Pancreatic cancer (PC) is rapidly fatal, and the fourth leading cause of cancer deaths in men and women in the US. Other than tobacco smoking and some aspects of diet, little is known about its environmental etiology. Although chronic pancreatitis has been described as a risk factor for PC development, the extent of involvement of other factors has not been resolved (e.g. smoking, alcohol, or their interaction, whether certain types of pancreatitis are independent risk factors for PC, are intermediates between exposure and cancer, or are early manifestations of PC). The study of chronic pancreatitis is difficult because of its relative rarity in the general population and the heterogeneous nature of its etiology and clinical course. Most previous estimates of relative risk for PC and prior history of pancreatitis have been imprecise and potentially biased due to small number of study participants, presence of diabetes or other co-morbid conditions, and inadequate adjustment for confounding factors such as smoking and alcohol consumption. This analysis, the largest of its kind, pools data from 12 studies in the International Pancreatic Cancer Case-Control Consortium (PanC4), and includes over 5,000 cases of PC and 12,000 controls. Age- and sex-adjusted effect estimates for pancreatitis and PC can be stratified by type of pancreatitis, smoking status, pack-years, location of tumor, gallbladder conditions, alcohol consumption patterns, and prior history of adult-onset diabetes to remove potential confounding and to describe potential effect modification by these factors. Data on duration and age allows us to exclude recent pancreatitis (diagnosed <2 yr. or <5 yr.) that may be a consequence of PC. Information on the location of the tumor (head, body, or tail), when available, enables us to examine whether recently diagnosed pancreatitis is more often associated with tumors in the head of the pancreas (indicating blockage due to the tumor itself). Further, once all studies are pooled, this analysis will have the power to evaluate effect estimates for pancreatitis and pancreatic cancer in African Americans for the first time among 329 cases and 1108 controls. In preliminary analyses based on 2,676 cases and 7,694 controls (7 of the 12 studies), the pooled adjusted odds ratio (OR) for ever having been diagnosed with pancreatitis and PC was nearly seven-fold (OR = 6.9, 95% CI = 5.3 - 8.9, adjusting for age, sex, race/ethnicity, education, and cigarette smoking status). This estimate is lower than most previous estimates and suggests that a sizable proportion of pancreatitis is a consequence of PC.

Pancreatitis and Pancreatic Cancer Risk: A Pooled Analysis in the International Pancreatic Cancer Case-Control Consortium (PanC4)

Ersilia Lucenteforte;
2009-01-01

Abstract

Pancreatic cancer (PC) is rapidly fatal, and the fourth leading cause of cancer deaths in men and women in the US. Other than tobacco smoking and some aspects of diet, little is known about its environmental etiology. Although chronic pancreatitis has been described as a risk factor for PC development, the extent of involvement of other factors has not been resolved (e.g. smoking, alcohol, or their interaction, whether certain types of pancreatitis are independent risk factors for PC, are intermediates between exposure and cancer, or are early manifestations of PC). The study of chronic pancreatitis is difficult because of its relative rarity in the general population and the heterogeneous nature of its etiology and clinical course. Most previous estimates of relative risk for PC and prior history of pancreatitis have been imprecise and potentially biased due to small number of study participants, presence of diabetes or other co-morbid conditions, and inadequate adjustment for confounding factors such as smoking and alcohol consumption. This analysis, the largest of its kind, pools data from 12 studies in the International Pancreatic Cancer Case-Control Consortium (PanC4), and includes over 5,000 cases of PC and 12,000 controls. Age- and sex-adjusted effect estimates for pancreatitis and PC can be stratified by type of pancreatitis, smoking status, pack-years, location of tumor, gallbladder conditions, alcohol consumption patterns, and prior history of adult-onset diabetes to remove potential confounding and to describe potential effect modification by these factors. Data on duration and age allows us to exclude recent pancreatitis (diagnosed <2 yr. or <5 yr.) that may be a consequence of PC. Information on the location of the tumor (head, body, or tail), when available, enables us to examine whether recently diagnosed pancreatitis is more often associated with tumors in the head of the pancreas (indicating blockage due to the tumor itself). Further, once all studies are pooled, this analysis will have the power to evaluate effect estimates for pancreatitis and pancreatic cancer in African Americans for the first time among 329 cases and 1108 controls. In preliminary analyses based on 2,676 cases and 7,694 controls (7 of the 12 studies), the pooled adjusted odds ratio (OR) for ever having been diagnosed with pancreatitis and PC was nearly seven-fold (OR = 6.9, 95% CI = 5.3 - 8.9, adjusting for age, sex, race/ethnicity, education, and cigarette smoking status). This estimate is lower than most previous estimates and suggests that a sizable proportion of pancreatitis is a consequence of PC.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/914215
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