title: 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.
authors.affiliation: Unit of Clinical Epidemiology, National Cancer Institute, Genova, Italy. luigina.bonelli@istge.it
authors.forename: Luigina
authors.initials: L
authors.lastname: Bonelli
authors.forename: Hugo
authors.initials: H
authors.lastname: Aste
authors.forename: Paolo
authors.initials: P
authors.lastname: Bovo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Cavallini
authors.forename: Martina
authors.initials: M
authors.lastname: Felder
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gusmaroli
authors.forename: Erminio
authors.initials: E
authors.lastname: Morandini
authors.forename: Paolo
authors.initials: P
authors.lastname: Ravelli
authors.forename: Romolo
authors.initials: R
authors.lastname: Briglia
authors.forename: Lucio
authors.initials: L
authors.lastname: Lombardo
authors.forename: Alberto
authors.initials: A
authors.lastname: De Micheli
authors.forename: Vittorio
authors.initials: V
authors.lastname: Pugliese
mesh_terms: 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