The burden of pancreatic cancer in Australia attributable to smoking

Source: Arriaga, M. E., Vajdic, C. M., MacInnis, R. J., Canfell, K. , Magliano, D. J., Shaw, J. E., Byles, J. E., Giles, G. G., Taylor, A. W., Gill, T. K., Hirani, V. , Cumming, R. G., Mitchell, R. P., Banks, E. , Marker, J. , Adelstein, B. and Laaksonen, M. A. (2019), The burden of pancreatic cancer in Australia attributable to smoking. Med. J. Aust., 210: 213-220. doi:10.5694/mja2.12108

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.

• The known The future pancreatic cancer burden attributable to tobacco smoking has not been estimated in Australia.
• The new Nearly 22% of the future burden of pancreatic cancer is attributable to current and former smoking, 15% (5500 cases over the next 10 years) to current smoking alone. The smoking‐related burden of pancreatic cancer is markedly higher for men and for people under 65.
• The implications Reducing smoking rates among men and people under 65 would have the greatest impact on reducing the future burden of pancreatic cancer in Australia.