Tobacco and Public Health - TCSC Indonesia

Introduction
Chapter 27
Tobacco and pancreas cancer
Patrick Maisonneuve
In developed countries, pancreas cancer is the 10th most common form of cancer in
men and the 9th most common form of cancer in women, but because of its very poor
prognosis, it ranks as the fourth most common cause of cancer deaths in both sexes
(Ferlay et al. 2000).
The risk of pancreatic cancer increases rapidly with age, with 80% of the cases being
diagnosed after age 60. Pancreatic cancer has been predominantly a male disease,
presumably because of past differences in smoking habits, but the sex ratio decreases
with increasing age. Blacks are 50% more likely to contract pancreatic cancer than
whites (Coughlin et al. 2000). The cause for this racial difference is poorly understood.
There is little evidence to suggest that blacks smoke more than white, but suggestive
evidence that there are racial differences in the ability to degrade carcinogens
contained within tobacco smoke (Richie et al. 1997).
Risk factors for pancreas cancer comprise a diet rich in meat and fat, past medical
history of pancreatitis or diabetes, exposure to certain chemicals, and hereditary
factors, but tobacco smoking remains the major recognized risk factor for pancreatic
cancer.
Prospective studies
The strongest evidence of the association between cigarette smoking and pancreatic
cancer comes from a series of large prospective studies.
In 1966, Hammond and Horn investigated the relation between smoking and death
rates in a large prospective study of one million US men and women (Hammond and
Horn 1966). Between October 1959 and February 1960, 1 078 894 men and women
were enrolled in the study and completed a detailed questionnaire including smoking
habits. After 3 years of follow-up, the pancreatic cancer mortality ratio for men who ever
smoked regularly compared to men who never smoked was 2.69 for subjects aged 45 to 64
and 2.17 for subjects over 65 years of age. For women aged 45 to 64, the mortality ratio
was 1.81 for women who ever smoked regularly and 2.58 for women classified as
“Heavier” cigarette smokers. (At that time, many female cigarette smokers smoked
only a few cigarettes a day, did not inhale, and had been smoking for only few years.)