Is recurrent acute pancreatitis a risk factor for pancreatic cancer?

From the Guidelines

Recurrent acute pancreatitis is a significant risk factor for pancreatic cancer, particularly in individuals with chronic pancreatitis or those who have had pancreatitis for more than 5 years. The risk of pancreatic cancer in these patients is estimated to be around 2-3 fold higher compared to the general population 1. This increased risk is attributed to chronic inflammation, which leads to DNA damage, cellular mutations, and fibrosis in the pancreatic tissue, creating an environment conducive to cancer development. Other factors that can compound this risk include smoking, alcohol consumption, and certain genetic mutations like PRSS1, SPINK1, or CFTR.

Key Considerations

• The duration and severity of pancreatitis are directly related to the risk of developing pancreatic cancer, with longer duration and greater severity increasing the risk 1.
• Patients with recurrent acute pancreatitis should undergo regular surveillance, particularly if they have additional risk factors such as smoking, alcohol consumption, or genetic mutations 1.
• Lifestyle modifications such as smoking cessation, alcohol abstinence, and maintaining a healthy diet may help reduce the overall risk of progression to pancreatic cancer.
• The estimated lifetime risk of pancreatic cancer in individuals with hereditary pancreatitis is high, around 40%, and is directly related to the duration of recurrent pancreatitis and chronic inflammation 1.

Surveillance and Prevention

• Regular surveillance is crucial for patients with recurrent acute pancreatitis, especially those with additional risk factors.
• Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) can be used to detect microlithiasis in the gall bladder or common bile duct, and ductal anomalies such as pancreas divisum 1.
• Bile sampling may be the only way to identify patients with recurrent acute pancreatitis due to microlithiasis.
• Genetic testing may be considered in selected patients, particularly those with a family history of pancreatic cancer or known genetic mutations.

From the Research

Recurrent Acute Pancreatitis and Pancreatic Cancer Risk

• Recurrent acute pancreatitis (RAP) has been linked to an increased risk of pancreatic cancer, with studies suggesting that the risk is higher in patients with multiple episodes of RAP 2.
• A retrospective analysis of the Korean National Sample Cohort found that acute pancreatitis was significantly associated with an increased risk of pancreatic cancer, with a hazard ratio of 7.56 (95% confidence interval, 5.00-11.41) 2.
• The risk of pancreatic cancer increased with the number of recurrent acute pancreatitis episodes, with a hazard ratio of 5.25 (3.31-8.33) for one episode, 11.35 (6.38-20.19) for two episodes, and 24.58 (13.66-44.26) for three or more episodes 2.

Clinical Presentation and Outcomes

• Patients with RAP who develop chronic pancreatitis (CP) tend to be younger, active smokers, and have alcohol-related CP 3.
• These patients are more likely to experience chronic abdominal pain, nausea, and exocrine pancreatic insufficiency, and are more likely to use opioids and gabapentinoids 3.
• They also have more emergency department visits resulting in an opioid prescription and more CP flares requiring hospitalization 3.

Risk Factors for Recurrent Acute Pancreatitis

• Smoking history, infected pancreatic necrosis, and high low-density lipoprotein cholesterol (LDLc) level have been identified as significant independent risk factors for RAP 4.
• Etiology, smoking, and necrotizing pancreatitis have also been identified as independent risk factors for recurrent pancreatitis and CP 5.
• The cumulative risk for recurrent pancreatitis over 5 years was highest among smokers, at 40% (compared with 13% for nonsmokers) 5.