Patients with chronic pancreatitis have a markedly increased risk of pancreatic cancer compared with the general population Chronic pancreatitis has been proposed as an independent risk factor for the development of pancreatic cancer in a number of important studies.1–3 Problems with methodology however, such as patient selection, ascertainment bias, small patient numbers, and stringency of patient selection have been major criticisms, leading some authors to believe that the risk of pancreatic cancer in chronic pancreatitis is confounded by other risk factors such as smoking.4 The study presented by Malka and colleagues5 in this issue of Gut has addressed some of these considerations, in that it has prospectively followed a cohort of 373 patients with proven chronic pancreatitis, defined by stringent criteria, over a median of 9.2 years [see page 849] . The high incidence of pancreatic calcification (83%), elective surgery (60%), diabetes mellitus (54%), pseudocysts (46%), and venous occlusive disease (21%) leave little room for doubt that this is a true cohort of patients with chronic pancreatitis. Patients with pancreatic cancer were confirmed histologically in all cases and careful consideration was given to patients that were lost to follow up. The results of the study suggest a significantly overall increased risk of pancreatic cancer …