An absolute risk model to identify individuals at elevated risk for pancreatic cancer in the general population.
OBJECTIVE
We developed an absolute risk model to identify individuals in the general population at elevated risk of pancreatic cancer.


METHODS
Using data on 3,349 cases and 3,654 controls from the PanScan Consortium, we developed a relative risk model for men and women of European ancestry based on non-genetic and genetic risk factors for pancreatic cancer. We estimated absolute risks based on these relative risks and population incidence rates.


RESULTS
Our risk model included current smoking (multivariable adjusted odds ratio (OR) and 95% confidence interval: 2.20 [1.84-2.62]), heavy alcohol use (>3 drinks/day) (OR: 1.45 [1.19-1.76]), obesity (body mass index >30 kg/m(2)) (OR: 1.26 [1.09-1.45]), diabetes >3 years (nested case-control OR: 1.57 [1.13-2.18], case-control OR: 1.80 [1.40-2.32]), family history of pancreatic cancer (OR: 1.60 [1.20-2.12]), non-O ABO genotype (AO vs. OO genotype) (OR: 1.23 [1.10-1.37]) to (BB vs. OO genotype) (OR 1.58 [0.97-2.59]), rs3790844(chr1q32.1) (OR: 1.29 [1.19-1.40]), rs401681(5p15.33) (OR: 1.18 [1.10-1.26]) and rs9543325(13q22.1) (OR: 1.27 [1.18-1.36]). The areas under the ROC curve for risk models including only non-genetic factors, only genetic factors, and both non-genetic and genetic factors were 58%, 57% and 61%, respectively. We estimate that fewer than 3/1,000 U.S. non-Hispanic whites have more than a 5% predicted lifetime absolute risk.


CONCLUSIONS
Although absolute risk modeling using established risk factors may help to identify a group of individuals at higher than average risk of pancreatic cancer, the immediate clinical utility of our model is limited. However, a risk model can increase awareness of the various risk factors for pancreatic cancer, including modifiable behaviors.
Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, United States of America ; Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America ; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Alison P
AP
Klein
Sara
S
Lindström
Julie B
JB
Mendelsohn
Emily
E
Steplowski
Alan A
AA
Arslan
H Bas
HB
Bueno-de-Mesquita
Charles S
CS
Fuchs
Steven
S
Gallinger
Myron
M
Gross
Kathy
K
Helzlsouer
Elizabeth A
EA
Holly
Eric J
EJ
Jacobs
Andrea
A
Lacroix
Donghui
D
Li
Margaret T
MT
Mandelson
Sara H
SH
Olson
Gloria M
GM
Petersen
Harvey A
HA
Risch
Rachael Z
RZ
Stolzenberg-Solomon
Wei
W
Zheng
Laufey
L
Amundadottir
Demetrius
D
Albanes
Naomi E
NE
Allen
William R
WR
Bamlet
Marie-Christine
MC
Boutron-Ruault
Julie E
JE
Buring
Paige M
PM
Bracci
Federico
F
Canzian
Sandra
S
Clipp
Michelle
M
Cotterchio
Eric J
EJ
Duell
Joanne
J
Elena
J Michael
JM
Gaziano
Edward L
EL
Giovannucci
Michael
M
Goggins
Göran
G
Hallmans
Manal
M
Hassan
Amy
A
Hutchinson
David J
DJ
Hunter
Charles
C
Kooperberg
Robert C
RC
Kurtz
Simin
S
Liu
Kim
K
Overvad
Domenico
D
Palli
Alpa V
AV
Patel
Kari G
KG
Rabe
Xiao-Ou
XO
Shu
Nadia
N
Slimani
Geoffrey S
GS
Tobias
Dimitrios
D
Trichopoulos
Stephen K
SK
Van Den Eeden
Paolo
P
Vineis
Jarmo
J
Virtamo
Jean
J
Wactawski-Wende
Brian M
BM
Wolpin
Herbert
H
Yu
Kai
K
Yu
Anne
A
Zeleniuch-Jacquotte
Stephen J
SJ
Chanock
Robert N
RN
Hoover
Patricia
P
Hartge
Peter
P
Kraft
D000017:ABO Blood-Group System; D000230:Adenocarcinoma / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000453:epidemiology* / Q000208:ethnology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D012372:ROC Curve; D012307:Risk Factors; D012907:Smoking; D014481:United States / Q000453:epidemiology; D044465:White People
D000017:ABO Blood-Group System