The burden of pancreatic cancer in Australia attributable to smoking

Abstract

Objective To estimate the burden of pancreatic cancer in Australia attributable to modifiable exposures, particularly smoking. Design Prospective pooled cohort study. Setting, participants Seven prospective Australian study cohorts (total sample size, 365 084 adults); participant data linked to national registries to identify cases of pancreatic cancer and deaths. Main outcome measures Associations between exposures and incidence of pancreatic cancer, estimated in a proportional hazards model, adjusted for age, sex, study, and other exposures; future burden of pancreatic cancer avoidable by changes in exposure estimated as population attributable fractions (PAFs) for whole population and for specific population subgroups with a method accounting for competing risk of death. Results There were 604 incident cases of pancreatic cancer during the first 10 years of follow‐up. Current and recent smoking explained 21.7% (95% CI, 13.8–28.9%) and current smoking alone explained 15.3% (95% CI, 8.6–22.6%) of future pancreatic cancer burden. This proportion of the burden would be avoidable over 25 years were current smokers to quit and there were no new smokers. The burden attributable to current smoking is greater for men (23.9%; 95% CI, 13.3–33.3%) than for women (7.2%; 95% CI, –0.4% to 14.2%; P = 0.007) and for those under 65 (19.0%; 95% CI, 8.1–28.6%) than for older people (6.6%; 95% CI, 1.9–11.1%; P = 0.030). There were no independent relationships between body mass index or alcohol consumption and pancreatic cancer. Conclusions Strategies that reduce the uptake of smoking and encourage current smokers to quit could substantially reduce the future incidence of pancreatic cancer in Australia, particularly among men.

Pancreatic cancer in the Australian population: identifying opportunities for intervention

“…The study by McWilliams et al 33 was excluded from the present review as it is an international study based on data from the Pancreatic Cancer Case-Control Consortium and so was the study by Ansari-Moghaddam et al 28 as it contains data collated from countries in the Asia-Pacific region. Thus, 22 studies [19][20][21][22][23][24][25][26][27][29][30][31][32][34][35][36][37][38][39][40][41][42] were included in the review. Table 1 lists the various studies included in the review highlighting the source of their information.…”

“…Table 1 lists the various studies included in the review highlighting the source of their information. [19][20][21][22][23][24][25][26][27][29][30][31][32][34][35][36][37][38][39][40][41][42] Incidence, mortality and survival in pancreatic cancer There has been a moderate increase in the average annual percentage change in pancreatic cancer incidence (0.496%, 95% confidence interval (CI) 0.187-0.807) from 1982 to 2014 and annual percentage change in the mortality (0.298, 95% CI 0.084-0.511) from the disease from 1998 to 2015. 20 Pancreatic cancer (5-year) survival ranks among the lowest of all cancers in Australia with a survival of 5.2% irrespective of the sex of the patient, 32 although this was an improvement from 3% recorded between 1982 and1987.…”

“…as it contains data collated from countries in the Asia‐Pacific region. Thus, 22 studies 19–27,29–32,34–42 were included in the review. Table 1 lists the various studies included in the review highlighting the source of their information 19–27,29–32,34–42 …”

“…In fact, Australia went a step further in September 2012 passing a legislation to regulate the sale of cigarettes in plain, dark brown packs. These interventions have been a Table 1 Overview of the various studies highlighting the source of the data and the aspect of the disease being analysed [19][20][21][22][23][24][25][26][27][29][30][31][32][34][35][36][37][38][39][40][41][42] step in the right direction resulting in objective evidence to suggest a reduction in tobacco consumption in the two countries. [52][53][54] Further action on this front will likely provide a boost towards reducing smoking and its impact in the causation of pancreatic cancer.…”

“…The significant role of smoking (including current and recent) as a risk factor for the causation of pancreatic cancer as well as pancreatic cancer-related mortality has been confirmed by others. 19,31,36,41,42 A very encouraging finding has been the report of a decline in pancreatic cancer mortality since the introduction of smoking reduction programmes in Australia. 31 Adair et al 31 also confirmed a protective effect on pancreatic cancer mortality conferred by the consumption of fruits and vegetables.…”