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Socioeconomic Effect of Education on Pancreatic Cancer Risk in Western Europe: An Update on the EPIC Cohorts Study

Cirera L 1 , Huerta JM 2 , Chirlaque MD 2 , Overvad K 3 , Lindström M 4 , Regnér S 4 Show all authors , Tjønneland A 5 , Boutron-Ruault MC 6 , Rebours V 7 , Fagherazzi G 6 , Katzke VA 8 , Boeing H 9 , Peppa E 10 , Trichopoulou A 10 , Valanou E 10 , Palli D 11 , Grioni S 12 , Panico S 13 , Tumino R 14 , Ricceri F 15 , van Gils C 16 , Vermeulen RCH 16 , Skeie G 17 , Braaten T 17 , Weiderpass E 17 , Merino S 18 , Sánchez MJ 19 , Larrañaga N 20 , Ardanaz E 20 , Sund M 3 , Khaw KT 21 , Key TJ 22 , Jenab M 23 , Naudin S 23 , Murphy N 23 , Aune D 24 , Ward H 24 , Riboli E 24 , Bueno-de-Mesquita B 25 , Navarro C 26 , Duell EJ 27

Affiliations 

  • 1 Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain. luis.cirera@carm.es
  • 2 Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
  • 3 Department of Public Health, Aarhus University, Aarhus, Denmark
  • 4 Department of Clinical Sciences, Social Medicine and Health Policy, Lund University, Malmö, Sweden
  • 5 Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
  • 6 CESP, Faculté de Médecine - Université Paris-Sud, Faculté de Médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
  • 7 Pancreatology Unit, Beaujon Hospital, Clichy, France
  • 8 German Cancer Research Center (DKFZ), Heidelberg, Germany
  • 9 Department of Epidemiology German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
  • 10 Hellenic Health Foundation, Athens, Greece
  • 11 Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
  • 12 Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
  • 13 Dipartimento di Medicina Clinica e Chirurgia, Federico ii University, Naples, Italy
  • 14 Department of Cancer Registry and Histopathology, "Civic - M.P. Arezzo" Hospital, ASP Ragusa, Italy
  • 15 Department of Clinical and Biological Sciences, University of Turin, Italy
  • 16 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
  • 17 Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
  • 18 Public Health Directorate, Regional Government of Asturias, Oviedo, Spain
  • 19 Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
  • 20 CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  • 21 University of Cambridge, School of Clinical Medicine Addenbrooke's Hospital, Cambridge, United Kingdom
  • 22 Nuffield Department of Population Health, Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom
  • 23 Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France
  • 24 Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London, United Kingdom
  • 25 Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
  • 26 Department of Health and Social Sciences, University of Murcia, Murcia, Spain
  • 27 Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), L'Hospitalet de Llobregat, Spain
Cancer Epidemiol Biomarkers Prev, 2019 06;28(6):1089-1092.
PMID: 31160392 DOI: 10.1158/1055-9965.EPI-18-1153

Abstract

BACKGROUND: To analyze the potential effect of social inequality on pancreatic cancer risk in Western Europe, by reassessing the association within the European Prospective Investigation into Cancer and Nutrition (EPIC) Study, including a larger number of cases and an extended follow-up.

METHODS: Data on highest education attained were gathered for 459,170 participants (70% women) from 10 European countries. A relative index of inequality (RII) based on adult education was calculated for comparability across countries and generations. Cox regression models were applied to estimate relative inequality in pancreatic cancer risk, stratifying by age, gender, and center, and adjusting for known pancreatic cancer risk factors.

RESULTS: A total of 1,223 incident pancreatic cancer cases were included after a mean follow-up of 13.9 (±4.0) years. An inverse social trend was found in models adjusted for age, sex, and center for both sexes [HR of RII, 1.27; 95% confidence interval (CI), 1.02-1.59], which was also significant among women (HR, 1.42; 95% CI, 1.05-1.92). Further adjusting by smoking intensity, alcohol consumption, body mass index, prevalent diabetes, and physical activity led to an attenuation of the RII risk and loss of statistical significance.

CONCLUSIONS: The present reanalysis does not sustain the existence of an independent social inequality influence on pancreatic cancer risk in Western European women and men, using an index based on adult education, the most relevant social indicator linked to individual lifestyles, in a context of very low pancreatic cancer survival from (quasi) universal public health systems.

IMPACT: The results do not support an association between education and risk of pancreatic cancer.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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