Pancreatico-biliary malignancy: prevalence and risk factors.

Tumors arising in the pancreatico-biliary system arise from the same embryological source and share several similar clinical features. For both sites, the mortality rate is high and early diagnosis is difficult. Despite these similarities, there are clear epidemiologic differences between cancers of the biliary tract and cancers of the pancreas. Gallbladder cancer is more frequent in females, whereas pancreatic cancer is more frequent in males. High-risk populations for gallbladder cancer include Native American Indians and Hispanic Americans. Black populations are at high risk for pancreatic cancer. Gallstones are causally related to gallbladder cancer, but for pancreatic cancer, smoking is the major known risk factor. The increasing frequency of cholecystectomy in persons with gallstones should result in a reduction in the incidence of gallbladder cancer. For pancreatic cancer, public health efforts to reduce smoking offers the best chance for prevention.