The Effect of Modifiable Risk Factors on Pancreatic Cancer Mortality in Populations of the Asia-Pacific Region
- Alireza Ansary-Moghaddam1,
- Rachel Huxley1,
- Federica Barzi1,
- Carlene Lawes2,
- Takayoshi Ohkubo3,
- Xianghua Fang4,
- Sun Ha Jee5,
- Mark Woodward1 and
- Asia Pacific Cohort Studies Collaboration
- 1The George Institute, University of Sydney, Sydney, Australia; 2Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand; 3Ohasama Hospital, Iwate, Japan; 4Department of Epidemiology and Social Medicine, Capital University of Medical Sciences, Beijing, China; and 5Department of Epidemiology and Disease Control, Graduate School of Health Science and Management, Yonsei University, Seoul, Korea
- Requests for reprints:
Rachel Huxley, Asia Pacific Cohort Studies Collaboration Secretariat, The George Institute for International Health, P.O. Box M201, Missenden Road, Sydney, New South Wales 2050 Australia. Phone: 61-2-9993-4554; Fax: 61-2-9993-4501. E-mail: rhuxley{at}thegeorgeinstitute.org
Abstract
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 population. (Cancer Epidemiol Biomarkers Prev 2006;15(12):2435–40)
Footnotes
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Grant support: National Health and Medical Research Council of Australia, an unrestricted educational grant from Pfizer, Inc., and University of Sydney SESQUI Postdoctoral fellowship (R. Huxley).
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Accepted September 20, 2006.
- Received May 10, 2006.
- Revision received August 24, 2006.
