Cigarette smoking, elevated fasting serum glucose, and risk of pancreatic cancer in Korean men

Abstract

Pancreatic cancer is one of the most fatal human cancers and continues to be a major unsolved health problem. The goal of this study was to estimate the independent effects and interactions between cigarette smoking and diabetes on the risk of pancreatic cancer in Korean male population. Cigarette smoking and the risk of incidence and death from pancreatic cancer were examined in a 10-year prospective cohort study of 446,407 Korean men aged 40 to 65 years who received health insurance from the National Health Insurance Corporation and who had a medical evaluation in 1992. Relative risks (RR) and 95% confidence intervals (CI) were calculated using a Cox proportional hazards model after adjusting for age, body mass index, exercise and alcohol use. Current smoking was associated with an increased risk of incidence (RR 5 1.7, 95% CI 5 1.6-1.9) and mortality (RR 5 1.6, 95% CI 5 1.4-1.7) from pancreatic cancer. The RR for pancreatic cancer increased with both duration and amount of smoking. Diabetes was also associated with an increased risk of both incidence (RR 5 1.8, 95% CI 5 1.5-2.2) and mortality (RR 5 1.7, 95% CI 5 1.4-2.1) from pancreatic cancer. There was no interaction between smoking and fasting serum glucose in terms of pancreatic cancer risk. Thus, our prospective study has demonstrated that cigarette smoking and elevated fasting serum glucose are independently associated with an increased risk of pancreatic cancer in a large cohort of Korean males. ' 2006 Wiley-Liss, Inc.Key words: pancreatic cancer; smoking; fasting serum glucose; diabetes; cohort study Pancreatic cancer remains a major unsolved health problem at the start of the 21st century. Although cancer of the pancreas accounts for only 3% of all cancers worldwide, 1 its poor prognosis makes it the eighth major form of cancer-related death worldwide, causing more than 220,000 deaths annually. 2 Because of the poor prognosis and the minimal impact of conventional treatment methods, 3 it is important to focus on prevention of this disease. In many previous studies, risk factors associated with pancreatic cancer have been explored. Risk factors for pancreatic cancer are thought to include obesity, 4-7 nutritional factors, [8][9][10][11][12][13][14][15][16] alcohol drinking, 17-23 genetic factors 24,25 and a family history 3 of pancreatic cancer. However, the major risk factors that have been consistently reported are age, diabetes 26-29 and cigarette smoking. 30 Epidemiological studies from European countries and the United States have consistently shown that cigarette smoking is associated with an increased risk of pancreatic cancer, but the dose-response relationship has not been clear due to inconsistent findings among these studies. [18][19][20][21][22][23][31][32][33][34][35][36][37][38][39][40][41][42] In addition, recent observational studies have provided consistent evidence for an association of diabetes with increased risk of pancreatic cancer. [27][28][29] To date, however, very few studies have analyzed the potential interaction between s...

Metabolic Factors and the Risk of Pancreatic Cancer: A Prospective Analysis of almost 580,000 Men and Women in the Metabolic Syndrome and Cancer Project

“…This was not confirmed by the present study, which indicated an association between mid-BP and glucose levels and risk of pancreatic cancer, whereas the analysis of MetS z-score did not reveal any significant association. Epidemiologic data supports a relationship between obesity and pancreatic cancer (24,25), and between high glucose levels and pancreatic cancer (26)(27)(28), but most studies have reported null associations between cholesterol/hypertension and the risk of pancreatic cancer (29,30). The results in the present study are in accordance with these findings, except that there was no positive association between BMI and pancreatic cancer in men.…”

The Effect of Modifiable Risk Factors on Pancreatic Cancer Mortality in Populations of the Asia-Pacific Region

“…We were unable to exclude the possibility of residual confounding by consumption of alcohol due to a lack of information on alcohol intake within the Asia Pacific Cohort Studies Collaboration. However, several prospective studies have reported that adjustment for alcohol did not materially attenuate the association between smoking and pancreatic cancer (4,32).…”

Pancreatic Cancer and Factors Associated with the Insulin Resistance Syndrome in the Korean Cancer Prevention Study

“…The study design and methods for the Korean Cancer Prevention Study have been described in detail previously (17,18). Briefly, the cohort consists of 1,329,525 Korean civil servants and their dependents (846,907 men and 482,618 women) who received health insurance from the Korean Medial Insurance Corporation and who participated in at least one routine biennial medial evaluation between 1992 and 1995.…”