Population Attributable Risk for Pancreatic Cancer in Northern Italy

Rosato, Valentina; Polesel, Jerry; Bosetti, Cristina; Serraino, Diego; Negri, Eva; Vecchia, Carlo La

doi:10.1097/mpa.0000000000000251

Cited by 47 publications

(37 citation statements)

References 41 publications

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“…By comparison, a population study in Italy estimated that 9•7% of pancreatic cancer occurrence was attributable to diabetes. 33 The US National Cancer Institute estimated that diabetes is associated with a 1•8 times increased risk of pancreatic cancer. 34 From 1980 to 2014, in all countries, diabetes prevalence in adults either increased, especially in low and middle SDI locations, or at best remained unchanged; worldwide, the number of adults with diabetes has quadrupled, 19 so it is expected that diabetes will have a greater contribution to pancreatic cancer occurrence in the future.…”

Section: Discussionmentioning

confidence: 99%

The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Pourshams¹,

Sepanlou²,

Ikuta³

et al. 2019

The Lancet Gastroenterology & Hepatology

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450

232

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Background Worldwide, both the incidence and death rates of pancreatic cancer are increasing. Evaluation of pancreatic cancer burden and its global, regional, and national patterns is crucial to policy making and better resource allocation for controlling pancreatic cancer risk factors, developing early detection methods, and providing faster and more effective treatments. Methods Vital registration, vital registration sample, and cancer registry data were used to generate mortality, incidence, and disability-adjusted life-years (DALYs) estimates. We used the comparative risk assessment framework to estimate the proportion of deaths attributable to risk factors for pancreatic cancer: smoking, high fasting plasma glucose, and high body-mass index. All of the estimates were reported as counts and age-standardised rates per 100 000 person-years. 95% uncertainty intervals (UIs) were reported for all estimates. Findings In 2017, there were 448 000 (95% UI 439 000-456 000) incident cases of pancreatic cancer globally, of which 232 000 (210 000-221 000; 51•9%) were in males. The age-standardised incidence rate was 5•0 (4•9-5•1) per 100 000 person-years in 1990 and increased to 5•7 (5•6-5•8) per 100 000 person-years in 2017. There was a 2•3 times increase in number of deaths for both sexes from 196 000 (193 000-200 000) in 1990 to 441 000 (433 000-449 000) in 2017. There was a 2•1 times increase in DALYs due to pancreatic cancer, increasing from 4•4 million (4•3-4•5) in 1990 to 9•1 million (8•9-9•3) in 2017. The age-standardised death rate of pancreatic cancer was highest in the highincome super-region across all years from 1990 to 2017. In 2017, the highest age-standardised death rates were observed in Greenland (17•4 [15•8-19•0] per 100 000 person-years) and Uruguay (12•1 [10•9-13•5] per 100 000 personyears). These countries also had the highest age-standardised death rates in 1990. Bangladesh (1•9 [1•5-2•3] per 100 000 person-years) had the lowest rate in 2017, and São Tomé and Príncipe (1•3 [1•1-1•5] per 100 000 personyears) had the lowest rate in 1990. The numbers of incident cases and deaths peaked at the ages of 65-69 years for males and at 75-79 years for females. Age-standardised pancreatic cancer deaths worldwide were primarily attributable to smoking (21•1% [18•8-23•7]), high fasting plasma glucose (8•9% [2•1-19•4]), and high body-mass index (6•2% [2•5-11•4]) in 2017. Interpretation Globally, the number of deaths, incident cases, and DALYs caused by pancreatic cancer has more than doubled from 1990 to 2017. The increase in incidence of pancreatic cancer is likely to continue as the population ages. Prevention strategies should focus on modifiable risk factors. Development of screening programmes for early detection and more effective treatment strategies for pancreatic cancer are needed. Funding Bill & Melinda Gates Foundation.

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Section: Discussionmentioning

confidence: 99%

The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Pourshams¹,

Sepanlou²,

Ikuta³

et al. 2019

The Lancet Gastroenterology & Hepatology

Self Cite

450

232

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“…Additionally, a summary review of meta-analytical studies showed that the major protective factor is increasing fruit or folate intake, with respective population preventable fractions of 0-12%[70]. In the Italian population, 11.9% of pancreatic cancers were attributable to a low adherence to Mediterranean diet[71]. …”

Section: Etiology and Risk Factorsmentioning

confidence: 99%

“…Both type I and type II diabetes have doubled the risk of pancreatic cancer[72-74]. The pancreatic cancer burden study in the Italian population estimated that 9.7% of pancreatic cancers were attributable to diabetes[71]. The United States National Cancer Institute estimates that diabetes is associated with a 1.8-fold increased risk of pancreatic cancer, particularly in Hispanic men and Asians in comparison with whites and blacks[75].…”

Section: Etiology and Risk Factorsmentioning

confidence: 99%

Epidemiology of pancreatic cancer

Ilić

2016

WJG

1,146

828

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Cancer of the pancreas remains one of the deadliest cancer types. Based on the GLOBOCAN 2012 estimates, pancreatic cancer causes more than 331000 deaths per year, ranking as the seventh leading cause of cancer death in both sexes together. Globally, about 338000 people had pancreatic cancer in 2012, making it the 11th most common cancer. The highest incidence and mortality rates of pancreatic cancer are found in developed countries. Trends for pancreatic cancer incidence and mortality varied considerably in the world. A known cause of pancreatic cancer is tobacco smoking. This risk factor is likely to explain some of the international variations and gender differences. The overall five-year survival rate is about 6% (ranges from 2% to 9%), but this vary very small between developed and developing countries. To date, the causes of pancreatic cancer are still insufficiently known, although certain risk factors have been identified, such as smoking, obesity, genetics, diabetes, diet, inactivity. There are no current screening recommendations for pancreatic cancer, so primary prevention is of utmost importance. A better understanding of the etiology and identifying the risk factors is essential for the primary prevention of this disease.

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“…About 95% of pancreatic cancers are ductal adenocarcinomas (PC). Tobacco smoking is the main risk factor for PC and explains about 20% of the risk in a population where prevalence of smoking is 30% 4,5 . ABO non-O blood group, obesity, long-term type 2 diabetes, family history of PC, histories of pancreatitis and possibly heavy alcohol consumption, familial rare inherited mutations in BRCA2 , p16 and other genes, and common variants in at least eight genetic loci are other known PC risk factors 6–8 .…”

Section: Introductionmentioning

confidence: 99%

Menstrual and Reproductive Factors, Hormone Use, and Risk of Pancreatic Cancer

et al. 2016

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Objectives We aimed to evaluate the relation between menstrual and reproductive factors, exogenous hormones, and risk of pancreatic cancer (PC). Methods Eleven case-control studies within the International Pancreatic Cancer Case-Control Consortium (PanC4) took part in the present study, including in total 2,838 case and 4,748 control women. Pooled estimates of odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated using a two-step logistic regression model and adjusting for relevant covariates. Results An inverse OR was observed in women who reported having had hysterectomy (ORyesvs.no 0.78, 95%CI 0.67–0.91), remaining significant in post-menopausal women and never-smoking women, adjusted for potential PC confounders. A mutually-adjusted model with the joint effect for hormone replace therapy (HRT) and hysterectomy showed significant inverse associations with PC in women who reported having had hysterectomy with HRT use (OR 0.64, 95%CI 0.48–0.84). Conclusion Our large pooled analysis suggests that women who have had a hysterectomy may have reduced risk of PC. However, we cannot rule out that the reduced risk could be due to factors or indications for having had a hysterectomy. Further investigation of risk according to HRT use and reason for hysterectomy may be necessary.

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Population Attributable Risk for Pancreatic Cancer in Northern Italy

Abstract: These results suggest that an appreciable proportion of pancreatic cancers could be avoided in this Italian population by intervention on a few selected modifiable lifestyle factors.

Cited by 47 publications

References 41 publications

The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Epidemiology of pancreatic cancer

Menstrual and Reproductive Factors, Hormone Use, and Risk of Pancreatic Cancer

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