{Reference Type}: Journal Article
{Title}: Diabetes, antidiabetic medications, and pancreatic cancer risk: an analysis from the International Pancreatic Cancer Case-Control Consortium.
{Author}: Bosetti C;Rosato V;Li D;Silverman D;Petersen GM;Bracci PM;Neale RE;Muscat J;Anderson K;Gallinger S;Olson SH;Miller AB;Bas Bueno-de-Mesquita H;Scelo G;Janout V;Holcatova I;Lagiou P;Serraino D;Lucenteforte E;Fabianova E;Baghurst PA;Zatonski W;Foretova L;Fontham E;Bamlet WR;Holly EA;Negri E;Hassan M;Prizment A;Cotterchio M;Cleary S;Kurtz RC;Maisonneuve P;Trichopoulos D;Polesel J;Duell EJ;Boffetta P;La Vecchia C;Ghadirian P;
{Journal}: Ann Oncol
{Volume}: 25
{Issue}: 10
{Year}: Oct 2014
{Factor}: 51.769
{DOI}: 10.1093/annonc/mdu276
{Abstract}: <B>BACKGROUND: </B>Type 2 diabetes mellitus has been associated with an excess risk of pancreatic cancer, but the magnitude of the risk and the time-risk relationship are unclear, and there is limited information on the role of antidiabetic medications.<BR><B>METHODS: </B>We analyzed individual-level data from 15 case-control studies within the Pancreatic Cancer Case-Control Consortium, including 8305 cases and 13 987 controls. Pooled odds ratios (ORs) were estimated from multiple logistic regression models, adjusted for relevant covariates.<BR><B>RESULTS: </B>Overall, 1155 (15%) cases and 1087 (8%) controls reported a diagnosis of diabetes 2 or more years before cancer diagnosis (or interview, for controls), corresponding to an OR of 1.90 (95% confidence interval, CI, 1.72-2.09). Consistent risk estimates were observed across strata of selected covariates, including body mass index and tobacco smoking. Pancreatic cancer risk decreased with duration of diabetes, but a significant excess risk was still evident 20 or more years after diabetes diagnosis (OR 1.30, 95% CI 1.03-1.63). Among diabetics, long duration of oral antidiabetic use was associated with a decreased pancreatic cancer risk (OR 0.31, 95% CI 0.14-0.69, for ≥15 years). Conversely, insulin use was associated with a pancreatic cancer risk in the short term (OR 5.60, 95% CI 3.75-8.35, for <5 years), but not for longer duration of use (OR 0.95, 95% CI 0.53-1.70, for ≥15 years).<BR><B>CONCLUSIONS: </B>This study provides the most definitive quantification to date of an excess risk of pancreatic cancer among diabetics. It also shows that a 30% excess risk persists for more than two decades after diabetes diagnosis, thus supporting a causal role of diabetes in pancreatic cancer. Oral antidiabetics may decrease the risk of pancreatic cancer, whereas insulin showed an inconsistent duration-risk relationship.