657 10.2217/FON.09.32 © 2009 Future Medicine Ltd ISSN 1479-6694 part of Future Oncology Future Oncol. (2009) 5(5), 657–668 Pancreatic cancer is the fourth most common cause of cancer mortality in the USA, and its incidence is estimated to be around nine patients per 100,000 individuals [1] . Information on this malignancy in Latin America is scarce; in Brazil analyses have demonstrated a 10.23% increase in the mortality rate [2] . Among Chilean women there has been also a significant increase in this neoplasm [3] , and while the incidence in Colombia is 4.5 per 100,000 individuals [4] , in Mexico pancreatic cancer has had a slight decrease in the relative percentage occurence of gastrointestinal cancers from 1976 to 2003 [5] . In Peru, amongst digestive diseases, pancreatic cancer is the fifth most common [6] . For all stages combined, the 1-year survival rate for pancreatic cancer is approximately 20%, and the overall 5-year survival rate has remained dismally poor, at less than 5% [1] . Complete sur- gical resection remains the only curative treat- ment for pancreatic cancer, but because of the typically late onset of symptoms, only approxi- mately 15–20% of cases are amenable to surgi- cal resection at the time of diagnosis. Of the remaining 80–85% of patients, 40% present with advanced locoregional disease precluding complete resection, with a median survival time (MST) of 6–11 months, and the other 45% of patients present with metastatic disease, with a MST of 3–6 months [7,8] . The only possibility of cure, albeit small, is based on the combination of complete resection with negative histopathological margins (R0 resection) with adjuvant treatment [9] . At present, the most effective screening method for pancreatic cancer in high-risk patients is a multimodal screening approach of endoscopic ultrasound (EUS), computed tomography (CT) and endoscopic retrograde cholangiopancreato- graphy (ERCP). Continued efforts are therefore needed to elucidate effective testing to identify patients with nonhereditary risk factors who will benefit from screening protocols. A combined approach of serum markers, genetic markers and specific imaging studies may prove to be the future of pancreatic screening [10] . Risk factors The median age at diagnosis for pancreatic cancer is 69 years in white people and 65 years in black people, with a male:female ratio of 1.2–1.5:1. Risk factors are not well understood, since most cases seem to develop sporadically. Chronic pancreatitis [11] , cigarette smoking [12,13] , Limitations in improving detection of pancreatic adenocarcinoma Hugo Mendieta Zerón † , Jesús Rey García Flores & Martha Liliana Romero Prieto † Author for correspondence: Felipe Villanueva sur 1209, Col. Rancho Dolores 50170, Toluca, México n Tel.: +52 722 217 6605 n Fax: +52 722 219 4122 n mezh_74@yahoo.com Objective: To review the current trends in pancreatic cancer research and propose alternatives for an earlier diagnosis. Method: A search was conducted using the PubMed and Scielo electronic databases to find statistics related to the incidence of pancreatic cancer. Results: Pancreatic cancer is the fourth most common cause of cancer mortality in the USA; in Colombia the incidence of this neoplasia is 4.5 per 100,000 individuals; and in Peru, amongst digestive diseases, it is the fifth most common cause. In Brazil and Chile this cancer has increased in incidence, while in Mexico, it has decreased in terms of the relative percentage of gastrointestinal cancers from 1976 to 2003. Chronic pancreatitis, cigarette smoking, diabetes, obesity and dietary mutagen exposure are the most consistent risk factors implicated in the development of pancreatic cancer; however, the genetic and molecular changes underlying the epidemiological association between these factors and pancreatic cancer remain largely unknown, and only 5–10% are hereditary in nature. Conclusion: The prognosis for pancreatic cancer has not changed substantially for at least the last 20 years. The most useful tumor marker for pancreatic adenocarcinoma is still the carbohydrate antigen 19-9 (CA19-9). Currently, a multimodal-screening approach of endoscopic ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography are the most effective methods to detect pancreatic cancer in high-risk patients. Future options for early detection of this malignancy are focused on new molecular markers, telomerase enzyme, receptor-targeted imaging using multifunctional nanoparticles, detection of glycan changes and epigenetics. Keywords pancreatic adenocarcinoma n screening n telomerase Review For reprint orders, please contact: reprints@futuremedicine.com