The risk of pancreatic cancer after a primary episode of AP was reported by Rijkers et al. [106] in 731 patients who were followed for a median of 55 months. Pancreatic cancer incidence rate (per 1000 patient‐years) in the group who progressed to chronic pancreatitis was 9.0 compared with 1.1 in those did not progress to chronic pancreatitis. The median time to developing pancreatic cancer was 47 months in those with chronic pancreatitis and 12 months in those who did not have chronic pancreatitis. One wonders if the AP was secondary to the underlying pancreatic cancer in this group without chronic pancreatitis. No comparative group was utilized in this study [106].
Sadr‐Azodi et al. [107] performed a population‐based cohort study including all Swedish residents diagnosed with AP in order to determine the relationship between AP and pancreatic cancer. Approximately 70% of patients with pancreatic cancer had a history of AP. The risk of pancreatic cancer was increased during the first few years after the episode of AP and then gradually declined. The risk of pancreatic cancer between two months and two years after hospitalization for AP was highest in individuals aged 60 and above without gallstone‐related pancreatitis but with diabetes mellitus. Those cancers diagnosed within six months of AP were more likely to be localized [107].
A follow‐up, nationwide, matched cohort study from Denmark by Kirkegard et al. [108] found that patients with AP had increased risk of pancreatic cancer. Their risk for developing pancreatic cancer decreased with time but was still elevated at two and five years post episode and this included a three‐year washout period to reduce the likelihood of including prevalent cases of pancreatic cancer. Thus, we must continue to follow up and search for an underlying neoplasm in patients with AP who are older than 40 years of age, irrespective of the presumed cause of their AP. The reason(s) for this association may be similar etiologies, including alcohol, smoking, diet, diabetes, and obesity [109].
Thus, patients with a history of AP regardless of cause should likely undergo screening for pancreatic cancer in the five years after their initial episode.
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