DIAGNOSTIC-APPROACH AND TREATMENT OF PANCREATIC-CANCER - TRENDS IN THE POPULATION IN COTE-DOR (FRANCE) BETWEEN 1976 AND 1988

There is no study establishing time trends for the diagnostic and ther apeutic approaches to pancreatic cancer based on population data. The data of the Registry of Digestive Tumors of Cote-d'Or (France) were us ed to this end in 544 cancers diagnosed between 1976 and 1988. The pro portion of the histologically confirmed cases increased annually by 13 .4 % (P < 0.001). This was mainly due to progress in percutaneous biop sy (+ 25.7 % per year between 1983 and 1988, P < 0.001). As regards th e diagnosis, ultrasonography was used more frequently (+ 21.9 % per ye ar, P < 0. 001) as well as CT scan since its introduction in 1983 (+ 1 9.6 % per year, P < 0. 001). Pancreatic cancer was diagnosed by sonogr aphy in 16.7 % of the cases in 1976 and 70.6 % in 1988 (mean annual va riation: + 5.7 %, P < 0. 001). The proportions for CT scan were 12.8 % in 1983 and 23.5 % in 1988 (mean annual variation: + 3.5 %, NS). Ther e was no significant change in the use of retrograde cholangiopancreat ography over time. Other diagnosis criteria were less frequently used: laparoscopy was no longer used after 1983 and intraoperative diagnosi s was made less frequently (- 2.5 % per year, P < 0.001). Endoscopy or radiographic data were rarely used as a diagnosis criterion. These ch anges in approaches to the diagnosis of pancreatic cancer were not acc ompanied by any progress in diagnosis stage, therapeutic approach or s urvival suggesting that when clinical symptoms become evident, pancrea tic cancer is already advanced. Therapeutic advances, early diagnosis in patient at risk or identification or reasons for pancreatic cancer are the only means of progress in this problem.