Cigar and pipe smoking, smokeless tobacco use and pancreatic cancer: an analysis from the International Pancreatic Cancer Case-Control Consortium (PanC4).
BACKGROUND
Cigarette smoking is the best-characterized risk factor for pancreatic cancer. However, data are limited for other tobacco smoking products and smokeless tobacco.


METHODS
We conducted a pooled analysis of cigar and pipe smoking and smokeless tobacco use and risk of pancreatic cancer using data from 11 case-control studies (6056 cases and 11,338 controls) within the International Pancreatic Cancer Case-Control Consortium (PanC4). Pooled odds ratios (OR) and the corresponding 95% confidence intervals (CI) were estimated by unconditional multiple logistic regression models adjusted for study center and selected covariates.


RESULTS
Compared with never tobacco users, the OR for cigar-only smokers was 1.6 (95% CI: 1.2-2.3), i.e. comparable to that of cigarette-only smokers (OR 1.5; 95% CI 1.4-1.6). The OR was 1.1 (95% CI 0.69-1.6) for pipe-only smokers. There was some evidence of increasing risk with increasing amount of cigar smoked per day (OR 1.82 for ≥ 10 grams of tobacco), although not with duration. The OR for ever smokeless tobacco users as compared with never tobacco users was 0.98 (95% CI 0.75-1.3).


CONCLUSIONS
This collaborative analysis provides evidence that cigar smoking is associated with an excess risk of pancreatic cancer, while no significant association emerged for pipe smoking and smokeless tobacco use.
Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy; Department of Occupational Health, Section of Medical Statistics, University of Milan, Milan, Italy.
P
P
Bertuccio
Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy; Department of Occupational Health, Section of Medical Statistics, University of Milan, Milan, Italy.
C
C
La Vecchia
National Cancer Institute, Bethesda.
D T
DT
Silverman
Mayo Clinic, Rochester.
G M
GM
Petersen
University of California, San Francisco.
P M
PM
Bracci
Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
E
E
Negri
The University of Texas M.D Anderson Cancer Center, Houston.
D
D
Li
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven.
H A
HA
Risch
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA.
S H
SH
Olson
Toronto General Hospital.
S
S
Gallinger
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
A B
AB
Miller
National Institute for Public Health and the Environment (RIVM), Bilthoven; Department of Gastroenterology and Hepatology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
H B
HB
Bueno-de-Mesquita
Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico (CRO), Aviano, Italy.
R
R
Talamini
Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico (CRO), Aviano, Italy.
J
J
Polesel
Epidemiology Research Unit, Research Centre (CRCHUM), Montréal, Canada.
P
P
Ghadirian
Public Health, Women's and Children's Hospital, Adelaide, Australia.
P A
PA
Baghurst
Cancer Center & Institute of Oncology, Warsaw, Poland.
W
W
Zatonski
Louisiana State University, School of Public Health, New Orleans.
E T
ET
Fontham
Mayo Clinic, Rochester.
W R
WR
Bamlet
University of California, San Francisco.
E A
EA
Holly
Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy; Department of Occupational Health, Section of Medical Statistics, University of Milan, Milan, Italy.
E
E
Lucenteforte
The University of Texas M.D Anderson Cancer Center, Houston.
M
M
Hassan
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven.
H
H
Yu
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA.
R C
RC
Kurtz
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Cancer Care Ontario, Toronto, Canada.
M
M
Cotterchio
National Cancer Institute, Bethesda.
J
J
Su
European Institute of Oncology, Milan, Italy.
P
P
Maisonneuve
Catalan Institute of Oncology (ICO), Barcelona, Spain.
E J
EJ
Duell
Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
C
C
Bosetti
International Prevention Research Institute, Lyon, France; The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, USA. Electronic address: paolo.boffetta@mssm.edu.
P
P
Boffetta
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000209:etiology*; D012306:Risk; D012907:Smoking / Q000009:adverse effects*; D014029:Tobacco Use Disorder; D014030:Tobacco, Smokeless / Q000009:adverse effects*
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