People with a family history of pancreatic cancer should make an extra effort to stay off tobacco. A new study suggests smoking could trigger this deadly form of cancer in people who are at high risk of developing the disease.

Researchers from the Roswell Park Cancer Institute in Buffalo, New York, studied 826 people with pancreatic cancer, of whom 30 had at least one close relative who had also had the disease. They found that people with a family history were more likely to develop the disease at a younger age -- below 50 -- and also more likely to be smokers.

Smoking is known to raise the risk of pancreatic cancer, said study co-author John Gibbs, MD, FACS, a surgical oncologist and chief of the department of gastrointestinal surgery and endoscopy at Roswell Park.

"What was surprising is that when you have people with familial pancreatic cancer and they present at a younger age, [smoking] seems to be an added risk factor contributing to the malignant transformation," he explained.

"Patients with a family history of pancreatic cancer must be counseled strongly against smoking, and smokers with a family history of pancreatic cancer should be informed of their increased risk and offered enrollment into smoking cessation programs," Gibbs and his co-authors concluded.

Their findings were published in the November 8, 2004, online edition of the journal Cancer, and will appear in the December 15 print edition (Vol. 101, No. 12).

Pancreatic cancer strikes close to 32,000 Americans each year, according to American Cancer Society estimates. Unfortunately, most people who get the disease die from it, because it is very difficult to detect before it has spread to other parts of the body. Only about 4% of patients survive 5 years after being diagnosed.

Hereditary pancreatic cancer, the kind that runs in families, is believed to account for 5%-10% of all cases of the disease. People whose parents, siblings, or children have had the disease have a higher risk of developing it themselves, especially if more than 1 relative was affected.

There is not yet a reliable way to screen people for pancreatic cancer, Gibbs said. Although doctors are studying tumor markers and advanced imaging tests, these methods are still experimental.

People with a family history of pancreatic cancer should discuss their risk with their physicians, Gibbs said. They could also consider entering a clinical trial of screening methods, he said.

"Pancreatic cancer is a devastating disease, and the problem we have been facing is that in general, it has already spread at the time of detection," Gibbs said. "Our future strategy should be identifying people at risk to explore preventive measures as well as early detection measures.