BACKGROUND: 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. PATIENTS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Cancer Center and Institute of Oncology Warsaw Poland

Dalla Lana School of Public Health University of Toronto Toronto Canada

Dalla Lana School of Public Health University of Toronto Toronto Canada; Cancer Care Ontario Toronto Canada

Department of Cancer Epidemiology and Genetics Masaryk Memorial Cancer Institute Institute and MF MU Brno Czech Republic

Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy

Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center New York USA

Department of Epidemiology and Biostatistics University of California San Francisco San Francisco USA

Department of Epidemiology Harvard School of Public Health Boston USA

Department of Epidemiology Harvard School of Public Health Boston USA; Department of Hygiene Epidemiology and Medical Statistics School of Medicine University of Athens Athens Greece

Department of Epidemiology IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri' Milan Italy

Department of Health Sciences Research Medicine and Medical Genetics Mayo Clinic Rochester

Department of Medicine Memorial Sloan Kettering Cancer Center New York USA

Department of Preclinical and Clinical Pharmacology Mario Aiazzi Mancini Università degli Studi di Firenze Florence Italy

Department of Preventive Medicine Faculty of Medicine Palacky University Olomouc

Department of Public Health Sciences Penn State University Penn State

Division of Cancer Epidemiology and Genetics National Cancer Institute Bethesda

Division of Epidemiology and Biostatistics European Institute of Oncology Milan Italy

Division of Epidemiology and Community Health University of Minnesota Minneapolis USA

Institute of Hygiene and Epidemiology 1st Faculty of Medicine Charles University Prague Prague Czech Republic

International Agency for Research on Cancer Lyon France

Louisiana State University School of Public Health New Orleans USA

M D Anderson Cancer Center University of Texas Houston

National Institute for Public Health and the Environment Utrecht The Netherlands; Department of Epidemiology and Biostatistics School of Public Health Imperial College London London UK

Public Health Women's and Children's Hospital Adelaide SA Australia

Queensland Institute of Medical Research Brisbane Australia

Regional Authority of Public Health in Banská Bystrica Banská Bystrica Slovakia

The Tisch Cancer Institute and Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai New York USA

Unit of Epidemiology and Biostatistics CRO Aviano National Cancer Institute IRCCS Aviano

Unit of Nutrition Environment and Cancer Catalan Institute of Oncology L'Hospitalet de Llobregat Barcelona Spain

University Health Network Department of Surgery University of Toronto Toronto Canada

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Ann Oncol. 2014 Nov;25(11):2290-2291. doi: 10.1093/annonc/mdu458. PubMed

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Ann Oncol. 2014 Nov;25(11):2290. doi: 10.1093/annonc/mdu457. PubMed

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