Smoking, alcohol, and diet in relation to risk of pancreatic cancer in China: a prospective study of 0.5 million people.

Yuanjie Pang,Yu Guo,Fiona Bragg,Zhengming Chen,Ling Yang,Christiana Kartsonaki,Michael V Holmes,Liming Li,Junshi Chen,Iona Y Millwood,Andri Iona,Zheng Bian,Yiping Chen

doi:10.1002/cam4.1261

Abstract

In China, the incidence of pancreatic cancer (PC) has increased in recent decades. However, little is known about the relevance to PC risk of lifestyle and behavioral factors such as smoking, alcohol drinking, and diet. The China Kadoorie Biobank prospective study recruited 512,891 adults (210,222 men, 302,669 women) aged 30–79 (mean 52) years from 10 diverse areas during 2004–08. During ~9 years of follow‐up, 688 incident cases of PC were recorded among those who had no prior history of cancer at baseline. Cox regression yielded adjusted hazard ratios (HR) for PC associated with smoking, alcohol and selected dietary factors. Overall, 74% of men were ever‐regular smokers and 33% of men drank at least weekly, compared with only 3% and 2% of women, respectively. Among men, current regular smoking was associated with an adjusted HR of 1.25 (95% CI 1.08–1.44) for PC, with greater excess risk in urban than rural areas (1.46 [1.19–1.79] vs 1.04 [0.86–1.26]). Heavy, but not light to moderate, alcohol drinking (i.e. ≥420 g/week) was associated with significant excess risk (1.69 [1.21–2.37]), again more extreme in urban than rural areas (1.93 [1.29–2.87] vs 1.35 [0.74–2.48]). Overall, regular consumption of certain foodstuffs was associated with PC risk, with adjusted daily vs never/rare consumption HRs of 0.66 (0.56–0.79) for fresh fruit and 1.16 (1.01–1.33) for red meat. In China, smoking and heavy alcohol drinking were independent risk factors for PC in men. Lower fresh fruit and higher red meat consumption were also associated with higher risk of PC.

Highlights

Pancreatic cancer (PC) ranks as the sixth leading cause of cancer death globally [1] and its incidence and mortality have increased steadily in recent decades in China [2]
The associations of dietary factors with PC risk did not differ by sex (P for heterogeneity 0.25 for fruit and 0.79 for red meat, respectively). This is the first large prospective study in China examining the associations of smoking, alcohol, and certain dietary factors with risk of PC
We further extended the results from previous studies by showing the relevance of fresh fruit and red meat consumption to risk of PC

Summary

Introduction

Pancreatic cancer (PC) ranks as the sixth leading cause of cancer death globally [1] and its incidence and mortality have increased steadily in recent decades in China [2]. Its pathogenesis remains poorly understood, PC has a multifactorial aetiology, with several known risk factors such as age, male sex, smoking, heavy alcohol drinking, obesity, diabetes, history of chronic pancreatitis, and family history of PC [4]. Certain dietary factors have been implicated as risk factors for PC, including lower intake of fruit and vegetable and higher intake of red meat [4]. Prospective studies have been inconclusive on whether fresh fruit, vegetables, and red meat are associated with risk of PC [10,11,12]. Previous prospective studies from East Asia have reported increased risks of PC among current and former smokers and a null association with alcohol drinking [5, 6], while for dietary factors the prospective evidence is very limited

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Results

Conclusion