| Abstract |
Introduction: Pancreatic cancer is one of the most lethal malignant neoplasms worldwide, and it is estimated that the median survival time of patients with pancreatic cancer in Europe is less than 5 months, while less than 10% of patients survive beyond five years. Occupational exposures seem to play an important role in the occurrence of pancreatic cancer. Several epidemiological studies have reported excess risks of pancreatic cancer in relation to agricultural occupations, as farmers and other professionals and workers of the agricultural sector are exposed to a range of environmental exposures. In addition, age seems to play an integral role in pancreatic cancer.
Aim: Aim of this study was to explore pancreatic cancer burden in younger and older adult farmers in Crete.
Methodology: This study was include d in the project of the population based Cancer
Regist ration Center in Crete (C.R.C ..) and followed a design of a pooled data analysis
study withi n the open coho rt population of C.R.C. For the needs of the research for
pancreatic cancer based on occupation, the study population was defined as all the
permanent res idents of Crete , w h o are agricultural workers. From them, the total
number of ca ses that had a confirm ed diagnosis o f pancreatic cancer and were
recorded in C.R.C. database (as new cases) was extracted, for the period 1992 to
20 22. That was our study sample n = Data a n alysis focused on the calculation
of age we ighted incidence rates (ASIR/ an d age specific incidence rates
(ASpIR/ In addition, the annual percentage change (APC%) of incidence
rates was calculated. Non parametric test s were applie d (z-score, chi square, Mann-Whitney, Kruskal Wallis test, Spearman’s correlation coefficient) and univariate or multivariate binary logistic regression were performed. All controls were two-sided at a level of significance a=0,05.
Results: Pancreatic cancer ranked 11th among the fifteen most common types of malignant neoplasms in agricultural workers of Crete, with 12,1 new cases/100.000 agricultural workers per year, and higher rates in men (13,9/100.000 vs. 9,5/100.000/year). Regarding the longitudinal change of pancreatic cancers ASIRs in agricultural workers, there is statistically significant increase (Pvalue=0,01, APC%=1,4%, 95% CI, 1,2-1,6) from 5,3 in 1992 to 14,7 in 2022. Pancreatic cancer was more common in men than in women (66,4% και 33,6%, respectively) and men had higher increasing trends (1,4%) per year in comparison to women (1,1%). In addition, we observed intense increase of ASIR in younger age groups 20-34 years old (APC, 1,2%, 95% CI, 1,1-1,4) and 35-59 years old (APC, 1,9%, 95% CI, 1,7-2,2), while there were important decreases of APC in older adults >50 years old. Also, statistically significant changes in observed and predicted annual change (%) of pancreatic cancer ASpIR by age group, were observed in most age groups (p<0,05). Particularly, in the 20-34 age group the incidence showed an increase of 32,1% from 2001 to 2011, 39,7% from 2012-2022 and further increase is expected from 2023 to 2030 (predicted change, 45,3%). Similar trends observed in the 35-49 age group, where incidence showed an increase of 51,6% for the period 1992-2022 and expected increase of 62,8% from 2023 to 2030. In contrast, adults >50 years old showed decrease in ASpIR. Last but not least, all risk factors that have been examined, seems to have statistically significant effect on the incidence of pancreatic cancer in younger adults (Pvalue<0,05). More specifically, high BMI and BSA confer an increased risk of disease occurrence (RR=2,6 and 3,4 respectively), smoking and especially high pack/years showed RR 1,7 and 1,9 respectively, alcohol shows increased risk (RR=3,9, 95%CI-3,6-4,2), as well as number of drinks/week (RR=4,8, 95%CI-4,7-4,9). Exposure to pesticides also showed a significant effect (RR=3,6, 95%CI-3,1-4,2), and agricultural workers who had crops in greenhouses showed the highest risk (RR=3,4, 95%CI-3,2-3,6) in comparison with other crops.
Conclusions: Pancreatic cancer shows an increasing trend in the agricultural workers of Crete, mainly in men. At the same time there is a rapid increase in the incidence of pancreatic cancer in younger age groups >50 years old. This must be considered by the competent authorities, and they should organize raising awareness days for prevention and early detection of the disease. It is suggested for the population to be informed about modifiable lifestyle risk factors which are associated with pancreatic cancer, such us obesity, smoking, alcohol and exposure to pesticides, so they have the chance to modify them to improve their health status. Last but not least, it would be useful if the Ministry of Health considers to low the age limit about starting screening for pancreatic cancer.
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