@article{3090571,
    title = "Plasma cotinine levels and pancreatic cancer in the EPIC cohort study",
    author = "Leenders, M. and Chuang, S.-C. and Dahm, C.C. and Overvad, K. and Ueland, P.M. and Midttun, O. and Vollset, S.E. and Tjønneland, A. and Halkjær, J. and Jenab, M. and Clavel-Chapelon, F. and Boutron-Ruault, M.-C. and Kaaks, R. and Canzian, F. and Boeing, H. and Weikert, C. and Trichopoulou, A. and Bamia, C. and Naska, A. and Palli, D. and Pala, V. and Mattiello, A. and Tumino, R. and Sacerdote, C. and Van Duijnhoven, F.J.B. and Peeters, P.H.M. and Van Gils, C.H. and Lund, E. and Rodriguez, L. and Duell, E.J. and Pérez, M.-J.S. and Molina-Montes, E. and Castaño, J.M.H. and Barricarte, A. and Larrañaga, N. and Johansen, D. and Lindkvist, B. and Sund, M. and Ye, W. and Khaw, K.-T. and Wareham, N.J. and Michaud, D.S. and Riboli, E. and Xun, W.W. and Allen, N.E. and Crowe, F.L. and Bueno-De-Mesquita, H.B. and Vineis, P.",
    journal = "International Journal  of Cancer",
    year = "2012",
    volume = "131",
    number = "4",
    pages = "997-1002",
    issn = "0020-7136",
    doi = "10.1002/ijc.26452",
    keywords = "cotinine, adult;  article;  blood level;  cancer risk;  case control study;  cigarette smoking;  cohort analysis;  controlled study;  disease association;  exposure;  female;  high risk population;  human;  liquid chromatography;  logistic regression analysis;  major clinical study;  male;  mass spectrometry;  onset age;  pancreas cancer;  priority journal;  risk factor;  self report;  smoking habit, Case-Control Studies;  Chromatography, Liquid;  Cohort Studies;  Cotinine;  Female;  Humans;  Logistic Models;  Male;  Mass Spectrometry;  Pancreatic Neoplasms;  Smoking",
    abstract = "Smoking is an established risk factor for pancreatic cancer, previously investigated by the means of questionnaires. Using cotinine as a biomarker for tobacco exposure allows more accurate quantitative analyses to be performed. This study on pancreatic cancer, nested within the European Prospective Investigation into Cancer and Nutrition (EPIC cohort), included 146 cases and 146 matched controls. Using liquid chromatography-mass spectrometry, plasma cotinine levels were analyzed on average 8.0 years before cancer onset (5-95% range: 2.8-12.0 years). The relation between plasma cotinine levels and pancreatic cancer was analyzed with conditional logistic regression for different levels of cotinine in a population of never and current smokers. This was also done for the self-reported number of smoked cigarettes per day at baseline. Every increase of 350 nmol/L of plasma cotinine was found to significantly elevate risk of pancreatic cancer [odds ratio (OR): 1.33, 95% confidence interval (CI): 1.11-1.60]. People with a cotinine level over 1187.8 nmol/L, a level comparable to smoking 17 cigarettes per day, have an elevated risk of pancreatic cancer, compared to people with cotinine levels below 55 nmol/L (OR: 3.66, 95% CI: 1.44-9.26). The results for self-reported smoking at baseline also show an increased risk of pancreatic cancer from cigarette smoking based on questionnaire information. People who smoke more than 30 cigarettes per day showed the highest risk compared to never smokers (OR: 4.15, 95% CI: 1.02-16.42). This study is the first to show that plasma cotinine levels are strongly related to pancreatic cancer. Copyright © 2011 UICC."
}