Race, education and occupation are significant predictors of pancreatic cancer mortality in South Africa, local researchers say.
In their recent study, the team from the University of the Witwatersrand found a higher rate of pancreatic cancer among men and women who work in a management capacity, and among craft and related trade workers, with smoking being associated with a higher pancreatic cancer mortality risk in women, and with the Western Cape and Gauteng presenting the highest number of cases.
While males employed in managerial and craft and related trade occupations had a higher risk of death from cancer of the pancreas than other males, females who were managers, professionals, clerical support workers and elementary occupation workers were more likely than females in other occupations to die from this malignancy, they wrote in their study, published in the SA Medical Journal.
They noted that increased risks of pancreatic cancer mortality among workers in certain occupations might be due to exposure to solvents in the workplace. As solvents are common in different occupations, there is also the possibility of interactive effects of these solvents, which may increase the risk of death from pancreatic cancer.
People working in hospital-related occupations and industries and chemical petroleum processing are exposed to formaldehyde, and occupational exposure is linked to pancreas cancer, they wrote, with formaldehyde being widely used for preservation and disinfection as well as in the production of industrial chemical compounds. Chlorohydrin production workers who produced dichloromethane were also at greater risk of dying from pancreatic and lymphopoietic cancers.
Dichloromethane is commonly used in the food and pharmaceutical industries.
The study confirmed some results from previous epidemiological studies of occupational cancer, the team finding an association between elementary occupations and pancreatic cancer mortality; this is further corroborated by previous studies reporting an excess risk among those who worked as garagemen, dry cleaners and service station workers.
An excess in mortality of pancreatic cancer in an auto mechanics cohort study was reported in the Wits study and among vehicle drivers and railroad workers. The team said understanding associations between occupational and individual factors and pancreatic cancer mortality could help reduce deaths from this disease.
Avoidance of smoking, early diagnosis and treatment of pancreatic cancer, arrangement of working time and proper use of protective equipment at workplaces might reduce pancreatic cancer mortality.
A drawback to the study was the lack of detailed information about occupational risk factors, said the authors, while information about the duration of smoking and employment was not captured.
However, the research helped to resolve concerns about the scarcity of epidemiological studies on pancreatic cancer mortality in SA. The findings provided evidence for an association between smoking and pancreatic cancer mortality.
Although the team identified the predictors of pancreatic cancer mortality, further research evaluating the association between other extrinsic and intrinsic factors and pancreatic cancer mortality is needed to address the limitations of this study, they said.
Pancreatic cancer mortality in South Africa: A case-control study
M L Nhleko, I Edoka, E Musenge.
Published in SA Medical Journal in January 2024
Abstract
Background
There are variations in the numbers of pancreatic cancer deaths reported annually in South Africa (SA). Since pancreatic cancer deaths occurred in SA from 1997 to 2016, the number of cases has hugely increased, and reached 23 581 in both sexes. Sex differences are likely to contribute to the variations in the strength of associations between the risk factors and pancreatic cancer mortality.
Objective
To identify factors associated with an increased risk of pancreatic cancer mortality in SA.
Methods
A matched case-control study with 1:1 matching was conducted using data collected by Statistics SA from 1997 to 2016. Controls were randomly selected to be as similar as possible to the cases, and matched by age, sex and year of death. Conditional logistic regression was used to identify factors associated with pancreatic cancer mortality.
Results
This case-control study comprised a final selection of 23 581 cases (12 171 males and 11 410 females) and 23 581 controls (12 171 males and 11 410 females). A significantly increased risk of pancreatic cancer mortality was observed among males who were managers (odds ratio (OR) 2.99; 95% confidence interval (CI) 1.36 – 6.60; p=0.006) and craft and related trade workers (OR 1.89; 95% CI 1.14 – 3.14; p=0.013). Elevated risks of pancreatic cancer mortality were also found among females who were managers (OR 6.13; 95% CI 1.32 – 28.52; p=0.021), professionals (OR 2.12; 95% CI 1.24 – 3.63; p=0.006), clerical support workers (OR 3.78; 95% CI 1.79 – 7.98; p=0.001) and elementary occupation workers (OR 1.41; 95% CI 0.99 – 2.00; p=0.059). Smoking was significantly associated with pancreatic cancer mortality in females (OR 1.36; 95% CI 1.02 – 1.82; p=0.039). Working in several occupations was associated with an increased risk of pancreatic cancer mortality in males (OR 1.31; 95% CI 1.01 – 1.71; p=0.045) and females (OR 1.66; 95% CI 1.30 – 2.12; p<0.001).
Conclusion
Smoking and certain occupations increased the risk of pancreatic cancer mortality. Further research is needed to evaluate the associations between other extrinsic and intrinsic factors and pancreatic cancer mortality.
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