Thus, development of pancreatic cancer was not restricted to PRSS1-asociated HP, but was also found in patients with SPINK1 germline mutations, suggesting that long-term inflammation and existing CP involving hyperplasia and metaplasia of the pancreatic duct epithelium, not the mutations alone, increase the risk of pancreatic cancer. This evidence concerns the gene SPINK1 and familial pancreatic carcinoma.