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2. Smoking
A meta-analysis of 12 studies of approximately 1.500 patients with PC
associated levels of smoking with PC. The excess risk of PC was more than 2-fold
(relative risk, 2.4) among subjects who smoked less than one pack/day and more than
3-fold (relative risk, 3.3) among those who smoked one or more packs/day. Studies
have consistently confirmed the relationship between smoking and pancreatic cancer,
with smokers having about a 2-fold excess risk compared with nonsmokers(4).
Tobacco smoking releases many carcinogens. Several gene products mediate
the degradation of tobacco carcinogens; a recent study examined several detoxifying
genes in 455 patients with pancreatic cancer. 50 Variants in genes, such as CYP1B1-
4390-GG and uridine 5=-diphosphoglucuronosyltransferase, reduced the risk of
pancreatic cancer, whereas variants in others, such as GSTM1, increased risk. Little is
known about the mechanisms by which these genes affect the risk of cancer, but their
products could affect the inflammatory response, fibrosis, cell proliferation, and other
processes involved in carcinogenesis(5).