Pancreatic cancer: epidemiology, genetics, and approaches to screening.

Pancreatic cancer is a leading cause of cancer-related mortality. Treatment has limited efficacy, and 5-year survival rates remain less than 5%. Insights from epidemiology and discoveries in molecular genetics have laid the groundwork for a rational screening strategy for high-risk individuals. High-risk populations include those in their 6th to 8th decades of life, those with a family history of pancreatic cancer, and those with a personal history of tobacco smoking. Roughly 10% of cases are due to an inherited genetic susceptibility. Several familial syndromes with known genetic defects have been implicated, but the majority of familial cases result from as yet undefined genes. Acquired mutations have been identified in the oncogenes K-ras and HER2/neu, and in the tumor suppressor genes p16, p53, SMAD4, and BRCA2. No standard for screening or prevention exists, but strategies employing endoscopic, radiologic, and molecular methods to screen high-risk individuals are under investigation.