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 journalArticlepeer-review


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.

Bibliographical note

©2019 American Association for Cancer Research.

Subject classification (UKÄ)

  • Public Health, Global Health, Social Medicine and Epidemiology


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