Exocrine pancreatic cancer, cigarette smoking, and diabetes mellitus: a case-control study in northern Italy.
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.
Bonelli
Luigina
L
Unit of Clinical Epidemiology, National Cancer Institute, Genova, Italy. luigina.bonelli@istge.it
Aste
Hugo
H
Bovo
Paolo
P
Cavallini
Giorgio
G
Felder
Martina
M
Gusmaroli
Riccardo
R
Morandini
Erminio
E
Ravelli
Paolo
P
Briglia
Romolo
R
Lombardo
Lucio
L
De Micheli
Alberto
A
Pugliese
Vittorio
V
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D012923:Social Class; D011795:Surveys and Questionnaires; D013997:Time Factors