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Formal Discussion of "Cancers of the Pancreas and Biliary Tract: Epidemiological Considerations"¹

Department of Surgery, New York Hospital, Cornell Medical Center, New York, New York 10021

SUMMARIZING REMARKS: The present status of carcinoma of the pancreas is dismal and becoming worse because our treatment is not improving while incidence is increasing. Epidemiological data like those reported by Dr. Fraumeni have highlighted this situation and suggested some new ways to look at the disease.

High-risk groups in the population can be identified, but it is questionable whether screening is feasible with presently available diagnostic methods. If one recently published paper suggesting a tumor-specific protein is correct, it might become reasonable to explore such screening. Although surgical removal of these tumors has become safer and more effective and total pancreatectomy will be used more extensively in coming years, we cannot expect surgery to make an important impact on the disease since 90% of patients are inoperable when first seen.

Since prodromal and/or early malignant changes are not observable in human patients, we should turn vigorously to the creation of an animal model for biliary tract and/or pancreatic tumors. In this regard, existing evidence illustrates the close similarity of baboons to humans in bile chemistry and physiology. Furthermore, pancreatic cancer does occur in animals and suggests that carnivores and/or omnivores might be better candidates than herbivores to serve as animal models. Husbandry, management, and economic consideration make it entirely reasonable to turn to larger animals rather than mega-mice, if one is satisfied that phylogenetic similarity to humans and longer life-span are important.

It is reasonable to think that experimental studies following up on these epidemiological clues will produce useful data, and we can then hope that the coming years will produce better progress than we have made in our generation.

¹ This discussion of the paper by Joseph F. Fraumeni, Jr. (Cancer Res., 35: 3437–3446, 1975) was presented at the Conference on Nutrition in the Causation of Cancer, May 19 to 22, 1975, Key Biscayne, Fla.