Abstract

Pancreatic adenocarcinoma (PDAC) is associated with poor clinical outcomes and incomplete responses to conventional therapy. Therefore, there is an unmet clinical need to better understand the predisposing factors for pancreatic cancer in hopes of providing early screening to high-risk patients. While select risk factors such as age, race, and family history, or predisposing syndromes are unavoidable, there are several new and established risk factors that allow for intervention, namely by counseling patients to make the appropriate lifestyle modifications. Here, we discuss the best-studied risk factors for PDAC such as tobacco use and chronic pancreatitis, as well as newly emerging risk factors including select nutritional deficits, bacterial infections, and psychosocial factors. As several of these risk factors appear to be additive or synergistic, by understanding their relationships and offering coordinated, multidisciplinary care to high-risk patients, it may be possible to reduce pancreatic cancer incidence and improve clinical outcomes through early detection.

Keywords: Cancer prevention; Cancer risk factors; Cancer screening; Pancreatic cancer.

Figure 1.. Differences in gene expression by sex and race in the TCGA cohort of pancreatic cancer patients

(A,B) Using the TCGA genomic databases of pancreatic cancer patients (N=185), we evaluated differences in gene expression between male (N=102) and female (N=83) patients. Differences in mRNA expression were visualized via volcano plot, and genes with significant (FDR adjusted p-value < 0.05) differences between groups colored blue. For a complete list of these genes see Table 1. (C,D) In the same patient cohort, we evaluated differences in gene expression based on race. Of the 180 patients for which ethnicity was documented, 162 were white, and the remaining 18 African American or Asian (non-white). Differences in mRNA expression were visualized via volcano plot, and genes with significant (FDR adjusted p-value < 0.05) differences between groups colored blue. For a complete list of these genes see Table 1.