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Pancreatic cancer risk factors

This page presents information on the risk factors for pancreatic cancer, including cigarette smoking and tobacco, pancreatitis, diabetes, body weight and physical activity, family history, alcohol, diet, non-steroidal anti-inflammatory drugs and other factors.

A study published in December 2011 estimated that, in the UK, around 36% of pancreatic cancers in men and 39% in women are linked to lifestyle factors.74

 

Cigarette smoking and tobacco

A study published in December 2011 estimated that around 29% of pancreatic cancers in the UK in 2010 were caused by smoking.75 A British study reported that ex-smokers were 1.4 times more likely to die of pancreatic cancer compared with men who had never smoked. Current smokers of less than 25 cigarettes a day had 1.8 times the risk of death and smokers of 25 or more cigarettes a day were at 3.1 times the risk of never smokers.2 A recent European study showed risk increased by 27% for every five cigarettes smoked per day.81

Prospective studies have reported a positive trend with number of years of smoking among men but not women.3 Smokers are diagnosed on average 10 years younger than non-smokers.4 Some studies have reported that it takes10-20 years after cessation for risk to return to the level of a never-smoker,3,5,47,71 but recent results from the European Prospective Investigation into Cancer and Nutrition (EPIC) showed that risk fell to the level of a never-smoker within five years of giving up.50 While the chemical cause is unclear, it is possible that N-nitroso compounds in tobacco are carried to the pancreas in the blood.6 Regular cigar and/or pipe smokers have a 50% increased risk of pancreatic cancer.1

The International Agency for Research on Cancer states that smokeless tobacco smoke increases the risk of pancreatic cancer.78 There is evidence that risk increases with the use of snus,7,39   and it has been estimated that one in five cases of pancreatic cancer in Swedish men are due to this factor.52

According to EPIC, secondhand smoke exposure at home or at work increases the risk of pancreatic cancer by about 50%, and daily exposure in childhood doubles the risk of pancreatic cancer in later life.50,73 An American study showed that offspring of women who smoke have a 40% increased risk.51However, a Candadian case-control study and the Netherlands cohort study showed no significant risk increase with secondhand smoke exposure.70,71

section reviewed 01/08/05
section updated 01/08/05

 

Pancreatitis

Pancreatic cancer risk is almost threefold higher in people with chronic pancreatitis (long-term inflammation of the pancreas, typically caused by alcohol abuse), compared with healthy controls, a pooled analysis showed.80 Pancreatic cancer risk is higher still shortly after pancreatitis diagnosis, probably because of increased investigative activity in this period and/or initial misdiagnosis of pancreatic cancer as pancreatitis.80  

Pancreatic cancer risk is increased more than 50-fold in people with hereditary pancreatitis (inflammation of the pancreas beginning with acute episodes in childhood and usually resulting in chronic pancreatitis by age 20).11-13,82

section reviewed 14/04/14
section updated 14/04/14

 

Diabetes

Pancreatic cancer risk is between 40% and 120% higher in diabetics compared with non-diabetics, meta- and pooled analyses show.40,84,85,93 However it remains unclear whether diabetes is a cause or an early manifestation of pancreatic cancer.84

Type of diabetes treatment also appears to be associated with pancreatic cancer risk; though findings are inconsistent.86,87 Diabetics taking metformin may have lower pancreatic cancer risk, and diabetics taking sulfonylureas may have higher risk, compared with diabetics not taking these medications.86,87

section reviewed 17/12/13
section updated 17/12/13

Other medical conditions and previous cancers 

Gastric ulcer

A history of gastric ulcer is associated with an increase in pancreatic cancer risk,53 especially for people operated on for their ulcer, where the risk is approximately double that of the general population.54 It has been suggested that the bacteria that populate the stomach post-operatively cause formation of carcinogenic nitrosamines.34

Ulcerative colitis and Crohn disease

A seven-fold risk increase for pancreatic cancer, compared to the general population, has been shown for people who were hospitalised for ulcerative colitis before the age of 25, but a lower than doubling of risk was shown for people hospitalised for ulcerative colitis at a later age.55 A 75% risk increase for pancreatic cancer has been shown for people with a previous diagnosis of Crohn disease.56

Periodontal disease

Two studies have shown between a 50% risk increase and a doubling in risk of pancreatic cancer in people with periodontal disease.57,58

Allergies

A significant reduction in risk has been reported in people with a history of allergies and risk decreases with increasing number of allergies and severity of symptoms.31 The relevant allergies are those affecting the skin, such as eczema or hives and reaction to insect bites, hay fever and respiratory allergies other than asthma.32

Previous cancers

According to a large pooled analysis, people are at higher risk of developing pancreatic cancer within 10 years of a diagnosis of cancers of the pharynx, stomach, gallbladder, larynx, lung, cervix, corpus uteri, bladder, and eye and 10 years or later following a diagnosis of cancers of the stomach, colon, gallbladder, breast, cervix, placenta, corpus uteri, ovary, testis, bladder, kidney, and eye, as well as Hodgkin's and non-Hodgkin's lymphomas.Some of these risk increases are probably due to the shared risk factor of smoking. In other cases, it could be due to a genetic link, or to radiotherapy treatment for the first cancer.59

section reviewed 01/08/05
section updated 01/08/05

 

Overweight and obesity

Body fatness is classified by WCRF/IACR as a cause of pancreatic cancer, and abdominal fatness as a probable cause of pancreatic cancer (based on limited evidence).98 An estimated 12% of pancreatic cancers in the UK are linked with overweight and obesity.76

Pancreatic cancer risk increases by 10% per 5-unit BMI increase, a meta-analysis showed.16

section reviewed 01/08/05
section updated 01/08/05

Physical activity

Physical activity of all types (occupational, household, transport, and recreational) is classified by WCRF/IACR as possibly protective against pancreatic cancer, based on limited evidence.98

Pancreatic cancer is 28% lower in people with the highest levels of total physical activity compared with those with the lowest, a meta-analysis showed.21 The association may be limited to occupational activity, not recreational.21,22

section reviewed 01/08/05
section updated 01/08/05

 

Family history

Studies show that people with at least one first-degree relative diagnosed with pancreatic cancer have almost double the risk of someone without a family history.41,42 A 45% risk increase has been shown for people with a first-degree relative diagnosed with prostate cancer.42

section reviewed 01/08/05
section updated 01/08/05

Alcohol

Chronic heavy alcohol consumption is a risk factor for pancreatitis, but evidence for an association with pancreatic cancer is limited. Some research suggests an increased risk in heavy drinkers,27-29,48 but no increased risk for people consuming up to 30g of alcohol a day.30 However, a large nested case-control study showed no risk increase, even at consumption of 60g/day or more.72

section reviewed 01/08/05
section updated 01/08/05

Diet

A meta-analysis has shown that processed meat may increase risk of pancreatic cancer, showing a 19% increase in risk for every 50g intake (equivalent to a sausage or two rashers of bacon). The study also showed an increase in risk of pancreatic cancer in relation to total red meat intake in men, but not in women. The results showed there was a 29% increase in pancreatic cancer risk for men who ate 120g of red meat compared to those who ate no red meat. This may be because men in the study tended to eat more red meat than women.77 

Studies show no effect of fruit and vegetable intake overall.67-69 

According to the results of a meta-analysis, high dietary folate was linked to a 51% reduced risk, but supplements were not shown to have an effect.45 Since that analysis, results have been conflicting.49,60-61

Some studies have shown an increased risk of pancreatic cancer in relation to saturated or total fat intake.62-64  However, other studies have not shown an association.65-66 

Women who eat 28g of nuts twice per week have 35% lower pancreatic cancer risk compared with women who generally eat no nuts, a large US cohort study showed; nuts may help decrease insulin resistance.83

section updated 13/01/12

Infections

Hepatitis B and C

People with chronic Hepatitis B infection have around 20%-60% increased pancreatic risk, compared with Hepatitis B-negative people, meta-analyses have shown.88-90 Hepatitis C infection may also increase pancreatic cancer risk, but evidence remains unclear.90,91,97

section reviewed 28/02/14
section updated 28/02/14

Helicobacter Pylori (H.Pylori)

People with H.pylori have a 28-38% increased risk of pancreatic cancer, meta-analyses have shown.94,95

section reviewed 17/12/13
section updated 17/1213

Factors not shown to have an effect on pancreatic cancer risk

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAID use has no effect on pancreatic cancer risk, meta-analyses have shown.46,96

section reviewed 17/12/13
section updated 17/12/13

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Updated: 20 November 2013