Background : Pancreatic cancer is associated with a very severe prognosis and identification of risk factors is essential. Diabetes and obesity are both established risk factors, and they both cause hyperinsul e nemia. With this review we wished to appraise the evidence of a role of high insulin levels in causing pancreatic cancer. Methods : We searched PubMed, Embase, Cochrane Library and Medline, and all evidence on potential pathophysiology of hyperinsulenemia and pancreatic cancer was included. Metaand pooled-analysis on epidemiological evidence are rep orted, and individual studies were as appropriate for specific topics (role of therapies, central adiposity and role of physical exercise). Conclusion : Hyperinsul e nemia, and possibly hyperestrogenism secondary to a metabolic syndrome, are important elements in the pathogenesis of pancreatic cancer. Modification of certain life-style factors (exercise and weight loss) appears to modify the risk of pancreatic malignancy.
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