Introduction

Adenocarcinoma of the pancreas is the fifteenth most common cancer in the world, and is more frequent in developed, than in developing, countries. Tobacco is the most important etiological factor so far identified.

Histology, classification and diagnosis

Tumors of the pancreas can be divided into common adenocarcinomas and infrequent islet cell tumors of the endocrine pancreas. Many pancreatic tumors were formerly attributed to the gastro-intestinal tract or the liver, which may partly explain the reported incidence rise since 1950.

Descriptive epidemiology

Incidence

The incidence and distribution of adenocarcinomas has been reviewed by Mack (1982). Geographic variations are not as great as for other gastrointestinal cancers. Among males, high rates (over 10) are seen in American blacks, Maoris in New Zealand, and in some European countries; intermediate rates (over 4) in whites in North America, the rest of Europe, Australia, Japan, China, Israel and in most South American countries; and low rates (less than 4) in Africa, India and some South American countries (Figure 31.1). (The rate in male Koreans in Los Angeles is based on 11 cases.) In the USA, rates are higher in blacks than in whites, but are relatively low in Seventh Day Adventists and Mormons. A consistent association with social class has not been observed. Higher frequencies in urban than in rural areas may be a diagnostic artefact.