Other alcohol also boosted the risk, as did smoking, study found
WEDNESDAY, May 21 (HealthDay News) -- Heavy smoking and drinking, especially beer, may hasten the onset of pancreatic cancer, according to researchers who presented their data Tuesday at the Digestive Disease Week 2008 conference in San Diego.
Beer appears to exert a stronger influence than hard liquor or wine in lowering the age of onset of pancreatic cancer, said researcher Dr. Michelle A. Anderson, assistant professor of medicine at the University of Michigan.
Anderson and her colleagues evaluated patients from The Pancreatic Cancer Collaborative Registry, a multi-center, international patient registry, looking at whether the patients drank or smoked, and if so, how much and what type of liquor.
They evaluated the smoking and drinking (or abstinence) patterns of 453 patients in all, about equal numbers of men and women.
Patients who smoked did tend to develop pancreatic disease at a younger age and there were dose-related effects, Anderson said. Heavy smokers (such as those who have smoked more than a pack a day for 40 years, or more than two packs for 20 years) presented with pancreatic cancer an average of seven years before nonsmokers.
The average age of onset of pancreatic cancer is between 70 to 80, experts noted.
Heavy drinkers, defined as having more than three daily drinks, presented with pancreatic cancer 10 years younger than those who did not drink.
Comparing beer, wine and hard liquor, the team found that beer lowered the age of developing pancreatic cancer most, Anderson said. When she compared beer drinkers to non-beer drinkers, the effect was statistically significant; however, when she considered other variables that may affect cancer onset, the effect disappeared.
Cigarette smoking is already a well-known risk factor for pancreatic cancer. Heavy alcohol intake may induce chronic inflammatory changes that are also linked with cancer, Anderson said.
The combination of chronic smoking plus drinking had no stronger effect on pancreatic risk than either habit alone, the researchers found.
Pancreatic cancer is expected to be diagnosed in nearly 38,000 people in the United States this year, according to the American Cancer Society, and about 34,000 will die of the disease. The lifetime risk is about 1 in 79 but is affected by factors such as advancing age, obesity and family history.
Because it is often emerges without symptoms, pancreatic cancer is often not detected until its later stages, when treatment is less effective. But even if caught at stage one the outlook is bleak, researchers said. At stage one, the 5-year survival from pancreatic malignancy is about 33 percent.
The pancreas, about 6 inches long and less than 2 inches wide, extends across the abdomen. It makes key hormones, including insulin, and helps to balance blood sugar.
Finding pancreatic tumors earlier -- especially important for people with a family history, or other factor indicating high risk -- is the focus of much research. And a new study suggests that combining two methods may provide better screening, according to another researcher, Dr. Richard Zubarik, associate professor of medicine and chief of endoscopy at Fletcher Allen Health Care in Burlington, Vt.
His research team used a blood test called CA19-9 -- a test to detect a tumor marker most often used to monitor disease progress and predict survival rates. They then combined that screen with an endoscopic ultrasound to try to detect the cancer in the earliest stages.
Of the 272 patients enrolled, one patient was diagnosed with pancreatic cancer and one with abnormal pancreatic cell growth.
However, the method is expensive -- it cost $14,000 to detect the cancer and about $11,000 to detect the abnormal cell growth, Zubarik said.
Other strategies are being studied to see if they can increase the bleak survival rates. In another study, researchers compared the records of more than 4,000 patients with pancreatic cancer and divided them into two groups -- those who had the ultrasound (about 12 percent of the sample) and those who did not.
Those who received the ultrasound at diagnosis had a somewhat longer average survival time, said Dr. Ananya Das, associate chair of medicine, Mayo Clinic in Scottsdale, Ariz. Undergoing this screen increased average survival time for patients from 5 months to 9 months.
Going to a center that offers this method may mean that patients receive better overall care, he said. Endoscopic ultrasound is available at leading medical centers, he said.
In patients at very high risk of pancreatic cancer, such as those with a family history, surveillance performed by a team of specialists can also help, said Dr. Teresa A. Brentnall, associate professor of medicine at the University of Washington, Seattle.
"Our goal is to protect them from pancreatic cancer," she said. Her team found that two tests could help. One is the endoscopic ultrasound, the other is called an endoscopic retrograde cholangiopancreatography.
Brentnall's team followed 100 patients using these methods. Of the 100 patients, two developed cancer (one inoperable), and 20 had abnormal cell growths. The combination can help lead to detection of pancreatic pre-cancer, she said.
To learn more about pancreatic cancer, visit the American Cancer Society.
SOURCES: press conference, May 20, 2008, Digestive Disease Week, San Diego, with: Michelle A. Anderson, M.D., assistant professor of medicine, University of Michigan, Ann Arbor; Teresa A. Brentnall, M.D., associate professor of medicine, division of gastroenterology, University of Washington, Seattle; Ananya Das, M.D., associate chair of medicine, Mayo Clinic, Scottsdale, Ariz; Richard Zubarik, M.D., associate professor of medicine and chief of endoscopy, Fletcher Allen Health Center, University of Vermont Dartmouth-Hitchcock Medical Center, Lebanon, N.H.
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