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Reduced risk of pancreatic cancer associated with asthma and nasal allergies
  1. Paulina Gomez-Rubio1,
  2. Jan-Paul Zock2,
  3. Marta Rava1,
  4. Mirari Marquez1,
  5. Linda Sharp3,
  6. Manuel Hidalgo4,
  7. Alfredo Carrato5,
  8. Lucas Ilzarbe6,
  9. Christoph Michalski7,
  10. Xavier Molero8,
  11. Antoni Farré9,
  12. José Perea10,
  13. William Greenhalf11,
  14. Michael O'Rorke12,
  15. Adonina Tardón13,
  16. Thomas Gress14,
  17. Victor Barberà15,
  18. Tatjana Crnogorac-Jurcevic16,
  19. Enrique Domínguez-Muñoz17,
  20. Luís Muñoz-Bellvís18,
  21. Cristina Alvarez-Urturi6,
  22. Joaquim Balcells8,
  23. Luis Barneo13,
  24. Eithne Costello11,
  25. Carmen Guillén-Ponce5,
  26. Jörg Kleeff7,
  27. Bo Kong7,
  28. Rita Lawlor19,
  29. Matthias Löhr20,
  30. Josefina Mora9,
  31. Lim Murray12,
  32. Damian O'Driscoll3,
  33. Pablo Peláez10,
  34. Ignasi Poves6,
  35. Aldo Scarpa19,
  36. Francisco X Real21,
  37. Núria Malats1,
  38. PanGenEU Study Investigators22
  1. 1Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain
  2. 2Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  3. 3National Cancer Registry Ireland, Cork, Ireland, and Institute of Health & Society, Newcastle University, UK
  4. 4Hospital Madrid-Norte-Sanchinarro, Madrid, Spain
  5. 5Department of Oncology, Hospital Ramón y Cajal, Madrid, Spain
  6. 6Hospital del Mar—Parc de Salut Mar, Barcelona, Spain
  7. 7Technical University of Munich, Munich, Germany
  8. 8Exocrine Pancreas Research Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  9. 9Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  10. 10Department of Surgery, 12 de Octubre University Hospital, Madrid, Spain
  11. 11The Royal Liverpool University Hospital, Liverpool, UK
  12. 12Centre for Public Health, Queen's University Belfast, Belfast, UK
  13. 13Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
  14. 14Department of Gastroenterology, University Hospital Giessen and Marburg, Marburg, Germany
  15. 15Laboratorio de Genética Molecular, Hospital General Universitario de Elche, Elche, Spain
  16. 16Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
  17. 17Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
  18. 18Cirugía General y del Aparato Digestivo, Hospital Universitario de Salamanca, Salamanca, Spain
  19. 19Department of Pathology and Diagnostics, University of Verona, Verona, Italy
  20. 20Gastrocentrum, Karolinska Institutet, Stockholm, Sweden
  21. 21Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
  22. 22List of PanGenEU Study Investigators is in Supplementary Annex
  1. Correspondence to Dr Núria Malats, Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), C/ Melchor Fernández Almagro, 3, Madrid E-28029, Spain; nmalats{at}


Objective Studies indicate an inverse association between ductal adenocarcinoma of the pancreas (PDAC) and nasal allergies. However, controversial findings are reported for the association with asthma. Understanding PDAC risk factors will help us to implement appropriate strategies to prevent, treat and diagnose this cancer. This study assessed and characterised the association between PDAC and asthma and corroborated existing reports regarding the association between allergies and PDAC risk.

Design Information about asthma and allergies was collated from 1297 PDAC cases and 1024 controls included in the PanGenEU case–control study. Associations between PDAC and atopic diseases were studied using multilevel logistic regression analysis. Meta-analyses of association studies on these diseases and PDAC risk were performed applying random-effects model.

Results Asthma was associated with lower risk of PDAC (OR 0.64, 95% CI 0.47 to 0.88), particularly long-standing asthma (>=17 years, OR 0.39, 95% CI 0.24 to 0.65). Meta-analysis of 10 case–control studies sustained our results (metaOR 0.73, 95% CI 0.59 to 0.89). Nasal allergies and related symptoms were associated with lower risk of PDAC (OR 0.66, 95% CI 0.52 to 0.83 and OR 0.59, 95% CI 0.46 to 0.77, respectively). These results were supported by a meta-analysis of nasal allergy studies (metaOR 0.6, 95% CI 0.5 to 0.72). Skin allergies were not associated with PDAC risk.

Conclusions This study shows a consistent inverse association between PDAC and asthma and nasal allergies, supporting the notion that atopic diseases are associated with reduced cancer risk. These results point to the involvement of immune and/or inflammatory factors that may either foster or restrain pancreas carcinogenesis warranting further research to understand the molecular mechanisms driving this association.

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  • Acknowledgements The authors acknowledge the coordinators, field and administrative workers, technicians and study participants of the European Study into Digestive Illnesses and Genetics (PanGenEU) study.

  • Contributors NM; PG-R, J-PZ, FXR, MR: design of the study; analysis and interpretation of the data; preparation of the manuscript; and review and approval of the manuscript. MM: design, organisation and coordination of the study; management of the data and databases. LS, MH, AC, LI, CM, XM, AF, JP, WG, MOR, AT, TG, VB, TC-J, ED-M, LM-B, CA-U, JB, LB, EC, CG-P, JK, BK, RL, ML, JM, LM, DOD, PP, IP, AS: design of the study; recruitment of subjects; collection of biological samples; and review and approval of the manuscript.

  • Funding The work was partially supported by Fondo de Investigaciones Sanitarias (FIS), Instituto de Salud Carlos III, Spain (#PI11/01542, #PI0902102, #PI12/01635, #PI12/00815); Red Temática de Investigación Cooperativa en Cáncer, Spain (#RD12/0036/0034, #RD12/0036/0050, #RD12/0036/0073); European Cooperation in Science and Technology - COST Action #BM1204: EUPancreas. Acción Especial de Genómica, Spain (#GEN2001-4748-c05-03); EU-6FP Integrated Project (#018771-MOLDIAG-PACA), EU-FP7-HEALTH (#259737-CANCERALIA, #256974-EPC-TM-Net), Cancer Focus Northern Ireland and Department for Employment and Learning; and ALF (#SLL20130022), Sweden. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the local ethics committee of the participating centres.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data of the PanGenEU study are only available upon request and evaluation by the Study Steering Committee. Requests should be addressed to NM