Metabolic and Lifestyle related risk factors for pancreatic cancer
Background and aims: In spite of the fact that pancreatic cancer is a relatively infrequent disease, it ranks 8th in the worldwide ranking of cancer death due to the poor prognosis. The mortality rate is almost as high as the incidence with a M/I ratio of 98%, indicating an extremely dismal clinical course. This makes it imperative to try to develop new therapeutic strategies and to try to identify risk factors in order to intensify preventive efforts. The most important risk factor for pancreatic cancer is tobacco smoking, but there are other putative environmental risk factors and some pre-existing diseases that have been linked to pancreatic cancer. The aim of this thesis is to evaluate different epidemiological aspects in relation to pancreatic cancer; in more specific terms to investigate the relation between alcohol and pancreatic cancer, between trypsinogen, pancreatic secretory trypsin inhibitor (PSTI) and pancreatic cancer, between Helicobacter pylori infection and pancreatic cancer and to investigate if the metabolic syndrome is associated with the risk of pancreatic cancer. Results and conclusion: High alcohol intake, estimated using both a questionnaire on attitude towards alcohol and a laboratory marker in the form of γ-GT is associated with a subsequent high risk of developing pancreatic cancer. The previously established association between smoking and pancreatic cancer is confirmed. The hypothesis that pancreatic cancer is related to an imbalance between the trypsinogen isoforms is in line with the finding concerning the ratio of human anionic trypsinogen and human cationic trypsinogen (HAT/HCT). There is no overall association between H.pylori infection and the risk of pancreatic cancer, but H.pylori infection may increase the risk of pancreatic cancer in never smokers and in low alcohol consumers. High mid-blood pressure, high fasting glucose and the metabolic syndrome as an entity are associated with an increased risk of pancreatic cancer in women. In men, high mid-blood pressure is associated with the risk of pancreatic cancer and there is an indication of an association between high glucose levels and the risk of pancreatic cancer. Growing evidence have consistently shown that obesity, diabetes, metabolic factors, smoking and alcohol are associated with a high risk of pancreatic cancer.
Clinical Medicine, trypsinogen, body mass index, alcohol consumption, smoking, Keywords: Pancreatic cancer, epidemiology, pancreatic secretory trypsin inhibitor, Helicobacter pylori, metabolic syndrome.
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Lund University. Department of Clinical Science, Surgery. Skåne University Hospital, Malmö