title: Smoking cessation would substantially reduce the future incidence of pancreatic cancer in the European Union.
abstract: OBJECTIVE
  Since pancreatic cancer is one of the most rapidly fatal cancers, prevention is of paramount importance to reduce the future burden of this disease. We studied the impact of ceasing smoking on the future incidence of pancreatic cancer in the European Union (EU).
  
  
  METHODS
  We developed a computer simulation model, Markov multi-state type, using country-specific published data on population sizes, smoking behaviour, pancreatic cancer incidence and total mortality rates, corresponding relative risks for ex- and current smokers, and estimated probabilities of starting and ceasing smoking (transition rates), with which we refined previously reported preliminary results. We simulated a scenario based on theoretically maximal smoking reduction, a more feasible scenario based on the World Health Organization's 'Health for All' target in which smoking prevalence is reduced to 20% in 2015, and scenarios based on reductions in smoking prevalence in 20 steps of 5% (from 0% to 100% reduction) in 2015. Simulations were based on changes in transition rates for smoking behaviour. We estimated the absolute and relative reduction of pancreatic cancer patients in the EU, for each scenario compared to a reference scenario in which the current transition rates remained unchanged, for the period 1994-2015.
  
  
  RESULTS
  Theoretically, if all smokers would quit instantly, the estimated number of new pancreatic cancer patients up to 2015 in the EU could be reduced by 15% (around 150 000 patients). The more feasible scenario would lead to a reduction of almost 29 500 male and 9500 female patients. These results corresponded to a reduction in smoking prevalence with around 45% and 30% among men and women, respectively, in each EU country.
  
  
  CONCLUSIONS
  Giving up smoking would substantially reduce the future incidence of pancreatic cancer. This emphasizes the importance of prevention in the reduction of the future pancreatic cancer burden.
authors.affiliation: Department of Chronic Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Ina
authors.initials: I
authors.lastname: Mulder
authors.forename: Rudolf T
authors.initials: RT
authors.lastname: Hoogenveen
authors.forename: Marianne L
authors.initials: ML
authors.lastname: van Genugten
authors.forename: Paul G
authors.initials: PG
authors.lastname: Lankisch
authors.forename: Albert B
authors.initials: AB
authors.lastname: Lowenfels
authors.forename: Augustinus E
authors.initials: AE
authors.lastname: de Hollander
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003198:Computer Simulation; D005060:Europe / Q000453:epidemiology; D005062:European Union; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D017678:Sex Distribution; D016540:Smoking Cessation