An absolute risk model to identify individuals at elevated risk for pancreatic cancer in the general population.
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Klein Alison P, Lindström Sara, Mendelsohn Julie B, Steplowski Emily, Arslan Alan A, Bueno-de-Mesquita H Bas, Fuchs Charles S, Gallinger Steven, Gross Myron, Helzlsouer Kathy, Holly Elizabeth A, Jacobs Eric J, Lacroix Andrea, Li Donghui, Mandelson Margaret T, Olson Sara H, Petersen Gloria M, Risch Harvey A, Stolzenberg-Solomon Rachael Z, Zheng Wei, Amundadottir Laufey, Albanes Demetrius, Allen Naomi E, Bamlet William R, Boutron-Ruault Marie-Christine, Buring Julie E, Bracci Paige M, Canzian Federico, Clipp Sandra, Cotterchio Michelle, Duell Eric J, Elena Joanne, Gaziano J Michael, Giovannucci Edward L, Goggins Michael, Hallmans Göran, Hassan Manal, Hutchinson Amy, Hunter David J, Kooperberg Charles, Kurtz Robert C, Liu Simin, Overvad Kim, Palli Domenico, Patel Alpa V, Rabe Kari G, Shu Xiao-Ou, Slimani Nadia, Tobias Geoffrey S, Trichopoulos Dimitrios, Van Den Eeden Stephen K, Vineis Paolo, Virtamo Jarmo, Wactawski-Wende Jean, Wolpin Brian M, Yu Herbert, Yu Kai, Zeleniuch-Jacquotte Anne, Chanock Stephen J, Hoover Robert N, Hartge Patricia, Kraft Peter
Аннотация
PATIENTS AND METHODS: Using data on 3,349 cases and 3,654 controls from the PanScan Consortium, we developed a relative risk model for men and women of European ancestry based on non-genetic and genetic risk factors for pancreatic cancer. We estimated absolute risks based on these relative risks and population incidence rates.
RESULTS: Our risk model included current smoking (multivariable adjusted odds ratio (OR) and 95% confidence interval: 2.20 [1.84-2.62]), heavy alcohol use (>3 drinks/day) (OR: 1.45 [1.19-1.76]), obesity (body mass index >30 kg/m(2)) (OR: 1.26 [1.09-1.45]), diabetes >3 years (nested case-control OR: 1.57 [1.13-2.18], case-control OR: 1.80 [1.40-2.32]), family history of pancreatic cancer (OR: 1.60 [1.20-2.12]), non-O ABO genotype (AO vs. OO genotype) (OR: 1.23 [1.10-1.37]) to (BB vs. OO genotype) (OR 1.58 [0.97-2.59]), rs3790844(chr1q32.1) (OR: 1.29 [1.19-1.40]), rs401681(5p15.33) (OR: 1.18 [1.10-1.26]) and rs9543325(13q22.1) (OR: 1.27 [1.18-1.36]). The areas under the ROC curve for risk models including only non-genetic factors, only genetic factors, and both non-genetic and genetic factors were 58%, 57% and 61%, respectively. We estimate that fewer than 3/1,000 U.S. non-Hispanic whites have more than a 5% predicted lifetime absolute risk.
CONCLUSION: Although absolute risk modeling using established risk factors may help to identify a group of individuals at higher than average risk of pancreatic cancer, the immediate clinical utility of our model is limited. However, a risk model can increase awareness of the various risk factors for pancreatic cancer, including modifiable behaviors.