Seminar

Pancreatic cancer is the fourth leading cause of cancer death in the USA and leads to an estimated 227 000 deaths per year worldwide.1 Risk factors for this malignant disease include smoking, family history2 of chronic pancreatitis, advancing age, male sex, diabetes mellitus, obesity, non-O blood group,3,4 occupational exposures (eg, to chlorinated hydrocarbon solvents and nickel),5 African-American ethnic origin, a high-fat diet, diets high in meat and low in vegetables and folate, and possibly Helicobacter pylori infection and periodontal disease.1 Findings of prelimin-ary studies suggest that metformin could protect against development of pancreatic cancer.6 Coff ee intake is not regarded as a risk factor for disease. Although the cause of pancreatic cancer is complex and multifactorial, cigarette smoking and family history are dominant. About 20 % o