title: Risk factors for pancreatic cancer: case-control study.
abstract: OBJECTIVE
  Although cigarette smoking is the most well-established environmental risk factor for pancreatic cancer, the interaction between smoking and other risk factors has not been assessed. We evaluated the independent effects of multiple risk factors for pancreatic cancer and determined whether the magnitude of cigarette smoking was modified by other risk factors in men and women.
  
  
  METHODS
  We conducted a hospital-based case-control study involving 808 patients with pathologically diagnosed pancreatic cancer and 808 healthy frequency-matched controls. Information on risk factors was collected by personal interview, and unconditional logistic regression was used to determine adjusted odds ratios (AORs) by the maximum-likelihood method.
  
  
  RESULTS
  Cigarette smoking, family history of pancreatic cancer, heavy alcohol consumption (>60 mL ethanol/day), diabetes mellitus, and history of pancreatitis were significant risk factors for pancreatic cancer. We found synergistic interactions between cigarette smoking and family history of pancreatic cancer (AOR 12.8, 95% confidence interval [CI] 1.6-108.9) and diabetes mellitus (AOR 9.3, 95% CI 2.0-44.1) in women, according to an additive model. Approximately 23%, 9%, 3%, and 5% of pancreatic cancer cases in this study were related to cigarette smoking, diabetes mellitus, heavy alcohol consumption, and family history of pancreatic cancer, respectively.
  
  
  CONCLUSIONS
  The significant synergy between these risk factors suggests a common pathway for carcinogenesis of the pancreas. Determining the underlying mechanisms for such synergies may lead to the development of pancreatic cancer prevention strategies for high-risk individuals.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Manal M
authors.initials: MM
authors.lastname: Hassan
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Bondy
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: James L
authors.initials: JL
authors.lastname: Abbruzzese
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Peter W
authors.initials: PW
authors.lastname: Pisters
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: Rabia
authors.initials: R
authors.lastname: Khan
authors.forename: Ta-Hsu
authors.initials: TH
authors.lastname: Chou
authors.forename: Renato
authors.initials: R
authors.lastname: Lenzi
authors.forename: Li
authors.initials: L
authors.lastname: Jiao
authors.forename: Donghui
authors.initials: D
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015897:Comorbidity; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000209:etiology* / Q000235:genetics; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects