Our knowledge of the etiology of all forms of cancer including pancreatic cancer has improved dramatically in the second half of this century. The current model describes a gradual change from a normal pancreatic cell to a fully malignant cell requiring several stages with gradual and progressive alterations appearing at the genetic and the tissue level. Although there are many germ line diseases that are associated with pancreatic cancer it is probable that inherited diseases account for only about 10% of the total burden of pancreatic cancer. Avoidance of smoking and dietary modification are the current best strategies for reducing the risk of this tumor. In addition, newer molecular techniques and imaging procedures should provide clinicians with the ability to detect pancreatic cancer at an early, potentially curable stage.