Epidemiology: In the United States there are 28,000 to 30,300 newly diagnosed cases of pancreatic cancer and approximately an equal number of deaths per year from pancreatic cancer. Ductal adenocarcinoma is the most common form of pancreatic cancer. The annual incidence rate for all types of pancreatic cancer is approximately 9 new cases per 100,000 people, ranking it 11th among cancers. The peak incidence occurs in the seventh and eighth decades of life, with the average age at diagnosis being 60 to 65 years. The incidence rate is slightly higher in men than women (relative risk 1.35), and 30% to 40% higher in black men. This racial discrepancy persists in spite of similar cigarette smoking rates in black men (27%) and white men (25%). Survival in untreated patients with pancreatic cancer is poor. For all stages combined, the 1-year survival rate is 19% and the 5-year survival rate is 4%. Survival is low because of the late development of clinical symptoms, such that 80% of pancreatic cancers are metastatic at the time of diagnosis. Surgical resection (when margin negative and node negative) offers the best possibility for cure in pancreatic cancer, with the 5-year survival rate improving to 40%, when performed at specialized, high-volume major medical institutions. The perioperative mortality rate is considerably higher when resection is performed at low-volume institutions. In the United States the incidence rates of pancreatic cancer increased threefold between 1920 and 1978, an increase that has also been observed in other developed countries. Since 1978, incidence rates for men and women have declined slightly and appear to have stabilized at the current levels. A portion of the increased incidence from 1920 to 1978 may have been attributable to more accurate disease diagnosis and less misclassification of the disease. Additionally, improved surveillance may partially account for the increased incidence. Many studies have found a relationship between certain environmental exposures and cases of pancreatic cancer, including personal cigarette smoking, environmental tobacco smoke, and chemical exposures. Cigarette smoking in the United States and in other countries increased greatly in the first half of the 20th century, such that 40% of adult Americans smoked in 1965. A large portion of the increased incidence of pancreatic cancer is also likely attributable to increased smoking through the 1960s. By 1990 the prevalence of smoking had decreased to 25%, with modest declines again noted in 1999. It remains to be seen if this will translate into lower pancreatic cancer incidence rates in the future.