These findings are consistent with a major role of gallstones, or risk factors for gallstones, in the cause of gallbladder cancer. Additional information on whether or not screening high-risk subjects for gallstones or gallbladder cancer is needed.

In a population-based case-control study of dietary risk factors for pancreatic cancer, a total of 179 cases and 239 controls were interviewed between 1984 and 1988. This study demonstrated an increased risk of pancreas cancer associated with high levels of reported energy intake. After adjustment for age, sex, response status, lifetime cigarette consumption and energy intake, there appeared to be an association with total fat intake (odds ratio in highest quartile relative to lowest quartile 2.24 [95% Confidence Interval (0.74, 6.73)] and, particularly, saturated fat [OR = 4.32, 95% CI(1.39,13.7)]. Although dietary cholesterol intake appeared to increase risk and a number of many micro-nutrients were apparently associated with reductions of risk, none were statistically significant. The results are consistent with a role of nutritional factors in the etiology of pancreatic cancer. The magnitude of the risks involved emphasizes the necessity for larger studies of this topic.

Case-control studies of pancreatic cancer were conducted in 5 populations with moderate to high rates and differing dietary practices, using a common protocol and questionnaire. Comprehensive diet histories were completed for a total of 802 cases and 1669 controls identified in Adelaide (Australia), Montreal and Toronto (Canada), Utrecht (The Netherlands) and Opole (Poland). Positive associations were observed with intake of carbohydrates and cholesterol, and inverse associations with dietary fiber and vitamin C. These relationships were generally consistent among the 5 studies, and showed statistically significant and generally monotonic dose-response relationships. The relative risks for highest vs. lowest quintile of intake were estimated for carbohydrates to be 2.57 (95% confidence interval 1.64-4.03), cholesterol 2.68 (1.72-4.17), dietary fiber 0.45 (0.30-0.63), and vitamin C 0.53 (0.38-0.76). The consistency, strength, and specificity of these associations provides evidence for the hypothesis that some or all of these dietary factors may alter the risk of pancreatic cancer.

A multi-centre case-control study of pancreas cancer, designed to be population-based, to use a random sample of local populations as controls and to use a common protocol and core questionnaire, was conducted as the first study of the SEARCH programme of the International Agency for Research on Cancer. "Ever-smokers'' were found to be at increased risk for pancreas cancer compared with "never-smokers" consistently in all strata of gender, response status and centre. Risk of pancreas cancer was found to increase with increasing lifetime consumption of cigarettes, the relative risk rising to 2.70 (95% C.I. 1.95 to 3.74) in the highest intake category. The overall trend in risk was highly significant and the association was found consistently in each stratum of gender, response status and centre. Fifteen years had to pass from quitting cigarette smoking until the risk fell to a level compatible with that in never-smokers among the heaviest group of smokers; among the 2 lowest tertiles this happened within 5 years. Further, reported smoking habits more than I 5 years before diagnosis appeared to have no influence on pancreas-cancer risk, irrespective of amount smoked. The results are consistent with a causal role for cigarette smoking in the aetiology of pancreas cancer and illustrate that ceasing to smoke cigarettes can lead to reductions in the elevated risk of pancreas cancer produced by this habit.o 1996 Wiley-Liss, Inc.