Christina C. Dahm

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

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Sabine Naudin, Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France., France
  • Vivian Viallon, Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France., France
  • Dana Hashim, Department of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA., United States
  • Heinz Freisling, Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France., France
  • Mazda Jenab, Nutritional Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France., France
  • Elisabete Weiderpass, Director Office, International Agency for Research on Cancer, World Health Organization, Lyon, France., France
  • Flavie Perrier, Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France., France
  • Fiona McKenzie, d Section of Environment and Radiation , International Agency for Research on Cancer (IARC), World Health Organization , Lyon , France., France
  • H Bas Bueno-de-Mesquita, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom, University Medical Center, Utrecht, Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands., United Kingdom
  • Anja Olsen
  • Anne Tjønneland, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark., The Danish Cancer Society Research Center, Denmark
  • Christina C Dahm
  • Kim Overvad
  • Francesca R Mancini, CESP UMR1018, INSERM, Institut Gustave Roussy, Paris South University-Paris-Saclay University, Villejuif, France., France
  • Vinciane Rebours, Inserm UMR1149, DHU Unit, Paris-Diderot University, Paris, France., France
  • Marie-Christine Boutron-Ruault, CESP UMR1018, INSERM, Institut Gustave Roussy, Paris South University-Paris-Saclay University, Villejuif, France., France
  • Verena Katzke, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany. r.kaaks@dkfz-heidelberg.de., Germany
  • Rudolf Kaaks, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany. r.kaaks@dkfz-heidelberg.de., Germany
  • Manuela Bergmann, Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal 14558, Germany., Germany
  • Heiner Boeing, Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal 14558, Germany., Germany
  • Eleni Peppa, Hellenic Health Foundation, Athens, Greece., Greece
  • Anna Karakatsani, 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece., Hellenic Health Foundation, Athens, Greece
  • Antonia Trichopoulou, 1st Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece., Hellenic Health Foundation, Athens, Greece
  • Valeria Pala, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133 Milano, Italy., Italy
  • Giovana Masala, Cancer Risk Factors and Life-Style Epidemiology Unit. Institute for Cancer Research, Prevention and Clinical Network - ISPRO, 50141, Florence, Italy., Italy
  • Salvatore Panico, Department of Clinical and Experimental Medecine, University Federico II, Naples, Italy., Italy
  • Rosario Tumino, Cancer Registry and Histopathology Department, Civic M.P.Arezzo Hospital, Ragusa, Italy, Ragusa, Italy., Italy
  • Carlotta Sacerdote, Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy., Italy
  • Anne M May, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands., Netherlands
  • Carla H van Gils, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands., Netherlands
  • Charlotta Rylander, Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, The Arctic University of Norway, N-9037 Tromsø, Norway., Norway
  • Kristin Benjaminsen Borch, Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, The Arctic University of Norway, N-9037 Tromsø, Norway., Norway
  • María Dolores Chirlaque López, Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; ib-salut, Area de Salut de Menorca, Menorca, Spain., University Murcia, Spain
  • Maria-Jose Sánchez, Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Granada Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain., Spanish Consortium for Research and Public Health (CIBERESP), Spain
  • Eva Ardanaz, Navarre Public Health Institute, Pamplona, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain., Spanish Consortium for Research and Public Health (CIBERESP), Spain
  • José Ramón Quirós, Public Health Directorate, Asturias, Spain., Spain
  • Pilar Amiano Exezarreta, Public Health Division of Gipuzkoa, Basque Government, Spain; Health Research Institute, Biodonostia, San Sebastián, Spain., Spanish Consortium for Research and Public Health (CIBERESP), Spain
  • Malin Sund, Department of Surgical and Preoperative Sciences, Umeå University, Sweden., Sweden
  • Isabel Drake, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden., Sweden
  • Sara Regnér, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden., Sweden
  • Ruth C Travis, Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom., United Kingdom
  • Nick Wareham, MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom., United Kingdom
  • Dagfinn Aune, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0372 Oslo, Norway. d.aune@imperial.ac.uk., Imperial College, London, Bjørknes University College, Norway
  • Elio Riboli, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom, United Kingdom
  • Marc J Gunter, Nutritional Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France., France
  • Eric J Duell, Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain., Spain
  • Paul Brennan, Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France., France
  • Pietro Ferrari, 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., France

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.

Original languageEnglish
Article number35
JournalEuropean Journal of Epidemiology
Volume35
Issue10
Number of pages12
ISSN0393-2990
DOIs
Publication statusPublished - Oct 2020

    Research areas

  • pancreatic cancer, healthy lifestyle index, population attributable fraction, EPIC, prospective study

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