Pancreatic cancer – association with diabetes mellitus and smoking

Czech version

Authors: P. Dítě ¹; J. Trna ¹; J. Bělobrádková ¹; I. Novotný ²; M. Hermanová ³; P. Vlčková ¹; K. Klímová ¹; B. Kianička ⁴; Abdul Lemine ¹; M. Liberda ⁵; E. Geryk ¹
Authors‘ workplace: Interní gastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Aleš Hep, CSc. ¹; Masarykův onkologický ústav Brno, ředitel prof. MUDr. Jiří Vorlíček, CSc. ²; I. patologicko-anatomický ústav Lékařské fakulty MU a FN u sv. Anny Brno, přednostka prof. MUDr. Markéta Hermanová, Ph. D. ³; Gastroenterologické oddělení II. interní kliniky Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MUDr. Miroslav Souček, CSc. ⁴; Interní oddělení nemocnice Valašské Meziříčí, přednosta prim. MUDr. Pavel Prodělal ⁵
Published in: Vnitř Lék 2011; 57(2): 159-162
Category: Original Contributions

Overview

Introduction:
Pancreatic cancer is a disease with rather poor prognosis. This can be explained, among other reasons, by unusually aggressive course of the tumour growth and, in the majority of cases, late, and thus further treatment limiting, diagnosis. In addition, no effective screening programme for pancreatic cancer is available and thus identification of risk factors associated with the development of pancreatic cancer represents a possible approach to diagnosing early stages of the disease. Smoking represents a general and diabetes mellitus a specific risk factor for pancreatic cancer.

The aim of our prospective study in pancreatic cancer patients was to identify patients with diabetes mellitus and divide these into smokers and non-smokers – in association with the diagnosis of pancreatic carcinoma. Materials and methods: We included 83 patients, 50 men and 33 women, with pancreatic cancer who were divided into 3 groups – non-smokers with diabetes mellitus, smokers and smokers with diabetes mellitus; the mean age was 64.2 years in male and 59.8 years in female patients. Pancreatic cancer was confirmed histomorphologically from pancreatic biopsies or a histology of pancreatic tissue obtained during a surgery.

Results:
Pancreatic cancer was diagnosed after 3 or more years in patients with diabetes mellitus, the majority of diagnoses in smokers were made within the first year from the first dyspeptic symptoms. We found that the proportion of patients with subsequent diagnosis of pancreatic cancer increased with the number of cigarettes smoked per day (33.3% up to 10 cigarettes per day and 66.5% over 10 cigarettes per day). The highest incidence of pancreatic cancer, in 42 persons (50.6%), was associated with concurrent diabetes and smoking.

Conclusion:
Pancreatic cancer was identified in 24% of patients with diabetes mellitus, 25.3% of smokers with no diabetes and in more than 50% of smokers with diabetes mellitus. We assume that smoking is an independent risk factor for pancreatic cancer induction and it importantly increases the risk of pancreatic cancer in patients with diabetes mellitus.

Key words:
pancreatic cancer – diabetes mellitus – smoking

Sources

1. Bramhall SR, Allu WH, Jones AG et al. Treatment and survival in 13,560 patients with pancreatic cancer and incidence of the disease in the West Middlands: an epidemiological study. Br J Surg 1995; 82: 111–115.

2. Fernandez E, La Vecchia C, Porta M et al. Trends in pancreatic cancer mortality in Europe, 1955–1989. Int J Cancer 1994; 57: 786–792.

3. Trna J, Dítě P, Hermanová M et al. Výskyt diabetes mellitus u pacientů s karcinomem pankreatu. Čes Slov Gastroent Hepatol 2008; 62: 69–73.

4. Bonelli L, Aste H, Bovo P et al. Exocrine pancreatic cancer, cigarette smoking and diabetes mellitus. A case control study in Northern Italy. Pancreas 2003; 27: 143–149.

5. Everhart J, Wright D. Diabetes mellitus as a risk factor for pancreatic cancer. A meta-analysis. JAMA 1994; 331: 81–84.

6. Gullo L, Pezzilli R, Morselli-Labate AM. Diabetes as a risk of pancreatic cancer. N Engl J Med 1994; 331: 81–84.

7. Boyle P, Maisonneuve P, Bueno de Mesquita B et al. Cigarette smoking and pancreas cancer: a case-control study to the search programme of the IARC. Int J Cancer 1996; 67: 63–71.

8. Muscat JE, Stellman SD, Hoffmann D et al. Smoking and pancreatic cancer in men and in women. Cancer Epidemiol Biomarkers Prev 1997; 6: 15–19.

9. Kessler I A genetic relationship between diabetes and cancer. Lancet 1970; 1: 218.

10. Silverman DT, Schiffman M, Everhart J et al. Diabetes mellitus, either medical conditions and familial history of cancer as a risk factors for pancreatic cancer. Br J Cancer 1999; 80: 1830–1837.

11. Permert J, Ihse I, Jorfeldt L et al. Pancreatic cancer is associated with impaired glucose metabolism. Eur J Surg. 1993; 159: 101–107.

12. Partanen TJ, Vainio HU, Ojajarvi IA et al. Pancreas cancer, tobacco smoking and consumption of alcoholic beverages: a case-control study. Cancer Lett 1997; 116: 27–32.

13. Noy A, Bilezikian JP Diabetes and pancreatic cancer: Clues to the early diagnosis of pancreatic malignancy. J Clin Endocrinol Metabol 1994; 79: 1223–1231.

14. Chari ST, Leibson CL, Rabe KG et al. Probability of pancreatic cancer following diabetes. A population-based study. Gastroenterology 2005; 129: 504–511.

15. Pannala R, Basu A, Petersen GM et al. New-onset diabetes: a potential clue to the early diagnosis of pancreatic cancer. Lancet Oncol 2009; 10: 88–95.

16. Stolzenber-Solomon RZ, Graubard BI.Insulin, glucose, insulin resistence and pancreatic cancer in male smokers. JAMA 2005; 294: 2872–2878.

17. Pisani P. Hyper-insulinaemia and cancer: metaanalysis of epidemiological studies. Natl Rev Cancer 2008; 8: 915–928.

18. Hemkens LC, Grouven U. Risk of malignancies in patients with diabetes treated with human insulin or insulin analogues: a cohort study. Diabetologia 2009; 52: 1732–1744.

19. Chari ST, Leibson CL, Rabe KB et al. Pancreatic cancer – associated diabetes mellitus: prevalence and temporal association with diagnosis of cancer. Gastroenterology 2008; 134: 95–101.

20. Pannala R, Leirness JB, Bamlet WR et al. Prevalence and clinical profile of pancreatic cancer- associated diabetes mellitus. Gastroenterology 2008; 134: 981–987.

21. Fuchs CS, Colditz GA, Stampfer MJ et al. A prospective study of cigarette smoking and the risk of pancreatic cancer. Arch Intern Med 1996; 156: 2255–2260.

22. Villeneuve PJ, Johnson KC, Hanley AJG et al and the Canadian Registries Epidemiology Research Group. Alcohol, tobacco, and coffee consumption and the risk of pancreatic cancer: results from the Canadian Enhanced Surveillance System case-control project. Eur J Cancer Prev 2000; 9: 49–58.

23. Smith GD, Ether M, Shipley MJ et al. Post-challenge glucose concentration, impaired glucose tolerance, diabetes, and cancer mortality in men. Am J Epidemiol 1992; 136: 1110–1114.

24. Hong SG, Jung SJ, Joo MK et al. Prevalence of pancreatic cancer in diabetics and clinical characteristics of diabetes-associated with pancreatic cancer – comparison between diabetes with and without pancreatic cancer. Korean J Gastroenterol 2009; 54: 167–173.

25. Ogawa Y, Tanaka M, Inoue K et al. A prospective pancreatographic study of the prevalence of pancreatic carcinoma in patients with diabetes mellitus. Cancer 2002; 94: 2344–2349.

26. Inoue M, Iwasaki M. Diabetes mellitus and the risk of cancer: results from a large--scale population based cohort study in Japan. Arch Intern Med 2006; 166: 1871–1877.

27. Law R, Parsi M, Lopez R et al. Cigarette smoking is independently associated with chronic pancreatitis. Pancreatology 2010; 10: 54–59.

28. Grote VA, Becker S, Kaaks R. Diabetes mellitus type 2 an independent risk factor for cancer? Exp Clin Endocrinol Diabetes 2010; 118: 4–8.