Introduction
Pancreatic cancer is the most lethal and hard to diagnose type of cancer and thus often called the “silent killer”. Currently, no early detection method and no effective treatment are available for pancreatic cancer. Moreover, out of all patients diagnosed with pancreatic cancer, 75% will die within the first year where most within 3-6 months (Klein, 2013). While it is practically impossible to tell what person will develop this type of cancer the essential pathophysiology of cancers can help with understanding the origins and reasons for pancreatic cancer development.
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Like most cancers, pancreatic cancer is caused by damage to DNA leading to its mutation. These mutations can be originated from different sources which can be categorized according to the nature of the occurrence. Three main categories of mutations have been universally recognized: inherited mutation, age-related, carcinogen caused or due to human behavior (Klein, 2013). The outcome of the exposure to one or multiple DNA mutation causes may be the formation of the neoplasms in the pancreatic tissue which may progress to actual pancreatic cancer where initial growth of the tumor is silent; therefore, symptoms are usually a sign of advanced disease.
The objective of the present research paper is to highlight the epidemiological facts related to pancreatic cancer (i.e frequency, distribution and determinants of health) and identify the public health authorities’ approaches towards management and control of this devastating health condition.
Frequency, Distribution And Determinants of Health
According to Canadian Cancer Registry age-standardized incidence rated (ASIR) of pancreatic cancer has been declined for men by 0.46% on the course from 1991 to 2007 with 11.2 case per 100,000 population in 1991 and 10.5 cases in 2007 respectively. However, during the same period of time the ASIR of pancreatic cancer for women per 100,000 population remained steady with a slight fluctuation hovering around 8.5 case.
The prevalence rate in United States and Europe has been calculated to be about 99,901 cases before 2012 with an incidence of 37,685 new cases in 2012. Despite the fact that some significant progress in cancer survival rate has been attained the projected 5-year rate of survival remained persistent slightly rising to 5.4% since 1975. Such poor outcomes are mostly due to the fact of the nature of the cancer where more than 80% of the patients presenting with already advanced stage and metastatic aetiology (Klein, 2013).
However, despite the poor prognosis of 5 years that has been shared by researches conducted both in US, Europe and Canada the age-standardized mortality rate (ASMR) in Canadian men has declined substantially by 0.61 percent since 1992 lingering around 8.9 cases per 100,000 in 2009 (95% confidence interval). With regards to women ASMR the data from Statistics Canada claims the decrease of 0.2% for the same period of time which attests to the stability of rates in women (Zaheer & Gallinger, 2013).
Determinant of Health
The most commonly recognized carcinogen related to pancreatic cancer is cigarettes. Smoking remains the most associated risk to cancer development having odds ratio (OR) of 1.74, 95% confidence interval (CI). Thus, the cessation is the main recommendation being disease specific (Zaheer & Gallinger, 2013).
Less putative risks associated with this type of cancer include: body mass index (BMI) over 35 (OR of 1.55 and 95% CI) and alcohol consumption of over 6 beverages a day is seen to be associated (OR 1.46, 95% CI) (Borgida et al., 2011).
Original Epidemiological Studies
Management of pancreatic adenocarcinoma in Ontario, Canada: a population-based study using novel case ascertainment
This uses prospective case-control and cross-sectional survey observational study design. The study population is pancreatic adenocarcinoma (PA) patients in Canada with data sources from diagnosed patients of PA between 2003 and 2006 who were identified using electronic pathology reporting (E-path) of the Pathology Information Management System (PIMS). For more information questionnaires were mailed to patients. The main results showed a low participation rate of 26% (351 out of 1325). Nonresponders were mostly over 70 years old and more likely to have had treatment in non-academic centres. While, 54% of responders had a potentially curative operation with 77% being 70 years or younger (p=0.03). Academic centres had higher resection rates and less frequently aborted resections with curative intent. Low rates showed 43% of responders received chemotherapy and 7% participated in clinical trials (Borgida et al., 2011).
Diagnosis and management of pancreatic cancer
This uses case-control and prospective observational study design. The study population is Canada with data sources from Cochrane for systematic reviews, reference lists from prior studies, Medline, PubMed and Google Scholar using MeSH terms. The main results shows the diagnosis and treatment relevant to the general clinician includes screening via Triphasic abdominal contrast computed tomography is most preferred for diagnosis, smoking cessation as the sole preventative measure, curative potential remains with surgery, adjuvant chemotherapy, and survival benefit from FOLFIRINOX, gemcitabine alone and plus for advanced cases (Zaheer & Gallinger, 2013).
Identifying people at a high risk of developing pancreatic cancer
This uses cohort, case-control and prospective observational study design. The study population is North America with data sources from familial pancreatic cancer registry and other registries (Klein, 2012). The main results was that through relatives of pancreatic cancer patients there has been demonstrated in relation to pancreatic cancer a familial aggregation of 1.5–1.3-fold increased risk, quantified risk of this cancer and other cancers, identification of susceptibility genes in these high risk families and initiation of screening trials (Klein, 2012).
Public Health Approaches
Electronic Pathology Reporting System
Electronic Pathology Reporting System (E-path) is an approach used to identify pancreatic adenocarcinoma (PA) patients across Ontario. It is implemented to provide the fastest source of cancer information. Ontario Cancer Registry uses Pathology Information Management System (PIMS), which relies on E-path. The E-path system is a database used for collecting electronic pathology information from laboratories in Ontario that process tumour specimens. E-path provides reports in a timelier manner than paper-based reports and has shown an increase in report’s completeness. This has great advantage when studying patients that have fast and progressive disease such as PA. In this system, electronic pathology reports come from each laboratory and are queued in a database by health record technicians for on-screen review. This process occur daily in most laboratories and weekly in some low-volume laboratories. If the health record technician see the report findings useful, the report will be coded and consolidated with the OCR database. Reports of particular cancers like PA are filtered and printed by study personnel for review (Borgida et al., 2011).
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Educational Events and Symposia
Organizations such as Pancreatic Cancer Canada host some series educational events for Pancreatic Cancer (PC) patients, their families, relatives, and friends in places across Canada. These events give opportunity for patients learn more about the topics related to pancreatic cancer. Also, there are meetings or conferences held by leaders in the PC field to talk about different topics and bring mutual trust and friendship to survivors and those touched by the disease (Pancreatic Cancer Canada, 2011).
Research
Established partnerships with leading research hospitals to raise the profile of the disease. Funding is being provided by organization like PCC to continue the fight for cancer (Pancreatic Cancer Canada, 2011).
References
Borgida, A. E., Ashamalla, S., Wigdan, A-S., Rothenmund, H., Urbach, D., Moore, M., Gallinger, S. (February 2011). Management of pancreatic adenocarcinoma in Ontario, Canada: A population-based study using novel case ascertainment. U.S. National Library of Medicine National Institutes of Health, 54(1), 54-60. doi: 10.1503/cjs.026409
Klein, A. P. (December 6, 2012). Identifying people at a high risk of developing pancreatic cancer. U.S. National Library of Medicine National Institutes of Health, 13(1), 66-74. doi: 10.1038/nrc3420
Pancreatic Cancer Canada. (2011) Educational Events and Symposia. Retrieved from:
Pancreatic Cancer Canada. (2011) Research. Retrieved from: http://www.pancreaticcancercanada.ca/
site/PageServer?pagename=research_main
Zaheer K. S., & Gallinger, S. (2013). Diagnosis and management of pancreatic cancer. Pancreatic Cancer Canada. Retrieved from: http://www.pancreaticcancercanada.ca/site/DocServer/Steven_Gallinger_report_April_23_2012.pdf?docID=1361
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Epidemiology is the study and analysis of the distribution, patterns and determinants of health and disease conditions in defined populations. It is a cornerstone of public health, and shapes policy decisions and evidence-based practice by identifying risk factors for disease and targets for preventive healthcare
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