Which patient is at greatest risk for pancreatic cancer?

• A. An elderly African-American man who smokes
• B. A young white obese woman with gallbladder disease
• C. A young African-American man with type 1 diabetes
• D. An elderly white woman who has pancreatitis

Answer: (A)

The factor being tested is who has the highest overall risk for pancreatic cancer based on age, race, and exposure to risk factors. Smoking is the strongest modifiable risk factor for pancreatic cancer, and risk increases with age. African American individuals have a higher incidence than White individuals. Putting these together, an elderly African-American man who smokes carries the combination of age, ethnicity, and tobacco exposure that yields the greatest risk.

The other scenarios don't combine these high-risk elements as strongly. A young person has a much lower baseline risk despite other factors. Obesity and gallbladder disease, while related to various health risks, are not as strongly associated with pancreatic cancer as smoking, especially when age and race are not both present. A young person with type 1 diabetes is not the highest risk group, and pancreatitis does raise risk, but the profile described here does not surpass the strong, combined risk from advanced age, African American ethnicity, and smoking.