Exocrine Pancreatic Cancer, Cigarette Smoking, and Diabetes Mellitus: A Case-Control Study in Northern Italy

Abstract

The role of cigarette smoking and diabetes mellitus as risk factors for exocrine pancreatic cancer (PC) was investigated in a hospital based case-control study. Current smokers were at increased risk for PC (OR = 2.36, 95% CI 1.53-3.63): the magnitude of the risk was related to the lifetime amount of smoking (chi2(trend) = 17.00; P < 0.0001). Among former smokers, after 15 years from ceasing smoking, the risk for PC dropped to the level of a lifetime non-smoker, whichever the lifetime smoking amount. Diabetes was associated with a 2.89-fold increased risk for PC (95% CI 1.71-4.86): the risk was 4.76 (95% CI 1.99-11.53) for diabetes diagnosed up to 2 years before the diagnosis of PC and dropped to 2.07 (95% CI 1.02-4.20) for diabetes diagnosed more than 5 years before PC. The risk for PC was estimated according to the treatment used to control diabetes: it was 6.49 (95% CI 2.28-18.48) for insulin treated diabetes and 2.12 (95% CI 1.16-3.87) for diabetes treated with oral hypoglycemic drugs. The risk of PC for diabetes treated for more than 5 years before the diagnosis of PC was 6.21 (95% CI 1.61-23.96) for patients treated with insulin and 1.21 (95% CI 0.50-2.92) for those treated with oral hypoglycemic drugs: the type of treatment needed to control the disease may discriminate between the diabetes that represents a consequence of cancer from the diabetes that could represent an etiological co-factor. More studies are needed to clarify whether long-lasting insulin-treated diabetes is an etiological co-factor in PC.

Passive smoking and the use of noncigarette tobacco products in association with risk for pancreatic cancer: A case‐control study

“…However, the strongest associations were observed among regular smokers and among women, consistent with previous findings. [3][4][5] We also observed that the most important parameter of smoking that affected pancreatic cancer risk was the duration of regular smoking, although risk also increased with the number of cigarettes smoked per day. The finding that the risk of pancreatic cancer was associated more strongly with the duration than with the intensity of smoking may reflect in part the accuracy with which these 2 parameters are measured.…”

“…1 It has been demonstrated that cigarette smoking is responsible for approximately 25% of pancreatic cancer cases. [2][3][4][5] Other factors, such as diet, history of chronic pancreatitis, diabetes, family history of pancreatic cancer, and some hereditary conditions, also may contribute to the development of this deadly disease. [6][7][8][9][10][11] Smoking prevalence in the United States has declined since 1997; however, despite the overwhelming evidence of the harmful effects of smoking, almost 22% of adults in the United States still smoked cigarettes in 2003.…”

Cigarette smoking, environmental tobacco smoke exposure and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition

“…As far as we know, no published cohort data on smoking and pancreatic cancer risk are available for Central or Southern European countries. Six primarily hospital-based case-control studies that were conducted in Greece, 23 Italy [24][25][26][27] and Spain 28 reported conflicting results. Three studies 23,24,26 showed an increased pancreatic cancer risk for current smokers, whereas the other three found no association.…”

“…Six primarily hospital-based case-control studies that were conducted in Greece, 23 Italy [24][25][26][27] and Spain 28 reported conflicting results. Three studies 23,24,26 showed an increased pancreatic cancer risk for current smokers, whereas the other three found no association. 25,27,28 The increased pancreatic cancer risk we observed among current smokers in Northern and Central, but not in Southern European countries, may be explained by small numbers or by differences in smoking practices.…”

Implications of Type II Diabetes Mellitus on Gastrointestinal Cancers

“…In an analysis requiring a 5-year duration of diabetes resulted in similar results, with RR of 2.0 (95% CI 1.2-3.2) in 11 epidemiologic studies [ Table 2]. In a hospital based case-control study, Bonelli et al have demonstrated that the risk of pancreatic cancer was increased by 6.2 fold in patients with diabetes, which necessitated insulin therapy for greater than 5 years (Bonelli et al, 2003). Jamal and colleagues further supported these findings with their large population-based case-control study of 1,172,496 patients, by demonstrating that occurrence of pancreatic cancer was increased by threefold in DM patients compared to controls (frequency of pancreatic cancer in DM subjects 0.9% compared to control subjects 0.3% with OR:3.22, 95% CI: 3.03-3.42) (Jamal et al, 2009) [Table 2].…”