Pancreatic cancer rates of Swedes vs the rest of Europe.

[jaylp11]

Hello All,
I keep hearing that there is an increased risk of pancreatic cancer in snus users, but cannot find any info on just how much of an increased risk it is. I was wondering if anyone had information on the overall pancreatic cancer rates of Swedes vs the rest of the EU, or of snusers vs non-tobacco users. Thanks,
Jay

[Zero]

From a Norwegian study :

The relative risk of pancreatic cancer for snus use was 1.67 (95% confidence interval [CI] = 1.12, 2.50); that of oral and pharyngeal cancer was 1.10 (95% CI = 0.50, 2.41), that of esophageal cancer was 1.40 (95% CI = 0.61, 3.24), and that of stomach cancer was 1.11 (95% CI = 0.83, 1.48).

To read those numbers, for example, for the pancreatic cancer means they're 95% sure that your chances of getting pancreatic cancer are between 1.12 times and 2.5 times as likely as someone who doesn't snus with the mean prediction being around 1.65 times as likely, etc.

If the mean is 1 then there's no change - if it's less than one then snusers are less likely than non snusers to come down with the disease and if it's greater than one then you are more likely.

[chainsnuser]

Even if the scientists dare to draw a 95% confidence-interval for the relative risk, the absolute numbers are much more interesting:

Approximately 80 out of 125.000 snusers in a study developed pancratic cancer. Among the same number of non-tobacco-users, only 40 people get the disease on average.
( http://www.snuson.com/viewtopic.php?...ght=pancreatic )

I don't think, any statistical statements can be made, when using these tiny numbers. There's a chance, that the 40 more cases (out of 125000 = 0,032%) have nothing to do with the snus use, but more with snusers being overall more willing to take a risk, than other people, means, e.g., being more likely to drink alcohol, eat surströmming or barbecue-meat etc. Maybe some of the snusers in that study even liked to smoke once in a while and got the pancreatic cancer therefrom.

So, there still is a chance, that a snuser, who has no other "vices", even has a lower risk of getting pancreatic cancer, than a non-tobacco-user. Hence the confidence-intervals in Zero's post mostly begin below 1 :!:

Statistical uncertainties besides, compared to smoking, with a 50% chance, to die from a related disease, the chances of getting cancer from snusing are, even in the worst case, not worth thinking about IMHO.

Cheers!

[jaylp11]

pancreatic cancer rates

I read the 40 year study, and if I read it right, they used smokers who were also snusers. Smoking is a HUGE risk factor as far as pancreatic cancer rates are concerned. If that is the case, the study would have a serious flaw where reporting of pancreatic cancer rates was concerned.

[darkwing]

Nicotine over many years elevates this risk. So no matter whether you indulge in snus, cigs, or nicotine gum or patches, you have a higher risk of this quite rare cancer.

[jaylp11]

pancreatic cancer

I appreciate all the replies. So much good info and resources in this group. Thanks.
Jay

[KarlvB]

Zero, could you answer a question for me?

I am re-reading one of the reports from SCENIHR

http://ec.europa.eu/health/ph_risk/c...nihr_o_009.pdf

On page 85 it says...

In the Swedish construction worker cohort (Luo et al. 2007) and compared to never users of any tobacco, relative risks for pancreatic cancer in ever, current and former snus users were 2.0 (95% CI: 1.2-3.3), 2.1 (95% CI: 1.2-3.6), and 1.4 (95% CI: 0.4-5.9),respectively. The trend by amount of snus consumed/day was statistically significant (>10g/day RR 2.1 (95% CI: 1.1-3.8 ))."

Does this mean that using more than 10g of snus per day will increase the confidence index and mean relative risk?

Also, do we know if these reports took into account the findings that periodontal disease may contribute to pancreatic cancer?

"Encouraged by other information that suggests gum inflammation (periodontal disease) and tooth loss may also be associated in some way with an increased risk of pancreatic cancer, researchers from Harvard University and the University of Puerto Rico looked at a large database of information to find out whether there was any evidence of such a connection.

he theory may appear farfetched, but there has also been recent interest in a possible link between gum disease and coronary artery disease, based on the theory that gum disease may lead to increased levels of inflammation throughout our bodies.

Why this would increase the risk of pancreatic cancer is unknown, although we know that chronic pancreatitis -- an inflammation of the pancreas that can at times be severe and life-threatening -- is associated with a significantly increased risk of developing cancer of the pancreas.

Could this same gum disease cause inflammation-related disease in our pancreas, and increase the risk of cancer?

The answer, according to this report, is a possible "yes."

In this study of 51,529 male health professionals, 216 men were diagnosed with pancreatic cancer.

All of these men had been followed through surveys for many years. One of the questions they were asked was whether they had any history of gum disease or tooth loss.

When the researchers compared the answers of the men who had developed pancreatic cancer to those who had not, they found that the risk of developing the disease was 64 percent greater in the men who had gum disease.

If a participant had tooth loss within the previous four years, their risk of developing pancreatic cancer was 2.7 times greater than another man who had not lost a tooth during that time period."

My non-scientific brain is saying to me that a percentage people who did develop pancreatic cancer could also have been those who suffered from periodontitis from using snus. So the link may be more between periodontitis than with snus alone.

Of course I could be wrong and the people conducting the study could have factored in this increase in RR from periodontitis. Or the amount of people who had both is too small to prove anything..

Or am I waaaaay off here with my idea?

[STORM6490MT]

I believe the Swedes and Norwegians are less likely to develop cancer than us because Americans eat tons of fake sugar, exercise little and have a lot of stress in their life. On the other hand, the Scandinavians eat better, work and get stressed out less and don't rely on high fructose corn syrup for sweetener.

Adding snus to a sedentary lifestyle with a poor diet is a HUGE health risk.

I could be terribly wrong but I believe that if you want to make a change to help your quality of life. You need to get out and exercise for at least 30 minutes a day and have a good diet of whole foods.


All the numbers and percentages are great but each person is a different snowflake.


All things in moderation. Enjoy life! You can't go to the grave healthy!

[Zero]

^ I'd probably go so far as to say that a poor diet and sedentary lifestyle are much, much greater risks to your health than snus. Snus or not, eating chicken-fried bacon strips and cheese-dogs while watching TV and drinking coca-cola all day long will definitely kill you before your time whether you snus or not.

Karl - as for the effect of periodontal disease contributing to the risk of pancreatic cancer, it would have been factored out of the study by the nature of the control group. They took a large number of construction workers and split them up into groups of people who had never used snus, who currently used snus, and who had formerly used snus. If any of them got pancreatic cancer from periodontal disease, we would expect that all three groups would have the same distribution of incidence and so it cancels out of the equation.

The only thing it wouldn't measure is whether there was in increased risk of periodontal disease in the group that used snus, which is quite possible. All that might tell us, though, is that some portion of the added risk of pancreatic cancer in the snus-user group would have been caused by their increased risk of getting periodontal disease. To be more thorough about it, you could extend the study by breaking up both the snus users and non-users into two groups based on whether or not they had a history of periodontal disease and then do the calculation again. It may not be as significant as it may sound, however, since you would have to factor in the added risk due to the gum disease on top of only that portion who did get the gum disease, which would be less than the total, so it becomes a game of adding ever smaller fractions onto the pile.

At any rate, the data about the >10g/day doesn't really look to make as big a difference as they make it sound. The mean stays the same (RR 2.1) but the spread in the data is larger. This could simply be a matter of having fewer people in the >10g/day group since both the lower and the upper confidence limit have gotten smaller and larger, respectively.

Also, if it's confusing at all, the "ever" category is simply the combination of both current and former snusers.

[TropicalBob]

Darkwing is dead-on here. It doesn't matter how you get your nicotine. It doubles the risk of a very, very rare and extremely deadly cancer. Pancreatic cancer.

A hypnosis seminar to quit smoking, of all things, provided the best medical information I've ever heard or seen on what nicotine does in the body and how it does it. Let's begin with it reaching the brain. The brain releases dopamine and serotonin. That gives you the relaxed and powerful feeling. Nice, those chemicals.

Within a few minutes, the nicotine enters your liver and causes a dump of sugar into the blood stream. You get an energy boost. The pancreas learns of this elevated sugar dump and produces insulin to bring things back to normal. But this is a nicotine pendulum. Your blood sugar drops lower than when you started the hit of nicotine. You get agitated, tired and want more nicotine.

About 20 minutes later, the nicotine causes the release of adrenaline, tensing you and increasing your heart rate. This is the "crash" side and you pop another snus or light another cigarette to start the cycle all over again.

You were born to seek pleasure and avoid pain. The addicted brain keeps you doing that with nicotine. At first, it's for pleasure. It later becomes avoiding the pain of withdrawal. You can only hope that the jerky yo-yo actions you put your liver and pancreas through 10-20-30 times a day don't haunt you later as organ cancer.

[phish]

Ok, here's some quickly calculated maths

I don't think, any statistical statements can be made, when using these tiny numbers. There's a chance, that the 40 more cases (out of 125000 = 0,032%)

Given a population of 125000 the ideal sample size for 95% confidence with a 5% error is:

N (z/2e)^2
------------
N - 1 + (z/2e)^2

Which equals 383, so their sample is not really adequate. Given their sample size, a 95% confidence interval can be achieved but only with a 10% error of the estimated sample statistics in terms of the population parameter. Which means the population confidence interval is actually +/- 10% of theirs.

If the lower bound sample confidence interval is 1.12 with a 10% error, the population confidence interval is equal to 1.01, which is more or less nothing.

I haven't read the paper but with the data we could recreate the model and extract the actual amount of variance explained by the variables they used and statistically determine if there are other unexplained factors contributing to the cancer rates.

In conclusion, statistics is a dangerous thing in the wrong hands

[KarlvB]

Thanks Zero for simplifying the results and explaining the process of these studies.

phish, you are right about the danger of statistics...I mean just look at my wild ramblings / half-arsed hypothesis

"I haven't read the paper but with the data we could recreate the model and extract the actual amount of variance explained by the variables they used and statistically determine if there are other unexplained factors contributing to the cancer rates."

Sounds good phish. I for one would be very interested in the results...

I think my main problem with all these studies and reports is that SCENIHR chose to read it as snus = carinogenic therefore we ban it outright. That makes no sense. Especially considering the marginal risk that it carries.

I know the EUs decision is something that has been much discussed here and we all feel the same, but every time I think about it I can't but help to compare it to the UK's new non domiciled tax laws in the UK i.e. an idiotic reactionary decision that was based on shoddy numbers.....

[krugerfred]

Interesting facts about Pancreatic Cancer
http://www.swedishmatch.com/Eng/Snus...aticCancer.asp

[Anti]

Using regular sized portions as an example, how many are equivalent to 10g/day?

[lxskllr]

Using regular sized portions as an example, how many are equivalent to 10g/day?

1 regular portion is about 1g, so 10...