The effect of modifiable risk factors on pancreatic cancer mortality in populations of the Asia-Pacific region

Ansary-Moghaddam A, Huxley R, Barzi F, Lawes C, Ohkubo T, Fang X, Jee SH, Woodward M (2006) The effect of modifiable risk factors on pancreatic cancer mortality in populations of the Asia-Pacific region. Cancer Epidemiol Biomarkers Prev 15:2435-2440

BACKGROUND: Pancreatic cancer accounts for about 220,000 deaths each year. Known risk factors are smoking and type 2 diabetes. It remains to be seen whether these risk factors are equally important in Asia and whether other modifiable risk factors have important associations with pancreatic cancer. METHODS: An individual participant data analysis of 30 cohort studies was carried out, involving 420,310 Asian participants (33% female) and 99,333 from Australia/New Zealand (45% female). Cox proportional hazard models, stratified by study and sex and adjusted for age, were used to quantify risk factors for death from pancreatic cancer. RESULTS: During 3,558,733 person-years of follow-up, there were 324 deaths from pancreatic cancer (54% Asia and 33% female). Mortality rates (per 100,000 person-years) from pancreatic cancer were 10 for men and 8 for women. The following are age-adjusted hazard ratios (95% confidence interval) for death from pancreatic cancer: for current smoking, 1.61 (1.12-2.32); for diabetes, 1.76 (1.15-2.69); for a 2-cm increase in waist circumference, 1.08 (1.02-1.14). All three relationships remained significant (P < 0.05)="" after="" adjustment="" for="" other="" risk="" factors.="" there="" was="" no="" evidence="" of="" heterogeneity="" in="" the="" strength="" of="" these="" associations="" between="" either="" cohorts="" from="" asia="" and="" australia/new="" zealand="" or="" between="" the="" sexes.="" in="" men,="" the="" combination="" of="" cigarette="" smoking="" and="" diabetes="" more="" than="" doubled="" the="" likelihood="" of="" pancreatic="" cancer="" (2.47;="" 95%="" confidence="" interval,="" 1.17-5.21)="" in="" both="" regions.="" conclusions:="" smoking,="" obesity,="" and="" diabetes="" are="" important="" and="" are="" potentially="" modifiable="" risk="" factors="" for="" pancreatic="" cancer="" in="" populations="" of="" the="" asia-pacific="" region.="" activities="" to="" prevent="" them="" can="" be="" expected="" to="" lead="" to="" a="" major="" reduction="" in="" the="" number="" of="" deaths="" from="" this="" cancer,="" particularly="" in="" asia="" with="" its="" enormous="">