Biliary/Pancreas

21 - Familial Pancreatic Cancer Risk by Subsite of Primary Cancer: A Population-Based Study

Tuesday, October 9
8:50 AM - 9:00 AM
Location: Terrace Ballroom 4 (level 400)

Category: Biliary/Pancreas
Divyanshoo R. Kohli, MD1, Ken Smith, PhD2, Jathine Wong, BS2, Zhe Yu, BS2, Kenneth Boucher, PhD2, Randall Burt, PhD2, Karen Curtin, PhD2, Niloy J. Samadder, MD3
1Mayo Clinic, Overland Park, KS; 2University of Utah, Salt Lake City, UT; 3Mayo Clinic, Scottsdale, AZ

Introduction: Adenocarcinoma of the pancreas (PC) is a highly fatal malignancy with an undefined hereditary component. We quantified the familial risk of PC among relatives of index cases of PC.

Methods: This is a retrospective, population-based, case–control study of PC diagnosed in Utah between 1980-2011. The Utah population database and cancer registry were used to identify index patients with histologically-proven PC based on the International Classification of Disease-9 codes (C25.0-C25.9). The cancers were subdivided based on their location and age and sex of patients. Population controls were selected randomly from the databases and individually matched to cases by gender and birth year in a 10:1 ratio. The risk of PC in first-degree relatives (FDRs), second-degree relatives (SDRs), and first cousins (FCs) of index patients was compared with matched population controls.

Results: A total of 4,095 patients and 40,933 age and gender matched controls, were identified. The mean age at diagnosis was 69.6 years (table 1) and 68% of the cohort was >65 years of age. Overall, PC was present in 112 of the 20,104 FDR of cases compared to 633 of the 196,710 FDR of the controls (hazard ratio {HR}: 1.76; 95% CI: 1.35-2.29; P<0.0001). The HR for PC among SDR was 1.42 (95% CI: 1.18-1.7; P=0.0002) and FC was 1.08 (95% CI: 0.95-1.23; P=0.16). Similarly, the HR was elevated for FDR (HR: 1.62; 95% CI:1.15-2.3, P=0.006; table 2); SDR (HR: 1.4, 95% CI: 1.08-1.82; P=0.01) and FC (HR: 0.98, 95%CI: 0.82-1.17; P=0.82) of patients with PC of the head. Relatives of female PC cases had a greater risk of PC than relatives of male cases (HR: 1.96, 95% CI: 1.45-2.65 vs. HR: 1.55, CI: 1.07-2.26; table 3). The risk of PC was elevated in relatives of index patients whether they were above or below age 65 years (Table 3), though there was a greater risk amongst FDRs of young onset cases (HR 2.12, 95% CI: 1.37-3.28).  

Discussion: This is the largest population-based study which evaluates and stratifies the familial risk for PC based on the location of the PC, and age and sex of the index patient. There is an increased risk of PC in FDR and more distant relatives of patients with PC which may impact surveillance strategies in high-risk individuals.

Table 1: Characteristics of Index Patients with Pancreas Cancer. 1Includes overlapping sites and not otherwise specified
Table 2: Risk for pancreatic cancer in relatives of index patients stratified by site of cancer.
Table 3: Risk for pancreatic cancer in relatives of index cases stratified by gender and age of index case

Disclosures:
Divyanshoo Kohli indicated no relevant financial relationships.
Ken Smith indicated no relevant financial relationships.
Jathine Wong indicated no relevant financial relationships.
Zhe Yu indicated no relevant financial relationships.
Kenneth Boucher indicated no relevant financial relationships.
Randall Burt: Myriad Genetics – Consultant.
Karen Curtin indicated no relevant financial relationships.
Niloy Samadder: Cook Medical and Covidien Medical. – Consultant.

Divyanshoo R. Kohli

Virginia Commonwealth University
Richmond, Virginia

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