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

Lluís Cirera; José María Huerta; María Dolores Chirlaque; Kim Overvad; Martin Lindström; Sara Regnér; Anne Tjønneland; Marie-Christine Boutron-Ruault; Vinciane Rebours; Guy Fagherazzi; Verena A Katzke; Heiner Boeing; Eleni Peppa; Antonia Trichopoulou; Elissavet Valanou; Domenico Palli; Sara Grioni; Salvatore Panico; Rosario Tumino; Fulvio Ricceri; Carla van Gils; Roel C H Vermeulen; Guri Skeie; Tonje Braaten; Elisabete Weiderpass; Susana Merino; María José Sánchez; Nerea Larrañaga; Eva Ardanaz; Malin Sund; Kay-Tee Khaw; Timothy J Key; Mazda Jenab; Sabine Naudin; Neil Murphy; Dagfinn Aune; Heather Ward; Elio Riboli; Bas Bueno-de-Mesquita; Carmen Navarro; Eric J Duell

doi:10.1158/1055-9965.EPI-18-1153

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

Lluís Cirera, José María Huerta, María Dolores Chirlaque, Kim Overvad, Martin Lindström, Sara Regnér, Anne Tjønneland, Marie-Christine Boutron-Ruault, Vinciane Rebours, Guy Fagherazzi, Verena A Katzke, Heiner Boeing, Eleni Peppa, Antonia Trichopoulou, Elissavet Valanou, Domenico Palli, Sara Grioni, Salvatore Panico, Rosario Tumino, Fulvio RicceriCarla van Gils, Roel C H Vermeulen, Guri Skeie, Tonje Braaten, Elisabete Weiderpass, Susana Merino, María José Sánchez, Nerea Larrañaga, Eva Ardanaz, Malin Sund, Kay-Tee Khaw, Timothy J Key, Mazda Jenab, Sabine Naudin, Neil Murphy, Dagfinn Aune, Heather Ward, Elio Riboli, Bas Bueno-de-Mesquita, Carmen Navarro, Eric J Duell

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	1089-1092
Number of pages	4
Journal	Cancer Epidemiology Biomarkers & Prevention
Volume	28
Issue number	6
DOIs	https://doi.org/10.1158/1055-9965.EPI-18-1153
Publication status	Published - Jun 2019

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10.1158/1055-9965.EPI-18-1153

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Cirera, L., Huerta, J. M., Chirlaque, M. D., Overvad, K., Lindström, M., Regnér, S., Tjønneland, A., Boutron-Ruault, M.-C., Rebours, V., Fagherazzi, G., Katzke, V. A., Boeing, H., Peppa, E., Trichopoulou, A., Valanou, E., Palli, D., Grioni, S., Panico, S., Tumino, R., ... Duell, E. J. (2019). Socioeconomic Effect of Education on Pancreatic Cancer Risk in Western Europe: An Update on the EPIC Cohorts Study. Cancer Epidemiology Biomarkers & Prevention, 28(6), 1089-1092. https://doi.org/10.1158/1055-9965.EPI-18-1153

@article{2be30ced564044a48cff4918cbc028e5,

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

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.",

author = "Llu{\'i}s Cirera and Huerta, {Jos{\'e} Mar{\'i}a} and Chirlaque, {Mar{\'i}a Dolores} and Kim Overvad and Martin Lindstr{\"o}m and Sara Regn{\'e}r and Anne Tj{\o}nneland and Marie-Christine Boutron-Ruault and Vinciane Rebours and Guy Fagherazzi and Katzke, {Verena A} and Heiner Boeing and Eleni Peppa and Antonia Trichopoulou and Elissavet Valanou and Domenico Palli and Sara Grioni and Salvatore Panico and Rosario Tumino and Fulvio Ricceri and {van Gils}, Carla and Vermeulen, {Roel C H} and Guri Skeie and Tonje Braaten and Elisabete Weiderpass and Susana Merino and S{\'a}nchez, {Mar{\'i}a Jos{\'e}} and Nerea Larra{\~n}aga and Eva Ardanaz and Malin Sund and Kay-Tee Khaw and Key, {Timothy J} and Mazda Jenab and Sabine Naudin and Neil Murphy and Dagfinn Aune and Heather Ward and Elio Riboli and Bas Bueno-de-Mesquita and Carmen Navarro and Duell, {Eric J}",

note = "Publisher Copyright: {\textcopyright} 2019 American Association for Cancer Research.",

year = "2019",

month = jun,

doi = "10.1158/1055-9965.EPI-18-1153",

language = "English",

volume = "28",

pages = "1089--1092",

journal = "Cancer Epidemiology Biomarkers & Prevention",

issn = "1055-9965",

publisher = "American Association for Cancer Research Inc.",

number = "6",

}

Cirera, L, Huerta, JM, Chirlaque, MD, Overvad, K, Lindström, M, Regnér, S, Tjønneland, A, Boutron-Ruault, M-C, Rebours, V, Fagherazzi, G, Katzke, VA, Boeing, H, Peppa, E, Trichopoulou, A, Valanou, E, Palli, D, Grioni, S, Panico, S, Tumino, R, Ricceri, F, van Gils, C , Vermeulen, RCH, Skeie, G, Braaten, T, Weiderpass, E, Merino, S, Sánchez, MJ, Larrañaga, N, Ardanaz, E, Sund, M, Khaw, K-T, Key, TJ, Jenab, M, Naudin, S, Murphy, N, Aune, D, Ward, H, Riboli, E, Bueno-de-Mesquita, B, Navarro, C & Duell, EJ 2019, 'Socioeconomic Effect of Education on Pancreatic Cancer Risk in Western Europe: An Update on the EPIC Cohorts Study', Cancer Epidemiology Biomarkers & Prevention, vol. 28, no. 6, pp. 1089-1092. https://doi.org/10.1158/1055-9965.EPI-18-1153

TY - JOUR

T1 - Socioeconomic Effect of Education on Pancreatic Cancer Risk in Western Europe

T2 - An Update on the EPIC Cohorts Study

AU - Cirera, Lluís

AU - Huerta, José María

AU - Chirlaque, María Dolores

AU - Overvad, Kim

AU - Lindström, Martin

AU - Regnér, Sara

AU - Tjønneland, Anne

AU - Boutron-Ruault, Marie-Christine

AU - Rebours, Vinciane

AU - Fagherazzi, Guy

AU - Katzke, Verena A

AU - Boeing, Heiner

AU - Peppa, Eleni

AU - Trichopoulou, Antonia

AU - Valanou, Elissavet

AU - Palli, Domenico

AU - Grioni, Sara

AU - Panico, Salvatore

AU - Tumino, Rosario

AU - Ricceri, Fulvio

AU - van Gils, Carla

AU - Vermeulen, Roel C H

AU - Skeie, Guri

AU - Braaten, Tonje

AU - Weiderpass, Elisabete

AU - Merino, Susana

AU - Sánchez, María José

AU - Larrañaga, Nerea

AU - Ardanaz, Eva

AU - Sund, Malin

AU - Khaw, Kay-Tee

AU - Key, Timothy J

AU - Jenab, Mazda

AU - Naudin, Sabine

AU - Murphy, Neil

AU - Aune, Dagfinn

AU - Ward, Heather

AU - Riboli, Elio

AU - Bueno-de-Mesquita, Bas

AU - Navarro, Carmen

AU - Duell, Eric J

PY - 2019/6

Y1 - 2019/6

N2 - 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.

AB - 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.

U2 - 10.1158/1055-9965.EPI-18-1153

DO - 10.1158/1055-9965.EPI-18-1153

M3 - Article

C2 - 31160392

SN - 1055-9965

VL - 28

SP - 1089

EP - 1092

JO - Cancer Epidemiology Biomarkers & Prevention

JF - Cancer Epidemiology Biomarkers & Prevention

IS - 6

ER -

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

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