In June of the year 1801, a group of interested physicians and surgeons met in London to form an institution with the purpose of investigating the nature and the cure for cancer.
The members of the organization listed several questions which they deemed worthwhile for study. These questions as summarized below included:
· What are the diagnostic signs of cancer?
· Are there preexisting changes in an organ before development of cancer?
· May other diseases degenerate into cancer?
· Is cancer a hereditary disease?
· Is cancer contagious?
· Does climate or [environmental] factors render the human constitution susceptible to cancer?
· Are brute-creatures subject to any disease resembling cancer in humans?
More than 200 years later we are still seeking answers to many of these questions.
In one of the very early epidemiologic studies of pancreatic cancer, Wynder and co-authors conducted a case–control study of 100 patients with biopsy-proven pancreatic cancer and 294 control subjects. The findings of this study led Wynder to hypothesize that carcinogens derived from tobacco, occupational or other environ-mental sources might enter the bile and then cause pancreatic cancer by reﬂux through the pancreatic duct. This hypothesis has never been disproved and could explain the excess of pancreatic cancer known to occur in the head of the pancreas. Another early article reviewed risk factors for pancreas cancer; most of the findings are still valid today.
Table 1 compares early with current evidence about the epidemiology of pancreatic cancer.