Early detection of pancreatic adenocarcinoma

In an article in this edition of the journal Mthunzi et al. report on the geographic distribution of pancreaticobiliary malignancy in central South Africa. The incidence of pancreatic adenocarcinoma (PDAC) that was calculated in clusters according to geographical region seemed to be higher than the incidence in the general South African population. This comparison needs to be interpreted with caution as the diagnoses in the study were made on clinical and radiological grounds, as opposed to the National Cancer Registry (NCR), where the diagnosis is based on histological confirmation. With only a small proportion of patients with PDAC in South Africa being operated or biopsied, there is significant underestimation of the true incidence, which could have resulted in overestimation of the incidence of PDAC in the cohorts included in the study. In 2020 a total of 502 patients with PDACs were reported into the South African NCR, where it ranked as the 22nd and 21st most common tumour forms in males and females, respectively. The study in this issue identified only two PDAC patients with a family history and concluded the need for further research into identifying the obstacles around accurate identification and possibly under-reporting of genetic and familial contributors.