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Healthy lifestyle and the risk of pancreatic cancer in the EPIC study.

Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150, Cours Albert Thomas, 69372, Lyon Cedex 08, France. Department of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Nutritional Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France. Director Office, International Agency for Research on Cancer, World Health Organization, Lyon, France. Environment and Radiation section, Agency for Research on Cancer, World Health Organization, Lyon, France. Departement for Determinants of Chronic Diseases (Former), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Department of Gastroenterology and Hepathology, University Medical Center, Utrecht, The Netherlands. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom. Danish Cancer Society Research Center, Copenhagen, Denmark. Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. CESP, Faculté de médecine (USVQ), Université Paris-Sud, INSERM, Université Paris-Saclay, Villejuif, France. Inserm UMR1018, Institut Gustave Roussy, Villejuif, France. Pancreatology Department, Beaujon Hospital, AP-HP, Clichy, France. Inserm UMR1149, DHU Unit, Paris-Diderot University, Paris, France. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal, Germany. Hellenic Health Foundation, Athens, Greece. Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, ATTIKON University Hospital of Athens, Haidari, Greece. School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy. Department of Clinical and Experimental Medecine, University Federico II, Naples, Italy. Cancer Registry and Histopathology Department, Civic M.P.Arezzo Hospital, Ragusa, Italy. Unit of Cancer Epidemiology, Città della Salute e della Scienza University, Hospital and Center for Cancer Prevention (CPO), Turin, Italy. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway. Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain. Spanish Consortium for Research and Public Health (CIBERESP), Madrid, Spain. Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria, Universidad de Granada, Granada, Spain. Navarra Public Health Institute, Pamplona, Spain. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain. Public Health Directorate, Asturias, Spain. Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain. Department of Surgical and Preoperative Sciences, Umeå University, Umeå, Sweden. Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden. Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom. MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom. Department of Nutrition, Bjørknes University College, Oslo, Norway. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway. Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain. Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France. Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150, Cours Albert Thomas, 69372, Lyon Cedex 08, France. ferrarip@iarc.fr.

European journal of epidemiology. 2020;(10):975-986
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Abstract

Pancreatic cancer (PC) is a highly fatal cancer with currently limited opportunities for early detection and effective treatment. Modifiable factors may offer pathways for primary prevention. In this study, the association between the Healthy Lifestyle Index (HLI) and PC risk was examined. Within the European Prospective Investigation into Cancer and Nutrition cohort, 1113 incident PC (57% women) were diagnosed from 400,577 participants followed-up for 15 years (median). HLI scores combined smoking, alcohol intake, dietary exposure, physical activity and, in turn, overall and central adiposity using BMI (HLIBMI) and waist-to-hip ratio (WHR, HLIWHR), respectively. High values of HLI indicate adherence to healthy behaviors. Cox proportional hazard models with age as primary time variable were used to estimate PC hazard ratios (HR) and 95% confidence intervals (CI). Sensitivity analyses were performed by excluding, in turn, each factor from the HLI score. Population attributable fractions (PAF) were estimated assuming participants' shift to healthier lifestyles. The HRs for a one-standard deviation increment of HLIBMI and HLIWHR were 0.84 (95% CI: 0.79, 0.89; ptrend = 4.3e-09) and 0.77 (0.72, 0.82; ptrend = 1.7e-15), respectively. Exclusions of smoking from HLIWHR resulted in HRs of 0.88 (0.82, 0.94; ptrend = 4.9e-04). The overall PAF estimate was 19% (95% CI: 11%, 26%), and 14% (6%, 21%) when smoking was removed from the score. Adherence to a healthy lifestyle was inversely associated with PC risk, beyond the beneficial role of smoking avoidance. Public health measures targeting compliance with healthy lifestyles may have an impact on PC incidence.