Smoking Increases Risk of Familial Pancreatic Cancer
Thursday, May 29th 2003
A nested case-control study reported in the May issue of Gastroenterology identified smoking and having multiple first-degree relatives with pancreatic cancer as risk factors for developing pancreatic cancer. Based on these findings, the investigators suggest counseling these individuals not to smoke.
"Approximately 10% of pancreatic cancers are inherited, but the factors that affect tumorigenesis in familial pancreatic cancer are unknown," write Stephen J. Rulyak and colleagues from the University of Washington in Seattle. "We sought to determine whether smoking or other factors could predict cancer risk in familial pancreatic cancer kindreds."
This study included 251 members of 28 families, each of which had two or more members with pancreatic cancer. Smoking was an independent risk factor for familial pancreatic cancer (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.8 - 7.6), and smokers developed cancer one decade earlier than did nonsmokers (age of onset, 59.6 vs. 69.1 years; P = .01).
Risk was further increased in men (OR, 5.2), in subjects younger than 50 years (OR, 7.6), and in subjects with affected first-degree relatives (for each additional family member, OR = 1.4; 95% CI, 1.1 - 1.9).
Diabetes was associated with pancreatic dysplasia, but not with pancreatic cancer risk. In one third of families, the mean age of onset decreased by two decades between generations, reflecting genetic anticipation.
"Smoking is a strong, independent risk factor for the development of pancreatic cancer, resulting in a 4-fold increase in risk above and beyond the elevated risk at baseline. Moreover, there may be a dose effect, with risk increasing with five or more years of smoking compared with less than five years of smoking," the authors write. "These factors may be useful in selecting candidates for pancreatic cancer screening. Members of families with multiple pancreatic cancers should be counseled not to smoke."
Solvay Pharmaceuticals, Inc., helped support this study through a grant to one of the authors.
News Author: Laurie Barclay, MD
CME Author: Bernard M. Sklar, MD, MS
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